A college preparing for a surge in freshman enrollment must spend time and resources developing a plan of action in terms of how to best accommodate the needs of their students.  While working with Enrollment Services at Westminster College, I was exposed to the strategy of ensuring there are enough dorm rooms in student housing, quality mentors to help with the college transition, and adequate programs to satisfy the varied interests of the entire student body.  The challenge is not only in providing quality hospitality to the incoming class, but maintain the high level of expectations to retain all students and attract future ones.  With the recent passage of federal healthcare legislation, the United States is expected to extend coverage to an estimated 34 million uninsured by 2019.  As our country plans to care for these individuals, we must ask ourselves; do we have enough hospital beds and can our current health care amenities sustain this adjustment in enrollment?

With a record breaking class on the way, it is essential that our country takes proper steps in improving the design of health care facilities to better suit our ever growing culture that’s centered on convenience.  Whether it’s a college, shopping mall, or health care facility, convenience is almost always dependent on location.  Essentially, more convenient health care locations will result in better access and lower costs to patients in both urban and rural settings.  However, unlike colleges and shopping malls, health care facilities are subject to Certificate of Need (CON) laws that regulate where and when they can operate.  According to the National Conference for State Legislatures, “The basic assumption underlying CON regulation is that excess capacity (in the form of facility overbuilding) directly results in health care price inflation. When a hospital cannot fill its beds, fixed costs must be met through higher charges for the beds that are used.”

The history of CON laws date back to 1964 when New York enacted the first statutes giving state government the power to determine the need for a hospital, which led to a federal mandate for CON laws under the Nixon Administration in 1972.  Specifically, the Missouri Hospital Association and other Missouri health care facilities are regulated by the state CON laws enacted in 1979 under RSMo 197.300-197.366 that haven’t been modified since 1996.  In 1987, the federal mandate of CON laws was repealed, which led to fourteen states eliminating them from their state laws.  Opponents of CON laws believe the system is flawed by political influence and insist an open market would better control the cost and needs of patients, ultimately leading to better access and convenience.

Once facilities are established and operating, they are only convenient if they can run effectively and efficiently.  A patient’s experience is impacted by length of their stay, exposure to infection or medical deficiency, and privacy.  No patient enjoys being crammed into a small, curtain separated room for an over-extended period of time.

Studies show that medical errors within hospitals account for anywhere between 44,000 and 98,000 deaths each year in the United States at a cost of $17 to $29 billion to our nation’s economy.   In their review Transforming Hospitals:  Designing for Safety and Quality, the Agency for Healthcare Research and Quality (AHRQ) says “In the midst of this construction boom, hospital planners have an opportunity to create safer and more effective facilities that enhance patient safety, improve the quality of care, increase workforce satisfaction, and reduce the cost of care.”

Ambulatory Surgery Centers (ASCs) have become a model illustration in how to effectively run a convenient health care facility.  ASCs are facilities where surgeries that do not require hospital admission are performed and have excelled in areas of cost, patient safety, and efficiency.  On average, an operation is approximately one half to one third cheaper at an ASC than a hospital.  In addition, most ASCs take pride in providing individual, private pre and post operative rooms.  In terms of infection control, a 2007 report found that 71% of ASCs did not have a single complication per 1,000 patient encounters.  In summary, all of this efficiency is coupled with the convenience of going home the same day of surgery.

With challenges ahead in our health care industry, we must accommodate for what’s to come without dismantling and dissatisfying what we have.  Winston Churchill said “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”  As a Missouri contract lobbyist, I consider it my responsibility and opportunity to advise policy makers in fixing errors in the past, expanding on areas of proven success, and exploring new and innovative ideas for the future.  Whether it is re-evaluating CON laws, utilizing ASCs, or implementing more environmentally friendly hospitals, the United States of America must prepare for our incoming class.

This week, a Washington Post article about the risks that air medical emergency response teams face reminded me how often state & federal healthcare lobbyists forget the vital role that pilots with paramedics play.  The focus of that story had to do with the family lives lost to tragedy and inclement weather in duty – something that all private pilots know deserves more attention for the work that they do.

Maybe it’s just my love for general aviation that captures me to the beat of their rotors.   Maybe it’s my decade of experience lobbying for healthcare matters.  Every time that I see a BJC helicopter coming in or leaving out from Barnes-Jewish Hospital, I think about the times that I have known someone on that flight, or someone who needs it the most at that very moment.  Recently, it was my father-in-law being air-lifted to University Hospital, when an extensive crew did everything that they could to ease his pain.  Decades ago, I recall being near a fatal car accident in Perry County when it only took 15 minutes for an air evac ambulance to arrive from St. Louis, MO.  Even in rural mid-Missouri near Jefferson City or Columbia, I often see life flights to transport vital organs, blood supplies, and unique services across our river’s edge throughout the night.

I strongly recommend every child having a chance to see a helicopter team like this in a non-urgent situation.  In 1999, in Springfield, MO, I toured a hospital during the State Chamber of Commerce Leadership Missouri grassroots issue tours around each region.  Sometimes, healthcare facilities offer open houses where such tours are offered on site.  In order to understand how and why costs can be so high, it takes some first-hand knowledge of what this kind of operation crew requires to function.

As a border to many states, Missouri’s export of healthcare services is often extended by air in this fashion.  Many citizens may not take time to realize that access to care from top notch physicians – including anesthesiologists, cardiac surgeons, neuro surgeons, and trauma physicians – depends upon air lifts to urban core areas.

So, as we reconsider how our state laws, regulations, and practices related to adverse events might be improved in the next year’s legislative session, we should remind each other of the techniques like this that make our access to care uniquely-possible between our urgent care, surgery centers, & major hospital networks.  When we limit our reimbursements for how doctors can see patients, someone on the other end of that 911 call may not get the urgent help that they deserve.