|
If
you have questions or comments, or would like more information, please
contact us
Report
to the Community
On the St. Joseph's Community Hospital Forum
On
Monday, November 19, the board of directors and St. Joseph's Community
Hospital hosted a public forum at the West Bend High School Auditorium.
The forum's purpose was to share information and answer the community's
questions about the hospital's location selection process.
Approximately
250 people attended the forum. Health Care Futures; Hammel, Green, and
Abrahamson; and B.C. Ziegler & Company gave three presentations. In addition
to these presentations, questions were gathered from the audience and
answered by a panel, consisting of members of the hospital board of directors,
the hospital facility committee, hospital management, and firms hired
by the hospital board to assist with the building project.
The
questions were consolidated and directed to the various panel participants.
This format was chosen to address as many questions from the community
as possible.
In
keeping with the board's desire to answer the community's questions, the
hospital has prepared this question and answer document to answer every
question asked at the forum and questions asked since. To improve the
readability of this document, questions are grouped together by topic
and italicized, and answers are provided immediately below the questions.
This
document refers to our community and market area many times. Health Care
Futures defined our community and market area as West Bend, Slinger, Hartford,
Germantown, Colgate, Kewaskum, Campbellsport, Allenton, Jackson, Richfield,
Hubertus, and Newburg, which represent about 90 percent of our patients.
The
board of directors greatly appreciated the time and energy expressed by
the community members who attended the forum.
General
Question Topics
Assorted Questions
Why is a new hospital needed?
St. Joseph's Community Hospital of West Bend has been caring for people
in this community since 1930, and wants to continue that tradition of
quality care. However, the current hospital is at a point where it needs
substantial renovation to adequately meet the needs of our growing community
(West Bend, Slinger, Hartford, Germantown, Colgate, Kewaskum, Campbellsport,
Allenton, Jackson, Richfield, Hubertus, Newburg) and to be considered
a modern health care facility preferred by patients and physicians. Examples
of major renovation that is needed include our surgical suites, emergency
department, nursing floors and patient rooms. Other areas also need major
renovation and expansion.
What
are the advantages of a new hospital?
A new hospital would have significant advantages for patients, including:
- As
part of a healing environment, patient rooms would be private rooms,
where hospital staff and physicians care for patients efficiently and
confidentially. Patient and their families enjoy the privacy and comfort.
- Efficient
design for better traffic flow will benefit patients, visitors, and
employees. As a result of numerous remodelings in 1940, 1947, 1974 and
1990, a maze of corridors connects different parts of the hospital,
making it inconvenient for visitors and making delivery of supplies
inefficient and more time-consuming.
- Modern
surgical suites will have the size and capability of handling the complex
lighting, power, equipment, and medical personnel needed in surgery
today. Ceiling structure in the current 1974 facility is not adequate
for future needs.
-
More emergency beds and observation beds will handle increasing patient
volume.
- The
kitchen and cafeteria would be large enough to accommodate expanded
meal preparation for patients, visitors, and employees.
How will patients
benefit from a new hospital?
A new facility will enhance the quality of care provided to patients in
many significant ways. Patient privacy will improve. Surgical and other
patients will no longer use the same elevators and hallways used by visitors.
There will be adequate space for patients, reducing the number of transfers
to other facilities and delays in care. New, more efficient design improves
human traffic patterns, and accommodates infrastructure and technology
needs, including plumbing and electrical, heating and ventilating, and
computer needs. It also will accommodate new and enhanced specialty services.
How is St. Joseph's
Community Hospital governed?
A 19-member board of directors governs the hospital. Three of those board
members are physicians - one physician is an independent physician, one
physician represents Aurora Health Center - West Bend, and one physician
represents the West Bend Clinic. The hospital president/CEO holds one
seat. The remaining 15 board members are community members who were recommended
by the board's nominating committee and elected by the board.
How has the community
been involved in the process of planning for a new hospital?
In March of 2001, St. Joseph's held a series of forums on the topic of
planning for a new hospital. Three major questions were addressed: why
a new hospital was needed vs. remodeling, where the new hospital will
be built, how the new health system will be structured. Invitations were
sent to over 47,000 households in St. Joseph's service area (West Bend,
Slinger, Hartford, Germantown, Colgate, Kewaskum, Campbellsport, Allenton,
Jackson, Richfield, Hubertus, Newburg).
Also beginning in
March, more than a dozen community presentations were given to service
club organizations, other community organizations and special interest
groups. At these presentations and the community forums, questions were
answered and comments were listened to. Most recently, there was a forum
for the community held in November of 2001.
Every step of the
way in this planning process, the community has been informed and invited
to give feedback through a series of news releases, newspaper advertisements,
cable television shows, internet postings, direct mail pieces, etc.
Additionally, the
hospital board of directors - who is mostly comprised of community members
- in June voted to form a community advisory committee to help in the
planning process for a new hospital. Although this is a committee of the
board of directors, thirteen of its fifteen members, representing various
sectors of the community, are not board members or hospital employees.
The facility committee
was established to review potential sites in and around West Bend, including
the present site, for a new hospital. The facilities committee includes
hospital board members and three committee members who are not members
of the hospital board.
Why does the hospital
consider moving to the freeway?
Population growth in Washington County makes our area very attractive
to other health care systems. It is very possible that a competing system
- one that is not locally controlled - will build a hospital in our service
area. We need to increase our level of service to be preferred by patients
and physicians and ultimately, to survive as a competitive community hospital.
The hospital board
and facility committee have determined that the community will be best
served by locating the hospital at a site that is centrally located in
our community. They believe that choosing the site that best meets our
community needs will allow the hospital to increase services while keeping
health care costs in check. They also are considering the following elements:
- Impact on operating
costs and financial performance to ensure the provision of excellent
services and programs for the patients we serve, up-to-date technologies
and facilities, and competitive salaries for employees.
- Support for long-term
strategic goals and competitive positioning to ensure the success and
well being of the hospital for future generations.
- Accessibility/visibility
for patients and visitors so they know where to find us and can get
to us when they need us.
- Accessibility/proximity
to physicians and staff so we can recruit the best health care professionals
to work in our community.
- Community, city,
and county support so we can work together to provide the best health
care possible for our community (West Bend, Slinger, Hartford, Germantown,
Colgate, Kewaskum, Campbellsport, Allenton, Jackson, Richfield, Hubertus,
Newburg).
- Size of available
property/room for growth/program expansion to ensure our ability to
grow to meet our community's growing health care needs and accommodate
the technologies and facilities of the future.
- Development requirements/capital
cost so we can remain a financially strong organization.
Forty-nine percent
of St. Joseph's acute inpatients come through the emergency department,
and other hospitals that have built on freeways have experienced dramatic
increases in emergency patient volumes as well. The Health Care Futures
study shows that the hospital will have better success if it is located,
in order of preference, near the intersection of 1. Hwy. 45 and PV or
Hwy. 45; 2. Paradise; 3. Hwy. 45 and 60. The hospital's least desirable
location is the current site, which translates into fewer patients served
and the least desirable financial performance and competitive position.
Why do other successful
hospitals move to the freeway?
Other successful hospitals move to the freeway because location encourages
the provision of services to more patients in their communities, which
is usually reflected in the greater provision of emergency department
services and accessibility for patients. This in turn increases the ability
of a hospital to provide quality services and technology for their patients,
because hospitals have many fixed costs. The more patients come to a hospital,
the more money is available after paying utilities and other fixed costs
to invest in equipment and services for patients.
Many hospitals would
like to build on a new site but can't because they carry a debt load on
existing facilities. St. Joseph's is in an enviable position to be able
to build for the future. Once a new hospital is built on the current or
another site, however, that site must serve our community for many decades
into the future since we too will need to take on debt. Thanks to no historic
debt and sound fiscal management, as well as current steps to improve
its financial support through increasing patient volumes and cost management,
St. Joseph's is able to consider the possibility of a brand new hospital
for the community.
What impact does
competition have on the hospital's choice of location?
Competition is an important consideration in the hospital's choice of
location. Competition has an impact on medical staff recruitment, employee
recruitment, patient volumes, the types and variety of services and technology
available to patients, and more. The Health Care Futures study looked
at where inpatient volumes would be maximized both with and without competing
hospitals being built nearby. Assuming a competing hospital would be built
on Hwy. 60 and 45 is the more conservative approach. Health Care Futures'
recommendations are under the scenario of competition, and these recommendations
are:
- Health Care Futures
recommends St. Joseph's Community Hospital build a new hospital near
the intersection of Hwys. PV and 45.
 A location at Hwys. PV
and 45 is slightly better than a location at Paradise Drive and Hwy.
45.
- Health Care Futures
respects and appreciates community/city/county support as a criterion
but urges the board to weigh more heavily on the other criteria. In
the long run, Health Care Futures believes that patients will support
the hospital on the basis of the sophistication, depth and quality of
its facilities and services, as well as the quality of its medical staff.
- Health Care Futures
also recommends the board seek partnering relationships for selected
specialty services to enhance patient support and create additional
patient volume and enhanced financial performance.
What is the mission
of St. Joseph's Community Hospital? How does this project support the
hospital's mission?
The hospital's mission is to provide personalized, trusted care for our
patients and their families. The singular, underlying reason for pursuing
the building project is to support our mission.
How will a new hospital
provide more personalized and trusted care for patients and their families?
