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Growth Brings New Opportunities For Local Hospitals, Medical Centers In Dallas-Fort Worth

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In February, work was completed at Methodist Southlake Medical Center, expanding the size of its emergency room to 10,000 square feet, providing a larger waiting room and enhanced diagnostic capabilities for patients.

Ground broke in November 2021 on the hospital expansion before opening its first phase in September 2022 and finishing renovations in February 2023. The expansion includes new capabilities to treat abdominal pain, chest pain and infection as well as enhance the stabilization of patients.

“The expansion of services is part of the hospital’s efforts in becoming a full-service, acute care hospital,” said Methodist Southlake President Benson Chacko. “Having the emergency room with our certified emergency physicians that can handle pediatric and adult care gives an opportunity for us to take care of our community.”

This change in care capabilities also comes as the Tarrant County area sees growth in its population. The county is expected to reach over 2.6 million residents in 2040—a 23% increase from 2020’s population, according to the Texas Demographic Center.

As the population grows along the Hwy. 114 corridor, Chacko said making sure the hospital has access points for existing and projected patients is important. Since being acquired by Methodist Health System in 2016, the hospital now has a cardiology program with the capability for inpatient cardiac procedures, and it has capabilities for nuclear medicine as well as obstetrics and gynecology care.

After the first phase of expansion in September, which increased the emergency department’s beds from three to eight, he said there has been “tremendous growth” in the number of patients coming in.

“As we continue to grow in the community, families are starting to see that Methodist Southlake is not the same hospital that it was just two years ago,” Chacko said. “It’s the real deal.”

As of February, the emergency department now has 12 beds, with 54 beds total available throughout the hospital.

New Opportunities For Care

The expansion of a private business, such as Methodist Southlake, will help serve the rising population, according to Southlake Chamber of Commerce CEO Mark Guilbert.

“As the area grows, additional services are needed,” Guilbert said. “For Methodist to bring them here is indicative of our thriving economy.”

Methodist Southlake has also provided a new option for residents when choosing medical care. Previously, he said residents would have to leave Southlake to go to an emergency room.

Increasing care capabilities is not only a focus for Methodist Southlake, but Baylor Scott & White Medical Center in Grapevine. Baylor Grapevine’s President Naman Mahajan said hospital expansions mean providing better access and availability of medical technology closer to home.

“It is important for patients to have access to technology, such as robot-assisted surgery, that was previously only available in medical centers in downtown Dallas or Fort Worth,” Mahajan said. “Over the next five years, we’re going to be dealing with a lot more individuals and community members that are over the age of 65. With that, it really comes down to two things—access and availability.”

He said Baylor Grapevine is aiming to become a tertiary level center, meaning it has a full component of services it can offer to the community. When a population is significantly growing, he said it is important to provide care for heart disease, stroke and neurological services.

“As the community grows, each health care system and entity is having to look at how they are going to best serve,” Mahajan said. “It is also a goal that community members should not have to leave our area to receive that world-class care.”

Bearing The Load

With an increase in patients, Chacko said Methodist Southlake has hired more medical personnel during the last 18 months. The hospital has brought in more nurses, respiratory therapists and different specialists. Despite bringing on more staff, there are still industry-wide staffing issues the hospital is facing.

“When the COVID-19 pandemic began,  several hospital members left and became agency employees through private companies or independent contractors,” Chacko said.

Baylor Grapevine also saw nurses leave when the pandemic began, but Mahajan said nurses are returning to the workforce in a more permanent way, rather than being travel nurses.

Texas is projected to face a shortage of nurses through 2030, according to a study by the Health Professions Resource Center and the Texas Center for Nursing Workforce. North Texas is expected to see the biggest shortage across the state with 15,688 registered nurses needed by 2030. The Gulf Coast follows in second with a projected shortage of 13,877.

East Texas, South Texas and West Texas are expected to be short 5,000 to 6,000 nurses in each region. Central Texas and the Rio Grande Valley are each projected to have shortages between 6,000 and 7,500. The Panhandle is expected to have the smallest shortage of 355 registered nurses, according to the study.

“Growth in the community is going to increase the workload of local hospitals,” said Jack Frazee, director of government affairs and general counsel for the Texas Nurses Association. “We don’t have the ability to move excess nurses from one part of the state to another. We’re always struggling to keep up with the demand, and population growth is a big part of that.”

Listening to nurses is one step for hospitals to retain their staff, Frazee said. Under state law, hospitals are required to set up a nurse staffing committee to ensure positive patient outcomes and nurse satisfaction. He said working with the committee and making sure the policies set in place by the hospital support nurses is “critical” for retention.

The Texas Legislature is aware of issues with staffing nurses, Frazee said. The problem is being addressed by proposed bills which will increase the funding for education. While this is a step in the right direction, Frazee said funding solutions take time.

