Exempla changes area’s health-care playing field

In 2007, Exempla Good Samaritan Medical Center in Lafayette will expand its hospital by 30 beds for a total of 202 – second only to Boulder Community Hospital.

It’s also adding a new computed tomography, or CT, scanner, new mobile MRI and new nuclear medicine camera. The additions reflect Exempla’s growth, and seem to quell doubts that the Boulder Valley needed a fourth major hospital.

Part of that growth, however, has come at the expense of Boulder Community, Avista Adventist and Longmont United hospitals.

Since 2004, total inpatient and outpatient numbers are down 40.8 percent at Boulder Community, down 15.4 percent at Avista Adventist, and up only 1.8 percent at Longmont United. The numbers are collected by the Colorado Health Association based on discharge information provided by hospitals.

At the same time, the association reports total patient numbers in the county are up 20 percent since 2004.
Much of that growth is going to Exempla.

According to the association’s numbers, Exempla served a total of 23,378 inpatients and outpatients in 2006 – more than any of the other three hospitals.

Boulder Community took the biggest hit.

“Between ’04 and ’05 we had about a 19 percent drop because of the Kaiser contract, which was about 19 percent of our patients,´ said Boulder Community spokesman Rich Sheehan.

Kaiser Permanente switched its patients from Boulder Community to Exempla in 2004.

Spokesman Matt Hartzler said that Exempla’s impact has been minimal at Longmont United Hospital. The hospital hasn’t seen a major shift in patient numbers, which have gone up 1.8 percent in the past two years.
At Avista Adventist Hospital in Louisville, the main difference since Exempla’s arrival just fives miles away is in its emergency room, officials said.

“Patients in areas around (Exempla) Good Samaritan used to come to our hospital,´ said Chief Executive Officer John Sackett.

Despite the increasing competition, Avista’s operating revenues have risen 6 percent since Exempla joined the scene.

Exempla’s aggressive game plan in the Boulder Valley began in 2002. Where it normally would take about five years to build a 750,000-square-foot medical campus, Exempla did it in two and one-half years.

Director of Marketing and Communications Sharon Burnette said the hospital has met and succeeded on most of its initial goals. In 2002, Exempla projected an average daily census of 100 inpatients at the hospital by 2005. That year, the average was 105, she said.

Burnette credits Exempla’s location – easy accessibility from U.S. 287 and the Northwest Parkway interchange – as one of the main fuels for growth. The hospital is capturing business from eastern Boulder and western Weld counties that normally would have gone to hospitals toward Denver.

While some patient growth has come at cost to the other hospitals in the Boulder Valley, Exempla Good Samaritan also has affected patient flow throughout its own network – a decline in patients at Exempla St. Joseph in Denver is a direct result.

Much of the growth within Exempla has come from success in the medical imaging, surgical and emergency departments, officials said. Exempla’s focus on new medical technologies has attracted a lot of new patients.
But learning those new technologies has been one of the hospital’s biggest hurdles – particularly instituting a 100 percent electronic medical record system. It hasn’t quite reached that goal.

“It’s a monumental task, especially when the other hospitals (those outside the Exempla network) are using different systems,´ said Sandy Cavanaugh, vice president of community development at Exempla Good Samaritan.

“It’s not so much the technology that’s giving us problems; it’s the time and research being put into the training of a new system.”

Cavanaugh said most physicians who work at Exempla are onboard with the new system, but there are always a few who are hesitant to change.

Avista also is on the cutting edge of electronic medical records. Avista’s outpatient care centers – Boulder Medical Center on the Louisville campus and its Integrated Physician Network down the road in Superior – are hooked into the hospital’s medical-record system.

“We try to make the quality of care given to patients better by monitoring them through a common medical record,” Sackett said.

The specialty that draws patients to Avista is women’s health. According to Sackett, the hospital’s New Life Center birthing unit delivers more babies than any other Boulder Valley hospital, about 2,800 per year. It also has a level IIIA intensive-care nursery, which means ill infants can receive a high level of care for survival.

Another area of expertise is orthopedics, Sackett said. The hospital is known for its total joint replacement program and recently recruited spine specialists. In August a neurosurgeon will join the spine program, “So you can choose the type of surgeon you want,” he said.

Sheehan said Boulder Community’s doctors continually are educating themselves on new technology. A number of the hospital’s heart surgeons went to Baylor University Medical Center in Dallas last year to be trained in a new type of minimally invasive heart valve replacement, which now is offered at the hospital. The procedure requires only a four-inch incision instead of open-heart surgery and helps patients recover more quickly – three weeks instead of three months.

“We were the first hospital in the state to offer that treatment,” Sheehan said.

Community Hospital orthopedic surgeon James Rector recently became the first surgeon in Colorado to perform Birmingham Hip Resurfacing, an alternative to total hip replacement that allows a person to keep more of their hip anatomy. The repair lasts longer and allows patients to return to high-impact activities.

Beyond the battle for patients, the four hospitals in the Boulder Valley are competing for employees. According to their Web sites, Boulder Community has 76 job openings, Exempla has 73, Longmont has 42, and Avista has 24.

More than one-third of those jobs are in nursing, which echoes a national nursing shortage.

When Exempla opened, it garnered one-third of its staff from Exempla St. Joseph in Denver, one-third from Exempla Lutheran in Wheat Ridge and one-third from other hospitals in and out of state, said Sherry Benedetti, director of strategic planning at Exempla Good Samaritan.

At Longmont United, six people left to work for Exempla when it opened, Hartzler said. There was no large turnover, but competition for incoming employees has naturally increased, he said.

Boulder Community hasn’t had problems with the national nursing shortage, he said. Nursing staff levels have remained high, even with three competitors close by.

“We don’t have a shortage so people aren’t overtasked. There’s a lot of stresses involved in working in an understaffed hospital,” Sheehan said.

Plus, Sheehan noted that nurses are like doctors when it comes to their careers. “They want to provide up-to-date care, and this is a great environment for that.”

According to Sackett, competition from Exempla hasn’t had much effect on Avista’s staffing. The hospital has only lost four employees to its new neighbor. “We are doing well on the staffing level. Fortunately for us, people want to work at Avista.”

Competing caregivers

The Boulder Valley was home to three hospitals for about 15 years until Exempla Good Samaritan joined the market in December 2004. This chart compares the hospitals’ inpatient and outpatient numbers compiled by the Colorado Hospital Association, as reported by hospitals. According to the association, an inpatient is a person who is admitted to a hospital for treatment and also includes newborns. An outpatient undergoes surgery without being admitted to a hospital. Visits to an emergency room are classified in neither of the two categories.

Individual hospitals may track inpatients and outpatients differently. The chart also compares operating revenues, which the Business Report obtained from the hospitals.

Inpatient 2004 2005 2006
Avista Adventist, Louisville 8,024 7,993 7,296
Boulder Community, Boulder 12,287 9,784 8,527
Exempla Good Samaritan, Lafayette 98* 9,278 11,007
Longmont United, Longmont 10,044 9,973 10,158

Outpatient
Avista Adventist 5,972 5,117 4,548
Boulder Community 14,560 9,895 7,376
Exempla Good Samaritan 123* 2,691 12,371
Longmont United 2,442 2,691 2,544

Operating revenue
Avista Adventist $63,690,000 $66,528,000 $67,834,000
Boulder Community $258,470,966 $239,301,409 $242,427,230
Exempla Good Samaritan NA $148,133,000 $168,013,000
Longmont United $117,679,923 $132,326,214 $139,720,870
*December 2004 only

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