Care will become more personalized when a new facility provides patient
rooms that are private, in an environment where hospital staff and physicians
care for patients efficiently and confidentially, and when patients and
their families enjoy the additional privacy and comfort a new facility
will afford.
Efficient design
for better traffic flow will benefit patients, visitors, and employees.
Patients will receive greater privacy-enjoying private patient rooms and
patient-only corridors. Visitors will find their way more easily through
a friendlier design, and workers will be more efficient when departments
that work together are located near one another.
Care will become
even more trusted when modern surgical suites have the size and capability
of handling the complex lighting, power, equipment, and medical personnel
needed in surgery today. More emergency beds and observation beds will
handle increasing patient volume.
A location will be
selected that will allow us to serve as many of our community members
(from West Bend, Slinger, Hartford, Germantown, Colgate, Kewaskum, Campbellsport,
Allenton, Jackson, Richfield, Hubertus, Newburg) as possible in the most
cost-effective way. This means that more people will be able to afford
our services because increased numbers of patients to our facility will
help contain health care costs.
What is the vision
of St. Joseph's Community Hospital and how does the building project support
the vision?
Our vision is to be the preferred, community-governed hospital where:
- Patients desire
to receive their care, because of their trust in the skills of our staff,
our excellent facilities and technology, and the scope of our programs.
- Physicians desire
to practice, because of our commitment to quality patient care.
- People want to
work, because of our mission and supportive environment.
Additionally, our
vision is to expand the range of services that people in the region will
be able to access locally, through:
- Continued strong
commitment to the community.
- Enhancement of
specialized services and programs.
- Support of current
and new physician relationships.
- New facilities.
A new hospital will
help us achieve our vision because it will help us retain our quality
staff and recruit more high-quality staff when needed. Our facilities
and technology will become better and the scope of the programs we offer
will increase because of increased patient volumes and facility usage.
Physicians and employees will want to work in the new facility because
of the latest technology and the safe and supportive working environment
afforded by a new facility. Building a new facility will strengthen our
commitment to our community as we grow and strive to provide the best
services possible.
What are some
of the new features that will be present in a new facility?
A new hospital would have many new features, including:
- As part of a healing
environment, patient rooms would be private rooms, where hospital staff
and physicians care for patients efficiently and confidentially. Patients
and their families enjoy the privacy and comfort.
- Efficient design
for better traffic flow will benefit patients, visitors, and employees.
- Modern surgical
suites will have the size and capability of handling the complex lighting,
power, equipment, and medical personnel needed in surgery today. Ceiling
structure in the current 1974 facility is not adequate for future needs.
- More emergency
beds and observation beds to handle increasing patient volume.
- The kitchen and
cafeteria would be large enough to accommodate expanded meal preparation
for patients, visitors, and employees.
Can you tell me
what the "Community" in St. Joseph's Community Hospital represents?
Community is more than bricks and mortar, lines on a map, or zip codes.
Community at St. Joseph's means people - our patients and their families,
employees, physicians, volunteers, emergency service workers, neighbors,
and others who have a role in providing or receiving patient care at St.
Joseph's.
Geographically,
our community includes the patients, families, and others in our service
area. About 90% of our patients come from the following areas: West Bend,
Slinger, Hartford, Germantown, Colgate, Kewaskum, Campbellsport, Allenton,
Jackson, Richfield, Hubertus, and Newburg.
Can West Bend
alone support the development of a new hospital?
The Health Care Futures studies show that the City of West Bend alone
cannot support a successful hospital, but that it takes patients from
all over the region to support the health care services needed in our
community. That is why location is essential to the success of a new hospital.
The correct location should ensure the volume of patients needed to support
a new hospital.
Why not remodel?
Anyone who has put multiple additions on a home, or tried to run a high
tech business in an outdated building knows that remodeling can often
be challenging, and more costly than building new. When that high tech
business is a hospital, an efficient, modern facility also impacts patient
care and safety.
For example, today's
medical/surgical patient is generally older and in need of more intensive
nursing care than patients who were admitted 20 or 30 years ago. For that
patient, a healing environment means a private room, with a nurse nearby,
and able to accommodate the sophisticated equipment and technology needed
to care for him or her in the best way possible. That means designing
space between floors to house mazes of computer wiring and efficient air-handling
systems, and patient-friendly floor plans that put nurses closer to their
patients and needed supplies, rather than the current outdated configuration
with its long corridors.
Elevator banks, stairwells,
structural supports, and limited ceiling space in the current 1974 facility
make those patient-centered changes impossible to accomplish. Remodeling
around some areas would be difficult if not impossible, since some areas
of the hospital have lead walls (in radiology), huge elevator banks, stairwells,
support beams, and other structures.
How much does
remodeling cost?
We estimate that we would need to invest between $40 and $60 million in
the current building in order to bring it up-to-date. However, remodeling
will not solve many of the deficiencies present in the current building.
If we take that $40 to $60 million and invest it in a new facility, not
only do we get all of the updates we need and a new infrastructure, but
we also get a new building that is laid out efficiently for patients,
employees, and physicians. Our community gets far greater value for dollars
spent on new construction versus old and greater value in having an efficient,
state-of-the-art facility. Indeed the costs of renovation may be no different
than the cost of a new facility!
How will the quality
of care improve for patients?
Quality of care is a very important issue for physicians as well as the
community. St. Joseph's has always provided excellent, high quality care
to patients.
A new facility will
enhance the quality of care provided to patients in many significant ways.
Patient privacy will improve. Surgical and other patients will no longer
use the same elevators and hallways used by visitors. Better equipment
and more resources will be available to staff, improving their ability
to care for patients. And there will be adequate space for patients, reducing
the number of transfers to other facilities and delays in care.
New, more efficient
design improves human traffic patterns, and accommodates infrastructure
and technology needs, including plumbing and electrical, heating and ventilating,
and computer needs, as well as accommodates new and enhanced specialty
services.
How will a new
hospital affect our relationships with physicians?
Physicians
are important to the hospital because physicians admit patients to the
hospital. A new, state-of-the-art facility will help attract and retain
physicians to serve this area. New equipment, new operating rooms, new
patient rooms with improved patient privacy, and a new emergency department
will open the door to new physicians and procedures currently unavailable
in Washington County. This availability of equipment and ability to perform
new procedures will attract physicians and allow us to expand the current
scope of specialties available in the community. For example, specialties
that may become more widely available include rheumatology, neonatology,
gastroenterology, orthopedics, urology and cardiology. A new hospital
facility will have more efficient systems for communicating diagnostic
tests and other information among doctors, and clinic and hospital staff.
Location will also
be important for physicians whose homes and offices may be in one of many
communities in Washington County, and for consulting physicians who may
not be from the county. A location that is easy to get to saves critical
time as physicians travel to and from the hospital.
 Back
To Top
Access/Visibility
What is wrong with the present site? Most hospitals do not have expressway
immediate access? Why does the hospital have to be visible in order to
be viable since most of the excellent hospitals in Milwaukee are not?
If accessibility to the current site is an issue, and I believe for outlying
areas it is, has any consideration been given to improve accessibility?
(i.e. strategic off ramp from Hwy 45) If this issue has not been addressed,
why not?
As an independent, not-for-profit hospital, accessibility for our patients
and visibility to the public are very important considerations. Forty-nine
percent of our acute care admissions come to us through our emergency
room. We need to be easily accessible for emergency vehicles (who account
for 6 to 10 % of our emergency patients) and drive-up patients (who account
for 90 to 94 % of our emergency patients). A freeway location makes us
more accessible because lower speed limits, stop signs, and stop and go
lights will not slow patients. The hospital would benefit because the
hospital would come to patients' minds more readily when faced with emergency
situations.
Some other excellent
hospitals are not located near the freeway. This is mainly because most
hospitals have long-term debt and cannot afford to build a new facility
and continue to pay off their loans. However, most new hospitals are being
built with easy freeway access and greater visibility because they realize
the benefits to the community and hospital that can be realized from such
a location.
We have not explored
issues regarding accessibility through new freeway exits at our current
site.
Back
To Top
Affiliations
What serious thought has been given to global affiliations by the board?
(Total affiliation with Aurora or Froedtert/Community Memorial Hospital?)
Will the present hospital regardless of its location continue to be independent
10 years from now? Why can't some agreement be worked out with Aurora
so we don't end up with 2 hospitals in southern Washington County?
The board of directors is committed to remaining an independent, community-controlled
health system. We will collaborate with other organizations to enhance
our services to the community. We are having discussions with many other
health systems for providing related health care services. Aurora and
Froedert are among the organizations with whom we are having these discussions.
We do collaborate already with Aurora and Kettle Moraine Oncology through
the provision of cancer care services. St. Joseph's continues to pursue
appropriate relationships with third parties to support the development
of improved services to the community.
Back
To Top
Cancer Care Center
What explanation does the board give for not considering the expenditures
of Western Avenue and building the Cancer Care Center by willing to move
out of the city? Did you know of these plans at the time you have built
the cancer center?
Health care has gone through radical changes in the last five to ten years.
Therefore, different approaches are needed. No, we did not know of our
current plans when we built the Cancer Care Center.
Back
To Top
City/Taxes
If the present hospital site is not used for a new hospital, shouldn't
the City be entitled to impose real estate taxes on all or more of the
current 23 acres? What affects does moving to PV & 45 have on West Bend
residents with respect to loss of city revenue, increase in city expenses,
loss of business to city business, increase in insurance premiums, longer
response time, and unemployment in the city?