“There’s going to be a big burden on the hospital management to make sure that they are doing what they need to do internally to retain nurses and make sure that we’re not losing qualified nurses,” Frazee said. “Without these reforms though, staffing nurses will remain difficult. Training new nurses will help meet the demand seen across the state.”

Promoting health care as a profession can also be done by local hospitals.

“Baylor Grapevine is helping by providing tuition assistance to nursing students and other efforts,” Mahajan said. “So while we do know our population is going to grow … we anticipate that, and we have several strategies underway that will allow us to continue to expand our workforce to meet the COVID-19 health care needs.”

 

Source: Dallas-Fort Worth Community Impact

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Demand Calling For Taller Medical Office Buildings

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Look up. medical office building developers are sizing their assets much taller.

Given the growing number of seniors requiring health care and the accelerated population growth of some metros, providers are requiring larger, specialized facilities to expand their capabilities in key areas, according to a report by 42Floors.com.

Houston is leading the way with 2023’s largest medical office building delivery at 400,000 square feet across 12 floors: The O’Quinn Medical Tower. It is home to four other medical properties among the 20 largest nationwide — the highest concentration of any metro nationally.

Columbus, Ohio, and St. Louis are developing the second and third-largest buildings. Six properties in the top 20 are in Texas, followed by two each in New Jersey, Florida, and Kentucky.

Land Cost Drives Incentive to Go Big

“Due to the cost of land being so high, there’s an incentive to build larger office buildings,” Peter Hays, Practice Real Estate Group’s senior vice president and Houston agent, tells GlobeSt.com. “Buying a smaller piece of land and constructing a small building can be too expensive in comparison. Given the rapid growth rate of Houston, the land is quickly disappearing. Businesses and medical groups know what’s happening and are acquiring what’s left in anticipation of being able to eventually develop or sell it for a profit in the future. This is going to make it increasingly difficult for individual buyers to invest in land.”

Adding to the buzz about medical office space is that since the pandemic, it has gained the reputation of being one of the more resilient commercial asset types. Accordingly, multi-tenant medical buildings are increasingly popular with investors looking to diversify their portfolios amid uncertainty, according to the report.

What many entries in 42Floors’ top 20 had in common was the fact that they were all owner-occupied expansions of campuses belonging to larger healthcare operators.

While Texas led the overall list by state, New Jersey was next, based on total square footage. It is home to the fourth- and fifth-largest developments this year: The first is the construction of a new ambulatory medical pavilion that will be part of the Robert Wood Johnson University Hospital in New Brunswick at 210 Somerset St.

Second is Reconstructive Orthopedics, a conversion of an office building into a medical facility situated within New Jersey’s state borders but actually part of the Philadelphia metro area.

 

Source: GlobeSt.

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What The Shift To Outpatient Care Means For The Orthopedic Industry

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Eight orthopedic surgeons connected with Becker’s to discuss what the shift to outpatient care means for the orthopedic industry.

James Abbott, MD. Orthopedic Surgeon at Best Surgery & Therapies (Cincinnati)

It means providing more complex surgeries like total joint replacements and spine fusions with an outpatient model that can still leave the patient feeling safe and supported in their recovery process. To better accomplish this, we need innovative ways to manage patients with virtual coaching and monitoring systems that allow patients to have questions answered quickly and also develop safety net protocols for post-op patients to avoid issues turning into unnecessary emergency department visits. This will allow patients to shop around for the best experience, technique, and technology advancements when selecting a center for surgery and then control their recovery environment at home.

Wael Barsoum, MD. President and Chief Transformation Officer at Healthcare Outcomes Performance Co.

Over the last few years, CMS has removed close to 300 MSK procedures from the inpatient-only list, thus allowing these procedures to be performed in ASCs, which are typically lower cost. Although ASCs play a significant role in value-based care, cost should not be the only factor and come at the expense of quality and outcomes. Whether the site of care is a hospital or ASC, the choice should ultimately come down to which setting will provide the best patient outcome. High-risk patients will always need access to high-quality hospitals, and orthopedic surgeons should ensure that they are stratifying their risk and choosing the right site of care for the right patient at the right time.

Subir Jossan, MD. Chief Transformation Officer at MedVanta

Historically, the majority of surgical procedures in orthopedics had been done in an inpatient setting. The shift to outpatient care began almost two decades ago and has accelerated significantly in the last four to five years. This shift is multifactorial. Minimally invasive surgical techniques were the major initial driver of this trend. Technological advances in the orthopedic implant space have also aided in the shift to outpatient care. Anesthesia post operative pain control has allowed for major joint and spine surgical cases to be feasible in an outpatient setting. Finally, surgeon comfort with performing major cases in an outpatient setting has drastically increased due to training programs adopting the shift for younger physicians, whereas for older surgeons in private practice, the shift has occurred with less of an accelerated pace. Using orthopedic specialty trained assistants and increased utilization of physician extenders has also aided in increasing surgeon comfort with more complex cases into the outpatient setting.

