Regions puts a spotlight on patients in hospital's bid for more beds

About 10 years ago, Chuck Palokangas was hunting elk in Wyoming when he noticed an occasional tremor in his right thumb.

Within a few years, Palokangas was diagnosed with early onset Parkinson's disease, a condition that brought him last week from his home in Saginaw, northwest of Duluth, to Regions Hospital in St. Paul.

Medications helped moderate symptoms for several years, but he's now pinning hopes on an implantable medical device that's a bit like a pacemaker for neurology problems.

"There's nobody in Duluth that does that," Palokangas, 55, said of the implant.

Growth in specialty care drawing patients from outside Regions' base in Ramsey County is just one of many factors that officials said are pushing the hospital up against its current limit on beds.

Citing an aging population and sicker patients, Regions is pushing this spring for an exception to a state law so it can add 100 hospital beds by 2040. While the focus is long-term, Regions hopes to address current problems with ambulance diversions and patients backing up in the emergency room, as well.

Two of the hospital's competitors in St. Paul have raised concerns about the proposal, and sisters with the religious order that founded nearby St. Joseph's Hospital have voiced outright opposition.

Physicians at Regions are countering with stories about the patient need for more beds. An ER doctor at Regions, for example, told regulators this month how her mother had to wait 13 hours in the ER at Regions before she could be moved upstairs for additional tests and a pacemaker.

Her mother's story had a happy ending, the doctor said, but remains a cautionary tale.

"To put it bluntly, despite a serious life threat, a health care team dedicated to providing excellent care and a daughter who has some clout in the organization, my mother's care was compromised solely because there were not enough beds in a Level 1 Trauma Center to care for her cardiac, traumatic and neurosurgical emergencies," wrote Dr. Karen Quaday in comments filed with the state Health Department. "Just think what that means!"

Minnesota's moratorium on the construction of hospital beds dates back to the 1980s. Health economists say the concern is that if hospitals build too many beds, they will find ways to keep them full and drive up overall costs.

State law lets the Legislature grant exceptions to the moratorium. Earlier this year, health committees in both the House and Senate passed bills that would allow for the Regions expansion.

By the end of April, lawmakers hope to receive a preliminary report from the Health Department on whether the Regions project is in the public interest. Hospital officials hope the Legislature will take action before adjourning in May.

"We're a hospital that's at capacity," said Andrea Walsh, the chief executive of HealthPartners, the Bloomington-based health system that runs Regions. "The need in the community is larger than the bed capacity we have."

Regions would increase by 20 percent its current bed and employee counts, although the expansion wouldn't require adding to the footprint at Regions.

Sixty new medical/surgical beds would be located in space that Regions vacated as part of a campus expansion project completed in 2009. Another 20 beds would be placed on a vacant floor within the hospital's new tower for mental-health patients, which opened in 2012.

The remainder of the beds would be used for maternity care, with most allowing for better flow of patients, officials say, rather than growth. Regions says it's not looking to take patients from other health care providers, but simply respond to its own projected growth.

The hospital believes that Regions and its nearby competitors in downtown St. Paul — St. Joseph's Hospital and United Hospital — will need to add hospital beds in the future. Regions is different because it's already using all of its licensed beds, officials say, while St. Joseph's and United haven't yet hit their caps.

"We would like a level playing field," said Dr. Bret Haake, the chief medical officer at Regions. Haake said he generally agreed with the rationale for the regulating capacity, but said in the case of Regions, "If we grow a little bit, we think we can actually make costs go down and we will be more affordable."

Adding hospital beds seems contrary to the broader trend in health care, as more complex care is provided outside hospitals. Dr. Ezekiel Emanuel, a vice provost at the University of Pennsylvania, noted in a recent opinion article in the New York Times that the peak in hospitalizations in the United States came in 1981. At that time, there were nearly 1,400 more hospitals in the U.S. than today.

Haake said HealthPartners has been part of that trend to provide as much care as possible outside hospitals, yet the population in the east metro is getting older and more patients are using intensive care.

"We are seeing growth all across the east side with the 'silver tsunami,' " he said.

Allina Health System, which runs United Hospital, recognizes that Regions has been running at high capacity, "which is not ideal for safe hospital operations," the Minneapolis-based system said in comments filed with regulators. Allina would prefer a more gradual process for adding bed licenses, since approving 100 beds for use over more than 20 years "would seem to set a precedent that could lead to the kinds of expansion the moratorium law was intended to prevent," a spokesman said in a statement.

Minneapolis-based Fairview Health Services, which runs St. Joseph's Hospital, says it's concerned the expansion could hurt nearby hospitals financially, since HealthPartners is a large health insurer that could steer patients to Regions.

The real problem with hospital access in St. Paul is a shortage of mental health beds that "this proposal does not adequately address," Fairview said in comments filed with regulators.

In an interview this month, Regions Chief Executive Megan Remark said the hospital's proposal is incremental, in the sense that beds would come online over many years, and only if demand materializes, she said.

Currently, HealthPartners does have some insurance policies with "narrow networks" that don't include United or St. Joseph's, but Regions officials say most of the insurer's health plans provide a broad choice.

On mental-health beds, Regions says its proposal would add capacity at a facility that's already the largest in the east metro.

For now, Regions says it's taken dozens of steps to accommodate growing demand.

About two years ago, the hospital instituted daily "bed meetings," where nurse managers devise strategies for minimizing the amount of time patients had to wait for a bed. Following a meeting last week, nurse manager Heather Gleason explained: "If we're able to get patients discharged earlier in the morning, it allows us to make sure that we're not backing up the emergency department or the operating room."

Gleason works on the unit for neurosurgery patients like Chuck Palokangas of Saginaw. Neurology discharges have grown more than 40 percent over five years, Regions says.

Haake, the hospital's chief medical officer, says the hospital has boosted overall quality scores despite the high patient volumes, but he worries about the future.

"I'm more fearful of what happens if we don't grow," Haake said. "Because then we have to make decisions about who we care for."

Christopher Snowbeck • 612-673-4744 Twitter: @chrissnowbeck