St. Joseph's is a non-profit organization; properties we own that are
used for hospital services are tax exempt. If we buy a new piece of property
and use it for hospital services, it would be tax exempt. If we continue
to use our current site and use it for hospital services, it would be
tax-exempt also. If hospital properties would be used for other purposes,
they could be returned to the tax rolls.
We are an organization
that has an opportunity to add employment to the region. The right location
should increase patient volumes. This in turn should actually increase
employment for the City of West Bend and surrounding areas.
We have not made
any decision on location for the hospital. The location that has the greatest
ability to serve our community is the location that will be most cost
effective. Some costs associated with a new hospital will increase and
some will decrease, but the net impact has been shown to be offset by
increased revenues - which means overall rates for services will be kept
to the lowest level.
Potential sites drive
response times. Response time is determined by the location of the hospital,
location of the emergency vehicle and the location of the patient. We
serve 124,000 people living in Washington County and beyond. Just like
the current location, the time needed to get to the hospital will be shorter
for some people and longer for others. The Health Care Futures report
indicated that a location on Hwy. 45 would be accessible for the greatest
number of patients in our service area.
Because a new location
has not been selected, we don't know what, if any, impact there will be
on insurance premiums. We have built into our forecast a conservative
dollar amount to reflect increased costs. We have also built into our
forecast the increased volumes and revenues, and in all cases the revenues
exceeded the costs.
Back
To Top
Community Sentiment
Regardless of what the feasibility firms' recommendations are, if the
present site is financially feasible, as we are told it is, why antagonize
the people of Washington County by relocating the hospital into a rural
setting and potentially stimulating a response from Aurora that could
be devastating for every constituency concerned with this issue? If providing
quality healthcare to its patients is the primary mission of the hospital,
shouldn't the board give greater concern to not antagonizing the people
of West Bend who are its single largest group of customers and who have
supported the hospital for 71 years? Does the board agree with the feasibility
firm's recommendation that public attitude should be subordinate to other
factors?
The board of directors is well aware of community sentiment and has listened
to the community through an exhaustive process of personal contact with
individuals, letters to the board of directors, community involvement
through the communication committee and hospital facility committee, newspaper
articles and letters, community forums, and other activities. We are committed
to providing every patient who enters the hospital with personalized,
trusted care.
Community sentiment
is an important factor, but not the only factor the board is considering
while deciding where to locate a new hospital. The board is responsible
for weighing all of the factors that impact the success of the hospital,
and must fulfill its responsibility to make a decision that will ensure
the long-term success and viability of St. Joseph's Community Hospital
for the greatest number of people in the market we serve. The factors
the board is considering include:
- Impact on operating
costs and financial performance to ensure the provision of excellent
services and programs for the patients we serve, up-to-date technologies
and facilities, and competitive salaries for employees.
- Support for long-term
strategic goals and competitive positioning to ensure the success and
well being of the hospital for future generations.
- Accessibility/visibility
for patients and visitors so they know where to find us and can get
to us when they need us.
- Accessibility/proximity
to physicians and staff so we can recruit the best health care professionals
to work in our community.
- Community, city,
and county support so we can work together to provide the best health
care possible for our community (West Bend, Slinger, Hartford, Germantown,
Colgate, Kewaskum, Campbellsport, Allenton, Jackson, Richfield, Hubertus,
Newburg).
- Size of available
property/room for growth/program expansion to ensure our ability to
grow to meet our community's growing health care needs and accommodate
the technologies and facilities of the future.
- Development requirements/capital
cost so we can remain a financially strong organization.
Back
To Top
Competition
Where does the other large clinic in town stand? Mr. Anderson suggests
that another hospital would have no reason to build a 2nd new hospital
- why wouldn't Aurora build a hospital if their competition (SJCH) has
purchased their own staff of doctors and given them 5 of 13 votes on the
board? What would happen if the hospital would lose the 30% admissions
from Aurora? Am I correct - will General Clinic patients and doctors have
to use Hartford Memorial Hospital for medical help? Why would the board
tempt Aurora to build a hospital in WB if the new hospital is located
at PV & 45? 30% of the PV site - what happens when Aurora decides to build?
Why are the Doctors from the General Clinic not as welcomed at the WB
hospital as other doctors are? Will this change with the new hospital?
The Aurora Medical Group located in West Bend is affiliated with the same
organization that owns Aurora Medical Center - Hartford. We have had a
long-term relationship with the Aurora Medical Group and hope to continue
this relationship. The doctors of the Aurora Medical Group are as welcome
at St. Joseph's as other doctors are. This will not change once a new
hospital is built.
The forecast that
Health Care Futures developed with a competitive hospital at the corner
of 60 & 45 which resulted in part to the recommendation that we build
#1 at PV, #2 at Paradise, #3 60 & 45 and #4 our current location. Health
Care Futures assumed that we would lose a significant amount of admissions
if a competitive hospital was built.
We are acting consistent
with the mission of St. Joseph's Community Hospital, but we cannot control
the competitive marketplace around us. Many other organizations see St.
Joseph's primary service area as a community they want to serve. The decisions
that other health care systems make is something that we cannot control.
Health care systems are going to make decisions that they feel is in their
best interest to be competitive in their defined marketplace.
The hospital's 19-member
board of directors has three physicians - one independent physician, one
Aurora physician, and one physician from the West Bend Clinic. It is true
that the 13-member health system board has 5 West Bend Clinic physicians.
A line drawn from
St. Mary's Mequon to Community Hospital in Menomonee Falls to Hwy PV and
45 forms a triangle that would fit easily in Washington County, how can
you justify 3 regional health care centers in such a small area? Why should
we try to compete with Milwaukee major hospitals?
We are not trying to compete with major Milwaukee hospitals, but that
doesn't stop them from competing with us. Every day patients leave our
primary service area to receive care that St. Joseph's could provide.
Our objective is to provide the level of care that is appropriate for
a regional hospital, consistent with the needs of the community that we
serve. For example, in response to the community's need for cancer care
in the community, St. Joseph's Community Hospital built the comprehensive
Cancer Care Center. Just like cancer care, we believe that people would
prefer to not have to drive all the way down to Milwaukee if they have
high quality services in their community.
Our mission is to
provide personalized, trusted care for our patients and their families.
In order to fulfill our mission, we need to recruit specialists so that
we can strive for our vision. Our vision states that we will be the preferred
community-governed hospital where we can expand the range of services
that people in the region will be able to access locally.
The population that
was studied for our service area was 124,000, a population that's large
enough to support a regional healthcare facility.
How will the services
be expanded with any new hospital - will we be competing with Milwaukee?
It is the board's intention to provide personalized, trusted care for
the community. We believe that services should be provided locally so
people do not have to travel 15 miles to receive services. Health care
is a competitive industry. It is our intention to provide the level of
care needed for our community. Milwaukee hospitals will continue to compete
with us, strategizing to take market share away from our primary service
area if they can.
We will collaborate
with other organizations to enhance our services to the community. We
are having discussions with many other health systems for providing related
health care services. Aurora and Froedert are among the organizations
with whom we are having these discussions. We do collaborate already with
Aurora and Kettle Moraine Oncology through the provision of cancer care
services. St. Joseph's continues to pursue appropriate relationships with
third parties to support the development of improved services to the community.
An example of a service
we plan to expand are our obstetric services. We are looking at providing
perinatology and neonatology services so women with high risk pregnancies
and births can receive care locally.
How do you explain
the success of the major medical centers such as Mayo Medical Center -
Rochester Methodist Hospital & North Memorial Hospital centers in Minneapolis
- all old facilities that have grown, expanded and been remodeled on their
present residential sites - in your answer, please don't just focus on
population centers? Froedtert, St. Luke's & the Mayo Clinic have done
major new construction at existing sites, what do they know that we don't?
Many institutions in the country remodel at current sites. However, that
does not mean that organizations that have built new hospitals at new
locations are making mistakes, or the reverse. It's a complex set of factors
including current debt, current investment, opportunity to move the hospital,
the cost of remodeling versus building new, competition, population, access,
physician relationships and the regulatory climate.
Mayo Medical Center
had national and international name recognition and obviously is sitting
off the freeway in Rochester, MN. It has reasonable access but fundamentally
the Mayo name is the driver. North Memorial Medical Center at one point
was chosen as an excellent site in a growing community after moving from
the central city. They have begun to develop another campus west of their
existing hospital, at a major exit on the freeway, as a mechanism to try
to deal with their growing populations. They have had significant investment
in their current location. Although they have had discussions about building
a new hospital at a new location, this option would not be economically
feasible for them at this point.
Will moving to
a new location dissuade a for profit hospital from building a plush hospital
such as in Green Bay?
No. Being competitive will be the only reason to dissuade some other organization
from building nearby - be it a non-profit or for-profit hospital.
Back
To Top
Current Site
If the hospital is relocated, what will happen to the old hospital
building? In the presentation, it was mentioned that cancer care, rehab,
administration would occupy the old building. What percent of the square
footage would these functions occupy? If the hospital is moved - what
will the current facility be used for? Very specifically how will present
site be utilized if a new site is selection? What is going to happen to
the old hospital that I paid for - helped that is?
If the hospital is relocated, the board has full intentions of ensuring
that the current facility will have a productive use in the community.
In the presentation by HGA, it was mentioned that cancer care, outpatient
rehabilitation, laundry and administration would occupy the old building.