The shift to outpatient setting has improved outcomes, improved patient satisfaction and dramatically decreased the cost of orthopedic care. This has been seen in many studies. As a whole, the shift has more recently allowed orthopedic surgery groups to entertain different reimbursement models. Since surgeons choose the site of service and direct post operative rehabilitation, they realize that they can drastically affect the total cost of musculoskeletal care, while concomitantly increasing patient satisfaction and most importantly improving patient outcomes. The proactive orthopedic groups therefore will increasingly have the opportunity to capitalize on the shift to outpatient care from a financial perspective. Orthopedic groups with the foresight and the ability to create the infrastructure to capitalize on the shift from inpatient to outpatient care will be positioned to have significant financial impact to their organization.

Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Seattle)

The rise of value-based care is placing additional economic pressure on surgeons to deliver the highest standard of treatment for less cost. This is especially true in orthopedic surgery and the industry as a whole. As we are seeing a shift to value-based healthcare and reimbursement, we really need to re-evaluate how orthopedic surgical care is delivered and billed.

We have been able to demonstrate improved patient outcomes/satisfaction, efficiency, and cost savings when surgeries are performed in ASCs compared to the main hospitals and medical centers. Now we need to focus on expanding the surgeries that can be safely performed. This will likely be driven by enabling technologies (where industry plays a large role) and collaboration with our anesthesia colleagues. We also need to provide greater access to ASC opportunities. The upcoming growth of ASC access will also improve the overall quality, safety, efficiency, and value of surgeries being performed in ASCs.

Ultimately, an improved understanding of how ASCs fit into the value-based care equation that is dominating our healthcare landscape. Patient care and outcomes will always be the most important factor.

Emeka Nwodim, MD. Orthopedic Surgeon at the Centers for Advanced Orthopaedics (Bethesda, Md.)

There are numerous ways in which the orthopedic industry has been impacted by the shift to outpatient care.

The orthopedic industry, like any other industry in healthcare, is comprised of a myriad of components, entities, professionals and individuals. The shift to outpatient care inevitably impacts everyone; I believe, for the better.

Oftentimes, our focus is on the major players, such as payers, hospitals/health systems, and physicians/surgeons. In this regard, I believe the shift to outpatient care has appropriately reestablished a balance of powers. Before, the pendulum swung drastically in the favor of payers and hospitals/health systems. Now, orthopedic surgeons have a greater impact, more administrative influence, autonomy in patient care all while optimizing their entrepreneurship. This is not intended to disparage payers, hospitals or health systems as they face their own challenges, appropriately protecting and optimizing their interests. As in any other circumstance or industry, I sincerely believe that balance of power is necessary for optimal outcomes.

On a less visible impact, is the influence that it has had on other professionals and individuals within the orthopedic industry. This includes lower-level administrators, nurses and all other clinical and nonclinical staff. The shift to outpatient care provided everyone the opportunity to compete with the major players mentioned above. Whether they choose to remain in the inpatient setting or not, they have the leverage of being able to negotiate with an outside outpatient opportunity.

Paul Perry, MD. President of Tri-State Orthopaedic Surgeons (Evansville, Ind.)

The accelerating migration of orthopedic cases to the outpatient setting will facilitate and cement surgeon leadership in the delivery of surgical care. In many cases, surgeons exert considerably more control over care delivered in the ASC setting as opposed to the hospital setting. This care is delivered as a tremendous value proposition with higher quality and lower overall costs than similar inpatient care models. This is a win for patients, employers and third-party payers in systemic efforts to contain rising healthcare costs.

Thomas Schuler, MD. Founder and CEO of Virginia Spine Institute (Reston, VA)

A significant rise in outpatient surgery is transferring enormous numbers of surgical cases from hospital settings which is negatively affecting hospital revenue. Hospitals are trying to make up for this loss by building outpatient centers and pursuing complex cases that still need patient care. This is where complex spine surgeries can benefit hospitals and patients. As hospitals increase the complexity of spine surgery performed at their institution, more patients are able to receive the needed care that historically was difficult to find centers that performed such care. This does not mean that all hospitals and their physicians should provide such care, but it is a strategic opportunity for excellent spine surgeons to partner with their hospitals to elevate access to complex spine care for patients. Communities will benefit. Modern spine care significantly increases the quality of peoples’ lives when performed by talented surgeons aligned with a spine-focused hospital.

Anand Srinivasan, MD. Director of Anterior Hip Replacement Program at NorthShore Orthopaedic & Spine Institute (Gurnee and Glenview, Ill.)

The shift to outpatient care for the orthopedic industry, specifically in the setting of joint replacement surgery including anterior total hip arthroplasty, means that practices and institutions will have to employ tools and devices that allow for remote monitoring and care in a scalable fashion. This may involve smart implants, braces, or other equipment that allow for communication and most importantly, identification of patients that may have postoperative concerns.

 

Source: Becker’s Spine Review