In the study, HGA built into their financial forecast square footage estimates
for each of these functions on our current site. The total allocated space
for these four functions is estimated to be 65,000 square feet.
Money spent for improvements
and services that have helped treat the sick and injured over the past
years has not been wasted. While some money was spent over the past years
for plans that were later found to be outdated or unworkable, it would
be financially unsound to spend more money to build on those outdated
or unworkable ideas. As a non-profit hospital, St. Joseph's is obligated
to spend its money on health care for people, not profits for individuals.
That continues to be our intention.
Thanks to sound fiscal
management and community support, as well as recent steps to improve its
financial position, St. Joseph's is able to consider the possibilities
of a brand new hospital for the community (West Bend, Slinger, Hartford,
Germantown, Colgate, Kewaskum, Campbellsport, Allenton, Jackson, Richfield,
Hubertus, Newburg).
Back
To Top
Employee Retention
If the hospital moves closer to Milwaukee, what is to stop current
employees from driving 10-15 minutes more to Menomonee Falls, Froedtert,
etc. for more money? (you will have to pay higher wages to compete).
We are currently competing with the Milwaukee market for employees, and
we use Milwaukee health care wage statistics as our competitive market
for wages. Current trends have shown that we will be able to recruit and
retain staff at a new facility where people will enjoy working - a critical
factor in today's health care worker shortage. Current working conditions
are not conducive to providing the work environment we would like to provide
for our employees. A new facility will allow us to recruit and retain
employees more easily.
Back
To Top
West Bend Clinic
We are not addressing questions related to the clinic. The transaction
is consistent with the decision that was made last spring. Additionally,
we have signed confidentiality agreements with Advanced Healthcare. Below
are the questions on this topic that were asked at the forum.
Have you forgot
to find out our cost to bail out the West Bend Clinic? If St. Joseph's
is independently owned (community) then do they intend to buy out the
West Bend Clinic? Are you still buying out West Bend Clinic & at what
cost? When are we going to see financial data such as ownership & debt
of the West Bend Clinic & the proposed arrangements between the Hospital
and WB Clinic? What are the general conditions of agreements with the
West Bend Clinic? Have the WB Clinic doctors signed non-compete agreements
as part of their contracts with SJCH? How long is hospital lease on WB
Clinic building? What is the unusual relationship between the West Bend
Clinic and the new hospital ambulatory surgery if turned over to a private
clinic - am I correct to think that the new hospital has 3 sites planned,
cancer care site/subacute site, WB clinic site, new hospital site? Why
do the doctors have veto power over the nominees to the hospital board?
Who owns the West Bend Clinic building? The doctors or the hospital and
how does that affect the revenues (i.e.) lab, x-ray, out patient, surgery
etc. Understood the hospital had intentions on buying out the West Bend
Clinic physician from their Advanced Healthcare contract - is this a true
fact? If you use all of our hospital's approximately $20,000,000 of reserves
on this project so as to lower the amount we need to borrow how will the
financial arrangement with the West Bend Clinic be accomplished?
Back
To Top
Capital Development
How does this 2001-year annual development support compare to prior
years that have averaged $80,000 to $100,000 per year? With the economy
being shaky since the Sept 11th bombing, do you expect to have substantial
donations to support this?
Our annual development support is in process and we won't know the results
for some time yet. Because donations can be unpredictable, no donations
were built into Health Care Futures' financial feasibility projections
for this project. We have had wide variability in our donations from year
to year.
Back
To Top
Hospital Rates
On top of the 58% of price increases imposed by SJCH of WB during the
past 18 months, what price increases are contemplated over the next 12
months?
Despite our recent price increases, St. Joseph's rates are still below
the average for similar hospitals in our region. The average rate increase
of hospitals in our peer group over the past year has been approximately
10%. We expect our price increases to be consistent with other hospitals
in the market, adequate to cover the increasing costs of technology, salaries,
and decreasing reimbursement rates from Medicare.
Back
To Top
Incorporation
If the hospital moves out of the city - should not the assets revert
back to the city? Who owns the hospital - keep hospital at the same location?
How was the board chosen - by whom? Shouldn't the hospital be looked upon
as a community asset in the same light as our public library? The ownership
may be different but isn't the hospital at least as important to the city
of WB as the library art museum or County Historical Society? If the hospital
moves, will the board members still be basically from our community or
eventually be taken over by board member from Slinger, Hartford, Germantown,
Richfield and keep moving further away from our community?
The board has a mix of people presently from other communities other than
just West Bend. It is the desire of the board of directors to have representation
from the communities that use St. Joseph's Hospital. The hospital is a
non-profit corporation. Its bylaws provide that if it were to dissolve
the assets of that corporation would go back to another non-profit corporation
for appropriate purposes.
A 19-member board
of directors governs the hospital. Three of those board members are physicians
- one physician is an independent physician, one physician represents
Aurora Health Center - West Bend, and one physician represents the West
Bend Clinic. The hospital president/CEO holds one seat. The remaining
15 board members are community members who were recommended by the board's
nominating committee and elected by the board. The nominating committee
inside that board nominates successors to the board and that is how the
hospital has functioned since the time that the sisters relinquished their
management of the hospital and it became a community not-for profit hospital.
This is how most not-for-profit hospitals are governed.
Yes, the hospital
is a community asset, but it is not publicly funded like the library or
historical society. As a result, it has to function like every other business
in the private sector, serving its population well, while attending to
the economic realities of running a business.
It appears that
the biggest obstacle to a new hospital is the location - a referendum
would allow the majority of the people to be heard - when will you have
a referendum so we may be heard?
We will not have a referendum on this issue.
Back
To Top
Insurance
Don't insurance companies decide what hospital we can go to? ( not
location) Will insurance companies pay & cover private rooms or will the
patient or the patient's family pay for the private room? It seems insurance
companies are dictating shorter hospital stays. Is this taken into consideration
during these various studies?
There are many factors that impact the choice of a hospital by a patient,
including physician preference, personal preference, and insurance companies.
We have contracts with most insurance companies that do business in this
area and most insurance companies will pay for private rooms.
Back
To Top
Jackson
Jackson and the Fair Park are now at odds over the water & sewer issue.
If they can't agree on something like that after all the years the Fair
Park has been there - what does the hospital have for assurance they won't
end up in the same type of locked argument? Why build in the country where
you don't have sewer and water & have to buy land? I understand Jackson
already has a water shortage every year.
The evaluation process at various locations includes water, sewer, and
infrastructure. Those considerations are part of the evaluation process
for the site location decision-making process.
Back
To Top
Health Care Futures Report
Why can't they stay in town where they own the land etc.? Why do they
feel the Hwy 45 & PV location is better than Paradise & 45 - when at least
the Paradise site will still be in our community? Why weren't there any
locations checked out to the north? Why can't the hospital be built next
to the old hospital - we have 23 acres in West Bend which would be adequate
for parking and all - Parking lot can be at Oakbrook with a skywalk -
also they can keep this hospital for other uses & have a sky walk over
to the new hospital? If so many people want the hospital in West Bend,
why don't you meet them half way and put it on Paradise and 45? What would
cause less volume at present hospital? Why not erect a new hospital but
keep it in the West Bend City limits to retain its financial base - PV
site only slightly better than Paradise & 45?
The recommendation
from Health Care Futures is PV as the preferred location because of their
application of the board and facility committee selection criteria which
are:
- Impact on operating
costs and financial performance to ensure the provision of excellent
services and programs for the patients we serve, up-to-date technologies
and facilities, and competitive salaries for employees.
- Support for long-term
strategic goals and competitive positioning to ensure the success and
well being of the hospital for future generations.
- Accessibility/visibility
for patients and visitors so they know where to find us and can get
to us when they need us.
- Accessibility/proximity
to physicians and staff so we can recruit the best health care professionals
to work in our community.
- Community, city,
and county support so we can work together to provide the best health
care possible for our community (West Bend, Slinger, Hartford, Germantown,
Colgate, Kewaskum, Campbellsport, Allenton, Jackson, Richfield, Hubertus,
Newburg).
- Size of available
property/room for growth/program expansion to ensure our ability to
grow to meet our community's growing health care needs and accommodate
the technologies and facilities of the future.
- Development requirements/capital
cost so we can remain a financially strong organization.
Based
on those criteria, the Health Care Futures study shows that under the
eight scenarios they studied (four scenarios with competition and four
scenarios without competition), the hospital would survive if located
at Hwys. 45 and 60 or PV, or the Paradise or current locations, but location
will impact the degree of success the hospital will have. The rank order
of sites that Health Care Futures recommends to maximize St. Joseph's
potential for success if a competing hospital is built nearby is:
| 1. Hwy. 45
and PV |
| 2. Hwy. 45
and Paradise Drive |
| 3. Hwy. 45
and 60 |
| 4. Current
site |
Health Care Futures believes that our current site is the least desirable
site compared to other locations studied based on people who would use
the institution long-term, the impact of construction on use of the facility,
competitive positioning, financial performance, and ability to recruit
and retain employees.
Population growth
in Washington County makes our area very attractive to other health care
systems. It is very possible that a competing system - one that is not
locally controlled - will build a hospital in our service area?
We need to increase our level of service to be preferred by patients and
physicians and ultimately, to survive as a robust community hospital.
Forty-nine percent of St. Joseph's acute inpatients come through the emergency
department. Other hospitals that have built on freeways have experienced
dramatic increases in emergency patient volumes. St. Mary's-Ozaukee is
an example of this trend. Since its move to Mequon, St. Mary's-Ozaukee
has seen an increase in both its inpatient and emergency care business.
Volumes increased for inpatient business at an annual rate of 12.5%, while
emergency care business has seen annual volume increases of 21.6%.
Some sites to the
north were not studied because the greatest growth in our service area
is expected to come from the south. The hospital could be built next to
the current hospital and is still under consideration. The drawbacks to
building on the current site include decreased numbers of patients and
revenue as compared to other locations that were studied, in addition
to difficulties associated with delivering care during a three-year construction
project. These difficulties include:
- Lower numbers
of patients and revenue because patients don't want to receive care
at a location under construction.
- Patient and visitor
safety issues in a construction zone.
- Increased noise
caused by construction.
- Neighborhood
disruption caused by construction activities.
- Parking issues
caused by the new hospital being built in current parking areas while
the current hospital is in operation.
The north zip
codes are just as likely to use St. Agnes Hospital in Fond du Lac - what
impact does that have on the change of location of the West Bend Hospital?
Why do you disregard the people in Kewaskum & Campbellsport - aren't you
competing with Hartford? Germantown, Colgate & Hubertus aren't going to
come here? Why would Health Care Futures consider the Hartford and Germantown
populations when deriving market share when in fact those populations
are served by other local hospitals? Do you really believe we can capture
market share from Germantown & Richfield? Why was Newburg not included
in the study? Does this omission show the results to the south? Why were
the northern zip codes to the east and west of Campbellsport not factored
in, since historically they provide 8-10% of admits?
Health Care Futures, in like studies, usually use about 70% of admits
for the scope of their study. In our case, they used almost 90% to ensure
accuracy. Subsequently, they went back and evaluated the additional 8-10%
of admits from zip codes east and west of Campbellsport. The results of
this additional work indicated that there was no change in their recommendations.
The impact was minimal on the number of admits by site.
Within our entire
service area, defined primarily by the communities of Kewaskum, Campbellsport,
West Bend, Allenton, Jackson, Richfield, Hubertus, Newburg, Colgate, Germantown,
Hartford, and Slinger , there are multiple hospitals, capturing different
shares of their served market. For example, in their study, Health Care
Futures detailed our lower market share in the South, given our current
location. Currently we serve some patients from both the Hartford and
Germantown zip codes, with a current marketshare of less than 6% each
of those zip codes. It is projected that a move to the south of West Bend
would increase our marketshare in each of those zip codes. At the same
time, Health Care Futures assumed that there would be market share loss
to the north as a result of building at PV, and less market share loss
to the north if it the new hospital was built at Paradise. St. Joseph's
will have the greatest increase in the numbers of patients if located
at Hwy. PV and 45.
Newburg residents
were included in the study. For the most part, people living in Newburg
were included in the 53090 and 53095 zip codes because Newburg is a post
office box for reporting purposes.
Is the least
risk business plan to build a regional hospital with much more money spent
on specialists + more competition in Milwaukee? Since West Bend has a
community hospital, why did Health Care Futures put more emphasis on economic
& strategic support - citizens want a West Bend location?
Building a new hospital and improving the specialists is the recommend
strategy by Health Care Futures.
I do not understand
how the market share will increase or decrease by changing location (patients
go to hospital on which their doctors are on staff).
Patients do follow their physicians relative to inpatient care. That is
driven by the relationship they have with their physicians. Hospitals
that are easily accessible can recruit physicians more successfully. The
location is not as sensitive if the physician is already going to that
institution. But for emergency care location does have an effect on emergency
care. The Health Care Futures report shows examples where other organizations
have moved to new locations and how much increase that has made in emergency
services. Accessibility and visibility have an impact on emergency use
of the hospital.
In the recommendations
by Health Care Futures, it seems as the community support is not given
much consideration - how much consideration is really given and how much
would the recommendations change if the community support was factored
in?
Health Care Futures included the following criteria in their analysis:
- Impact on operating
cost and financial performance
- Support for long-term
strategic goals and competitive positioning
- Visibility/accessibility
to patients
- Accessibility/proximity
to physicians and staff
- Community/city/county
support
- Size of available
property/room for growth/program expansion
- Development requirements/capital
cost
Health Care Futures'
judgement was in terms of prioritization. They put greater emphasis on
the following criteria: strategic, competitive, and financial performance
for the long term. Health Care Futures did include community/city/county
support in their criteria, but they did not give it the same prioritization
as other criteria. The Hospital board of directors has the same criteria
and will consider all of the criteria when making their decision.
Please give us
the reasons why the present location is unfavorable.
Based on the criteria that Health Care Futures used in their study, they
ranked the current site as the least desirable location for a new hospital.
Compared to the other locations in the study, patient volumes will be
lower at the current location. As a result of not being located at the
best location, financial performance, strategic and competitive positioning
of a new hospital are compromised at the current location. Further, the
present location is least desirable because it will result in a loss of
revenues during the construction period. Finally, the current location
is not central to the population growth of the community St. Joseph's
serves.
Why move from
the present site for only 4 points of market share? How can you say that
income doubles at PV & 45 vs. remodeled when there is only an overall
12% increase in discharges?
Four points of marketshare equate to an increase of up to 3152 additional
patient days per year. This increase is equal to 9-12% additional volume
for the hospital. This additional volume equates to a 100% increase in
operating income over the desirable site.
Why are you now
getting the community involved when you have made up your mind (and don't
tell us it isn't) how does moving 4 miles south enable the hospital to
attract more primary care physicians or specialists - aren't doctors more
interested in number of patients, referrals by other doctors and facilities,
equipment and staff at the hospital?
The hospital has not made a decision on the location of the new hospital.
It is the recommendation of Health Care Futures that the hospital be located
at PV. Doctors are interested in number of patients, referrals by other
doctors and facilities, equipment and staff at the hospital. Another factor
that is important to physicians is convenience and accessibility to hospital
facilities. If you are a specialist, efficient access to the hospital
for call purposes and emergency services is an important criteria.
How can you determine
the patient load in a new location vs. the present - you are now drawing
from a majority of the city's populations?
Patient projections were made using a combination of data sources including
Claritas, a nationally recognized market research group, the U.S. 2000
Census, the State of Wisconsin Bureau of Health Information, and the Centers
for Disease Control Annual Survey of Hospitals. By using this data to
project population, use rates and market share, you can estimate how many
patients you will have in the future.
The residents of
the City of West Bend are part of St. Joseph's Community. However, the
hospital could not survive serving only the City of West Bend. The community
of St. Joseph's includes West Bend, Slinger, Hartford, Germantown, Colgate,
Kewaskum, Campbellsport, Allenton, Jackson, Richfield, Hubertus, and Newburg,
which represent about 90 percent of our patients.
Back
To Top
HGA Report
Please explain St. Mary's Rhinelander hospital as an example, it is
not done - is this a set contract? Mr. Spiering, from HGA said we would
be proud to have a facility such as the one in Rhinelander, in the community,
where could that type of facility be built in this community?
HGA presented St. Mary's Rhinelander as an example because it's the most
current up-to-date numbers they have. We cannot comment of terms of a
contract between HGA and Rhinelander.
Isn't the PV &
45 site inefficient for doctors from both clinics as far as seeing patients,
emergencies, etc.? The new hospital you showed all had clinics on site.
No. It is a very accessible location for our physicians, patients and
visitors within our service area. Our service area includes the communities
of West Bend, Slinger, Hartford, Germantown, Colgate, Kewaskum, Campbellsport,
Allenton, Jackson, Richfield, Hubertus, and Newburg.
How much money
will need to be spent on duplicate equipment if built on new site? What
amount of the $60,000,000 will go for building and how much will be used
for state of the art equipment?
There is almost no duplication of equipment if we build on a new site.
There may be one piece of equipment that would need to be duplicated with
the services that intended on staying at the current site - a piece of
radiology equipment for the cancer care center. HGA has included approximately
$10 million for equipment in its forecast. Much of the current equipment
will be transferred to the new campus. We have consistently kept up with
the state-of-the art technology and we will continue to hold that standard.
Why didn't the
consultants show some projects on existing sites, of which there are many?
The consultants at HGA only had comparable projects on new sites. If possible,
I would like a
copy of the advantages and disadvantages for on site remodeling and new
site-new buildings as presented by the architect - Thanks.
| |
Disadvantages
|
Advantages
|
Existing
Site/
Renovation and Addition |
-Operational inefficiencies |
-Maintains all existing buildings |
| -Expensive
$/square foot |
-Immediate
community acceptance |
| -Substandard
result |
-Continuity
with cancer care |
| -Disruption
during construction |
|
| -Limited
options for future growth |
|
| -Long
term issues with neighborhood |
|
| |
|
|
| |
Disadvantages
|
Advantages
|
| New
Site/ New Facility |
-Not
all operation on one site |
-Maximum
potential for ideal relationships between clinical components and
related operational savings |
| |
-Unlimited
growth potential |
| |
-Increased
opportunity for visibility and access |
| |
-Maximizes
construction $ spent |
| |
-Shortest
overall construction period |
The HGA study
on comparison does not utilize the possibility of the closure of Oak Street
which the city has agreed to do and the land now occupied by the Oakbrook
Clinic building and it does not address the possibility of an adjacent
multi-story parking structure - why not?
HGA did address the issue of a parking structure in their report. In that
study, HGA did more advanced studies of our site, utilizing the possibility
of closure of Oak Street. They believe that a parking ramp would need
to be developed next to the new hospital to provide convenient parking
for patients and staff. According to HGA, the ramp is needed to maximize
the usefulness of this site.
If the new hospital
was built with all departments (for example: subacute and laundry) plus
- how much would the cost be - not what you claim for the plan now?
We do not plan on moving laundry to the new facility under any circumstances.
Under this premise, we did not have it quoted in the HGA study. Subacute
is an additional alternate for this project. For example, the board is
considering three options with regard to subacute care: (1) We may move
the beds out of the hospital and into a skilled nursing facility because
the current subacute care beds are licensed as a skilled nursing facility
by Washington County. (2) We may operate the current beds at the current
location. (3) We may add this project onto the current, 80-bed project,
developing this service in the new facility.
What about the
cost of the land where the new hospital will be built?
The cost of the land has already been factored into the HGA study.
Why would we need
to include costs of a medical office building?
We did not include the costs of a medical office building in this project.
We anticipate that an office building will be built on the hospital campus
in the future. The funding for that project could be financed by non-hospital
funds.
Did I understand
that laundry facilities would remain at Silverbrook site?
Yes, most new hospitals that are developed either outsource their laundry
activities or have them remain at the current site. We believe the most
cost-effective thing for the organization is to leave the laundry facilities
at the Silverbrook site if a new location is chosen.
Is it true that
a conservative construction cost estimate for a new hospital at PV will
equal $62 million if you incorporate subacute care and mental health beds?
To be conservative, Health Care Futures incorporated $62 million of capital
costs into their forecast. HGA estimates that the capital costs to build
a new hospital are between $50-55 million. The exact approach to mental
health and subacute care has not been decided yet.
Back
To Top
Location Study
Why didn't you save the cost of the study when you knew what the
result of the study would be without doing the study?
The hospital's board of directors is committed to a process to determine
the best location for a new hospital. They did not know the outcome of
the location study before it was conducted. The board felt that to fulfill
their responsibility, they conducted a study, having those results verified
by other professionals.
Why do we have
the gag rule on our board, aren't they supposed to be communicating with
us - do they represent the community in that way?
We do not have a gag rule on our board. The board balances communication
with the community with its responsibility to hold sensitive business
issues confidential.
Comment on the
fire department.
One of the issues that the hospital has to evaluate before a final selection
of site occurs is the impact of services to that site. Fire and police
services are important. Water and sewer are also important issues that
will need to be resolved before a final determination can occur.
What are the plans
for Oakbrook Clinic - will it stay as is?
The board has not made a decision about the future plans for the Oakbrook
Health Center.
How soon will
the old site be shut down and Phase II of the new site be started?
If we choose to build at another location, the existing site would be
operating until the new hospital is completed. At that time there would
be a development plan implemented for the current site as well as the
new site. A decision has not been made about where the new hospital will
be located. If a hospital were built at another location we would develop
an 80-bed hospital. We do not have a Phase II plan in the HGA study.
Have police response
times been factored in on a non-city site? What would the costs be of
an upgrade to existing hospital security if Washington County can't meet
present city responses?
We have not studied police response times. We will study this before a
final site is selected.
We have not yet evaluated
the specific costs involved with security or relationship to the institution
due to the fact that the location of a new hospital has not been decided.
Those factors would be important factors that would have to be evaluated
prior to acquiring a piece of property after it has been optioned.
Are you planning
to bring hospital services up a level or two - are heart stents or open
heart surgery being planned? Menomonee Falls does these surgeries now.
How will patients who do not drive get to the new facility?
If you are suggesting in the question that it is a long distance to drive
to Menomonee Falls and it would be important to have a new facility closer
to the community, so that people would not have to drive to Menomonee
Falls for services, that is consistent with what we feel. We plan to address
transportation to help people get to the new location. The idea of open-heart
surgery, which is considered a tertiary service, not a level II service,
is not being planned for the new facility.
Would physicians
offices be located at the new facility (50 offices are planned or would
they stay at WB Clinic)?
Yes, we are contemplating having physician offices located on the campus
in the future, whether it is the current campus or a new one. We do not
have a Phase II plan. However, these physician offices could be financed
by non-hospital funds.
In evaluating
the costs of building a new hospital on the recommended site at PV & 45,
were the fire and safety services currently provided by the City of West
Bend considered? If yes, please explain, if no, be honest.
Relative to Health Care Futures analysis, they did not consider fire and
safety services currently provided. The hospital did raise, internally,
that the issue of fire and safety will be considered as part of the choice
of where a new hospital should be built.
I keep hearing
this is a done deal - it certainly seems like it - is it - why isn't WB
considered for a definite sight - 3 of the sites are Hwy 45 - why aren't
more every day citizens put on the committee - it looks like only the
top people of companies have been recognized - is making money the most
important part of where the hospital is located? What percentage of the
people on the research staff lives in the West Bend area and really understands
what our area needs?
We did get one of the best health care consultants in the country to look
at our situation, and come up with objective and unbiased information.
We are a private, non-profit organization, not a public non-profit organization.
The board of directors are volunteers and represent the community.
In addition to the
board's participation in the location selection for the new hospital is
the facility committee, a subcommittee of the board of directors. The
facility committee is made up of board members and three non-board community
members. This committee is tasked with making a site recommendation to
the board of directors. Upon hearing a recommendation from the facility
committee, the board will be making the decision on the location of the
new hospital.
The research staff
is made up of Health Care Futures, based in Chicago, IL; HGA, located
in Milwaukee, WI, and B.C. Zeigler & Company of West Bend, WI.
What is the margin
of error of your studies expressed in market share? Revenue?
Health Care Futures did not do a sensitivity analysis around their assumptions
for the feasibility study, but the management team of St. Joseph's Community
Hospital feels that it was a very conservative analysis.
Do you think that
the link that Dave Anderson mentioned, between hospitals that increased
visibility through moving closer to Hwy access etc and the increased emergency
care admittance has something to do with increased travel distance for
most patients, visitors, volunteer help, workers, etc. especially with
aging people this should be a huge concern. In adverse conditions this
can cost lives and should be a main concern. Of the various sites considered,
what makes the 45 & PV site most/more desirable? Regarding the Paradise
Drive site, why would the board consider spending $53,000,000 on a new
hospital on 1 ¼ miles away at a more congested site?
Health Care Futures evaluated three variables in their feasibility analysis:
market share, use rate, and population. Then they created a financial
forecast. Finally, they applied seven criteria points, developed by the
facility committee and approved by the board of directors, to their forecast
and made their recommendations. The criteria included:
- Impact on operating
cost and financial performance
- Support for long-term
strategic goals and competitive positioning
- Visibility/accessibility
to patients
- Accessibility/proximity
to physicians and staff
- Community/city/county
support
- Size of available
property/room for growth/program expansion
- Development requirements/capital
cost
Based on Health Care
Futures' analysis, a site near Hwy 45 and PV is preferred for the location
of the hospital; emergency access was an important consideration.
Is the financial
feasibility study applicable to all sites?
Four locations were included in the feasibility study and each location
included the same criteria.
When does the
board expect to make a decision?
The board has now received all the information to conclude their process,
including the public input from the forum and all of the information from
the studies. The board is now deliberating with this information.
Back
To Top
Communications
Committee
Why is the hospital communications committee casting aspersions on
motives of deep pocket donors?
The communications committee is an independent group whose purpose was
to present a balanced approach to the hospital issues.
Who paid for the
ad authored by Vic Albiero? (and who paid for the ad by the Friends of
St. Joseph's)? Can you identify the "Friends of St. Joseph's Hospital"
who ran the full-page ad about a week ago and will you allow them to speak
tonight?
The hospital did not fund the ad by Vic Albiero. We do not know specifically
who "The Friends of St. Joseph's" are.
Back
To Top
Name Change
Is the name of the hospital going to be changed - why - to what name
- keep at current location - West Bend should have a hospital in the city
limits.
Over the years
there has been periodic discussion regarding the name of the hospital.
There is no current discussion about a name change.
Back
To Top
Operating From Two Sites
Won't there
be higher operating costs using two locations vs. combining at one location?
How do you justify operating from two locations…?
Health Care Futures forecasted that there would be increased revenues
at a new location, versus our current location. Operating at two locations
will increase operating costs. However, the increased revenue generated
at a new location is greater than the additional costs of operations incurred
from operating at two locations.
Back
To Top
Occupancy Rate
What is the current occupancy rate (Aug through Oct) at the hospital?
Occupancy is a complicated question in healthcare because there is so
much variability by service line and by time of year. Last year we had
an acute care occupancy rate of approximately 50%. However, during that
same time period, the hospital had a shortage of specific beds in certain
departments for approximately 50 days.
Back
To Top
Parking
Structure
Why does an 80-bed new hospital at present site require a $4,000,000
parking structure now? Isn't it true that through properly designed lighting,
that if and when a PK structure at the present site is built it should
have minimal impact on the neighborhood?
HGA recommended that a parking structure be built because we would not
have enough parking spots during construction and after further development.
We believe that the construction of a parking structure would have a negative
impact on the neighborhood.
Back
To Top
Port Washington/Mequon
What reactions are evident in Port Washington since they moved their
hospital to Mequon?
More people from Port Washington use the hospital now than when it was
named St. Alphonsus and located in Port Washington. Since its move to
Mequon, St. Mary's -Ozaukee has seen an increase in both its inpatient
and emergency care business. Volumes increased for inpatient business
at an annual rate of 12.5%, while emergency care business has seen annual
volume increases of 21.6%.
Back
To Top
Timeline
What is best guess of when the present site will be abandoned if an
alternative site is chosen?
It is not our intention to abandon the current site. It takes approximately
3 years to design and build a new hospital. After a decision is made about
the site of the new facility, the board will consider options for the
use of the current building and site.
When do you plan
to build the medical office building? If you do plan on building a new
hospital how soon do you plan on starting construction?
No decision has been made about developing an office building. An office
building is contemplated at some time in the future.
Back
To Top
Transportation
Where do they intend to get all the volunteer help from if they move
the hospital? Would you get volunteers out on Paradise like there is now
because the Partners are mostly elderly and will not drive out there?
If you built outside city and needed to set up a transportation system
isn't that going to cut into your profit margin? It certainly is going
to cost money. How much weight was put on emergency transportation, especially
in bad weather conditions? Building out of the city will not have public
transportation. How will I without a car be able to get to the hospital
or visit those who may be there or use services? Meals on wheels is a
community service - a volunteer living in WB area would be expected to
drive out of town - deliver meals in WB and return to hospital to return
equipment then back to WB - lots of driving - or will this no longer be
a service? If the hospital is moved to PV & Hwy 45, won't there be a big
loss of current volunteer support? You said a hospital will be build on
60 & 45 Jackson regardless if we build or not - isn't that a definite
reason to keep the hospital in West Bend - rather than going south - are
you going to provide free transportation if you go out of the city for
us older people to receive health care? What kind of transportation to
go out of town for people who don't have a car? Where will you get volunteer
help from an area not serviced by taxi or bus?
If a competitive hospital is built on the corner of 60 & 45 Health Care
Futures has ranked order that the best sites for us would be (1) PV, (2)
Paradise, (3) 60 & 45, and our current site would be the least desirable.
If there was no competition, they ranked (1) 60 & 45, (2) PV, (3) Paradise
and our current site as the least desirable. You can see that under any
scenario the least desirable site according to Health Care Futures is
our current site. We would need to come up with a mechanism to provide
transportation to people to go to a location other than the current site.
We plan to continue
the excellent relationship with volunteers that we have had almost from
the hospital's inception. The hospital's mission - to provide personalized,
trusted care to patients and their families - has not changed, and we
hope our volunteers' commitment to our mission will not change as a result
of a new building. Under any circumstances, we will make sure that volunteers
and patients are able to get to our facility when they need to. We will
also continue to offer Meals on Wheels at the new facility, regardless
of where it is located.
Back
To Top
Composition of
the New Hospital
How many beds will the new hospital have?
There will be 80 acute care beds. This number includes medical surgical,
intensive care, and obstetrics beds.
If you expect
the use of the hospital to increase why are we building a smaller hospital
than we have? Wouldn't it make more financial sense to build a bigger
hospital? What is the purpose of building a new hospital if it's going
to hold the same amount of beds?
The cost of building a new facility versus remodeling is the same. Building
a new facility will create the adjacencies and efficiencies that are not
realized in the current facility. We are not building a smaller hospital
than we have; we are building a hospital of the same size as we currently
have. The reason the current size is being chosen is that we are going
to all private rooms and looking at standards in the industry for occupancy
level, and an 80-bed hospital is the appropriate size for the hospital.
There are also competitive forces that demand that we take a conservative
approach to sizing the new institution. We must build a new institution
in a location where we can have flexibility for growth in the future.
Is it correct
to say the new building is being built not to provide more beds but to
just get a better layout of beds?
Presently our current hospital has double beds (semi-private rooms) and
not the best layout for our nursing staff and other people providing care
to patients. A new hospital would allow us to have all single beds (private
rooms) and to design a state of the art layout of those beds in addition
to allow for flexibility for growth in the future.
The new hospital
has only 16 beds for OB - they are filled most of the time - why so few
beds?
The current OB service has a lot of capacity. They are not filled most
of the time. The establishment of the number of OB beds was attempted
to be done consistent with industry standards for occupancy levels.
The hospital
at its present location provides that there is a lease agreement with
the County Board Mental Health Inpatient Services as well as a sub-acute
unit. These are valuable community services. Is space for these community
services planned for at a new site? Is the cost to provide mental health
space included in the estimates of $52,000,000?
We agree that both subacute and the inpatient psychiatric services are
important services to the community. The County manages the psychiatric
services and the license is held by the hospital. The County holds the
license for our subacute care services and the hospital manages this service.
We have three options relative to what we do with these services: (1)
Relocate these services to another location that is not associated with
the hospital's current site (i.e.) have subacute be provided for at the
current county skilled nursing facility site or other skilled nursing
facilities in the community. For mental health, that might mean discontinuing
mental health services at our current site and integrating with another
provider in another county. (2) Another option is to maintain the services
at the current site, or (3) To develop the service at a new site. These
are not part of the $52,000,000 and the add-alternate costs for developing
these services at a new location are approximately $6,000,000.
If the present
location can take care of future needs…why are you insisting on moving
the new location to the south?
The recommendation by Health Care Futures is that we locate the new hospital
at the best location to service the needs of the community, as supported
by our mission and vision.
Our mission is to
provide personalized, trusted care for our patients and their families.
Our vision is to
be the preferred, community-governed hospital where:
- Patients desire
to receive their care, because of their trust in the skills of our staff,
our excellent facilities and technology, and the scope of our programs.
- Physicians desire
to practice, because of our commitment to quality patient care.
- People want to
work, because of our mission and supportive environment.
Additionally, our
vision is to expand the range of services that people in the region will
be able to access locally, through:
- Continued strong
commitment to the community.
- Enhancement of
specialized services and programs.
- Support of current
and new physician relationships.
We are dedicated
to our vision, and it is the board's responsibility to select a site that
allows for the vision to be best achieved. The present location is the
least desirable location according to the recommendations of Health Care
Futures.
We already have
adequate land at the hospital's present site - how can it be as reasonable
to build at a new site - we have been preparing for years by donating
to the capital development fund. No doubt those monies have already been
used with your search committee -
The study by HGA showed that the current site would be less than adequate
for the future needs of the hospital compared to a larger site.
Back
To Top
Our Name - St. Joseph's Community
Hospital of West Bend
Our hospital charter name is St. Joseph's Community Hospital of West
Bend - shouldn't the hospital remain in the city of West Bend? And remain
our hospital?
St. Joseph's Community Hospital serves the communities of Kewaskum, Campbellsport,
West Bend, Allenton, Jackson, Richfield, Hubertus, Colgate, Germantown,
Hartford, Slinger, and others in the region. St. Joseph's Community Hospital
would not survive if it just served the City of West Bend.
It seems you are
more concerned with market share then you are with health care for West
Bend citizens - is no longer West Bend Community Hospital for West Bend?
Mission is mandating our actions. A location that allows us to serve the
most people is consistent with our mission. If we were to service only
the citizens of the city of West Bend we would not survive as a hospital.
Why haven't the
full details of the feasibility study been made available to the public?
The full details of the report contain some market and financial information
that we feel is proprietary and could create competitive issues if released.
Back
To Top
Community Support
Why did the consultants down play the value of community support vs.
other factors? Why would you put financial criteria ahead of community
criteria when your vision & mission are directly tied to providing care
& service to the community?
The board of directors is well aware of community sentiment and has listened
to the community through an inclusive process of personal contact with
individuals, letters to the board of directors, community involvement
through the hospital facility committee, community advisory committee,
newspaper articles and letters, community forums, and other activities.
Community sentiment
is an important factor, but not the only factor the board is considering
while deciding where to locate a new hospital. The board is responsible
for weighing all of the factors that impact the success of the hospital.
The criteria include:
- Impact on operating
cost and financial performance
- Support for long-term
strategic goals and competitive positioning
- Visibility/accessibility
to patients
- Accessibility/proximity
to physicians and staff
- Community/city/county
support
- Size of available
property/room for growth/program expansion
- Development requirements/capital
cost
In weighing these
criteria, the board must fulfill its responsibility to make a decision
that will ensure the long-term success and viability of St. Joseph's Community
Hospital - otherwise our mission and vision will not be able to be fulfilled
to the very best of our ability.
Back
To Top
Use Rate
The population - use rate information that Health Care Futures used
in the handout included Hartford, Germantown which mainly use other hospital.
Could your report be redone to reflect the population use rate reflective
of its current service area?
The use rate is a measure of how many people from a population received
hospital care. The use rate that was used in the report is not specific
to our hospital, but rather to our region. If anyone in this population
used a hospital anywhere in the state of Wisconsin, that information was
used to calculate the use rate. The use rate would not change if you took
out Hartford, Germantown, and other locations. Taking those zip codes
out of the analysis would not have a material impact on the use rate in
Washington County.
You made a statement
about undiagnosed cases - what statistics back this up?
The use rate in Washington County is approximately 88.2. In other words,
for every 1,000 people in this county, 88.2 of them will seek inpatient
care annually. The county use rate is significantly lower than the state
use rate of 106.1. In locations where there are low numbers of physicians
per thousand population, the use rates are usually lower. Places with
higher use rates typically have more physicians per thousand population.
Back
To Top
Labor Costs
How does labor cost compare in Texas, Rhinelander, etc. to
those being paid in our area?
Labor costs are lower in Texas and comparable in Rhinelander.
Back
To Top
Remodel Versus Build New
Is it correct that a remodeling (option a) would have a total of 400,000
square feet versus 232,000 in option c?
HGA has projected that remodeling would have a total of 418,000 square
feet versus 231,500 in building new. The square footage after remodeling
is much larger than building new.
Explain to me
how remodel cost & new costs are same - what extent of remodel, square
feet of new infrastructure costs.
HGA presented the basis for them to make the estimates of remodeling and
new cost being the same. They developed a list of the services and departments
and used a cost per square foot that are within the area and number of
square of feet for the service level we have based on industry norms.
They came to the conclusion that the cost of building new and the cost
of remodeling were comparable.
Back
To Top
Community Forum
Why was the meeting called as early as 6 p.m. during deer season and
3 days before Thanksgiving - when many people travel? Why was this meeting
in the busy week of Thanksgiving & during deer hunting? Why did the board
schedule a public meeting on less than a week's notice during deer season
and a holiday week?
The meeting was arranged based on the schedule of the consultants that
we needed to have there and their time availability.
Back
To Top
John Reiling
Why was the search committee abandoned after its first turn down?
Decisions about the work relationship with John Reiling are not public.
What was the cost
of the study?
The cost of the study is not public information.
Mr. Reiling -
once the project construction starts, will you move to West Bend and stop
commuting to the Twin Cities?
If you have personal questions about John Reiling, please contact him
directly.
Back
To Top
Urban Sprawl
What is the hospital position on urban sprawl? Are you at all concerned
that the Hwy PV location contributes to urban sprawl compared to Paradise
Drive?
Urban sprawl is yet another important factor that the board needs to consider
when deciding where to locate a new hospital. All types of businesses
line the freeway from Milwaukee to West Bend. Growth continues at a rapid
pace, and is destined to continue.
Back
To Top
Travel Time
to the Hospital
Did you consider the time and distance emergency vehicles would need
to take people from the city to a hospital outside of West Bend?
Yes, we will have to have discussions, before a final decision is made
on a specific site, about the impact on emergency vehicles. Again, some
vehicles will have improved access and others will have their access diminished.
We need to choose a site that allows people maximum access within the
entire population that we serve. Most new hospitals built on the freeway
have had marked improvement in their emergency service volumes as a result
of the relocation.
Our hospital has
been here 70 years, should we not consider space to grow for future 70
years? Could Kewaskum probably get to PV & 45 as quick as traveling through
city at some busy traffic times?
The current hospital was developed on the west side of the city when it
was first started and we believe that we should be at a location where
we have enough space to develop over the long term. Those sites that are
being considered are at least double the size of our current site. The
travel time to the current hospital from Kewaskum is approximately 10:40.
It would take 12:25 to travel to PV. This time difference is less than
2:00 minutes.
If the hospital
is built south of West Bend, please address emergency response time, plus
the inconvenience it would be for the 30,000 people living in West Bend
and the people living north of West Bend.
There is no question that any move in location would improve emergency
response time for certain people and cause inconvenience for other people.
Our existing site is convenient for certain people and inconvenient for
other people. This is something that we will take into consideration.
It is a fact that many of the institutions that have moved to the freeway
have had significant growth in emergency services.
With the majority
of patients in West Bend does moving to an outlying area not present more
problems with safe travel especially in adverse weather conditions? Demographics
can be looked at in more than one way.
A move in location will improve accessibility for many people, but will
also adversely affect other people, just as our current location provides
accessibility to many people and adversely affects many people. St. Joseph's
Community Hospital needs to choose a location that can provide the best
location for the majority of patients that we serve. St. Joseph's serves
a community of 124,000 people including the communities of Kewaskum, Campbellsport,
West Bend, Allenton, Newburg, Jackson, Richfield, Hubertus, Colgate, Germantown,
Hartford, and Slinger.
Growth is on the
north side of West Bend if the new hospital is built on PV & 45 you will
be leaving West Bend residents with no choice but to go to Fond du Lac
hospital - why abandon West Bend residents? I am president of the Village
of Kewaskum, as one of two communities (Campbellsport being the other)
comprising of the northern group 1/6th of your 12 community total) how
can I tell my citizenry that any move south would better serve our health
care needs.
Health Care Futures did report in their study that there would be some
decline in marketshare from the north if the hospital is located on Hwy
45 and PV. Based on the report from the Village of Jackson, "With the
future of St. Joseph's at a Crossroads," the travel times from Hwy 45
and Hwy 28 East to the current site takes 10:40. If the hospital locates
at Hwy. 45 and PV, the travel time will change to 12:25, a change of less
than a 2 minutes.
Back
To Top
Miscellaneous
You keep saying that the neighbors of the current facility are being
bothered by the hospital. The hospital was there first and they opted
to build because they wanted to be close to the hospital. So there should
be no disadvantage there - so why do you keep bringing them up as a disadvantage
when the neighbors actually like the hospital there?
We are not saying that the neighbors are bothered by the hospital, what
we have been trying to say is:
- With the development
of a new hospital on the current site, and
- With the development
of a parking ramp on our current site, there would be a lot of development
that may be bothersome to the neighbors.
What's the judge's
verdict?
We purposely selected somebody that we felt was unbiased. We do not know
his opinion.
If you want to
do the best for the community, then why not keep the hospital in the community,
build new, but in West Bend?
We need to choose a location that best meets the mission and vision of
the hospital. We believe some of the key factors are maintaining a cost-effective
hospital with high volumes. In addition, we do not want to cause major
issues for people who are receiving care for the three years that it would
take to develop a hospital at the current site.
Does a better
location translate to additional or better services?
They are not necessarily linked that a new location means additional or
better services. A new location could mean additional volumes of current
services and have the ability to add or improve services because of stronger
location. The ability to recruit and retain staff and physicians should
be enhanced.
If you move outside
of the city, why don't you just dissolve & let another hospital come in
seeing how it is no longer a community hospital?
We believe that if we move to a new location that we will continue to
be a community hospital. A location inside or outside of the city does
not make us a community or non-community hospital. We believe that to
have a local community controlled institution is the best way to provide
care and most responsive way to provide care to the community in the future.
Our definition of community is much broader than the City of West Bend.
St. Joseph's serves a community of 124,000 people including the communities
of Kewaskum, Campbellsport, West Bend, Allenton, Newburg, Jackson, Richfield,
Hubertus, Colgate, Germantown, Hartford, and Slinger.
How about the
medical staff - what do they want or need to do their job?
The majority of the medical staff had indicated to us that they believe
we should build a new hospital at a new location so that they can provide
the highest quality of services for their patients.
You have asked
for community input but it appears that the board, who has the vote to
decide where the hospital is built, has already made up its mind about
the location.
The board has not made up their mind's on the location, but it is accurate
that they will decide where the hospital is built.
It is plain stupid
to relocate the hospital, it should stay in West Bend - why is this hospital
not good enough?
The cost of remodeling and the cost of building new are comparable; therefore,
the hospital needs to decide on the best location to provide care to its
community and the broader community for the long term.
What percentage
of patients coming to the hospital emergency room are brought in by private
transportation?
We see approximately 1300-1500 emergency department patients a month.
Over 90% of those patients are coming in through private transportation.
Why are the laundry
facilities staying at the old hospital in West Bend?
Because the capital cost of placing them in the new facility compared
to the cost of transportation makes it less expensive for us to maintain
them at our current site. Most new hospitals do not build laundry facilities,
but tend to outsource laundry. We have made the decision to continue laundry
at the current site because it is more economical for us to keep laundry
than to outsource it to a private firm.
Information I
have heard is that SJCH already purchased land from Peters. Is this at
the Highway PV and 45 intersection?
We have not purchased any property at this point.
Back
To Top
Financial Impact of New Hospital
When a hospital goes from no debt and no debt services to a large
amount of debt and debt service its costs go up dramatically - why haven't
we been told what these increased costs are and how they will affect our
hospital rates, and that effect on local business and patients?
We plan to add debt comparable to the other hospitals in our peer group.
The impact of the debt service for building a new hospital is similar
to remodeling. The depreciation and interest expense would amount to approximately
8% of our total costs.
Whether or not the
debt service will affect our hospital rates is to be determined. Increased
volumes of services could offset the need for hospital rates due to the
debt service. Most of the dramatic cost increases that are incurring in
health care are not related to debt service. They are related to the increased
cost of employees because of major shortages of nurses and other professionals
related to the hospital. Nursing salaries and benefits have gone up dramatically
in the last few years and probably will continue to rise at significant
rates. We are also competing with Milwaukee for professional people and
therefore our rates have to be competitive with the Milwaukee market.
The location that has the best financial performance and highest volumes
will be the location where the lowest rates will occur. The hospital will
need to develop approximately a $55,000,000 project under any circumstances
whether we remodel, build new, build new at our current site or build
at a new site. The hospital will need to invest the capital to upgrade
its facility, so the debt service will need to be incurred under any circumstances.
Is our hospital
currently in financial difficulty? Has the community failed to support
needed improvements at current site?
Our hospital is not in financial difficulty and has had very strong financial
operations. Most of the assets of the organization have been paid for
through the organization's own reserves. Less than 16% of the assets of
the organization have been financed by community support. The hospital
appreciates the support the community has made to the organization over
the years and hopes that support will continue in the future.
Back
To Top
If
you have questions or comments, or would like more information, please
contact us
|
Assorted
Questions