Musings on a Micro-Hospital for the City of Bremerton

Recently, Chelan County overwhelmingly passed a bond for $20 million to build a new hospital, with 64.87% approval.  The community felt their aging hospital was not viable and took matters into their own hands.  After the Bremerton Harrison Hospital closes, access will become more challenging in case of medical emergencies.  Bremerton has a large population of elderly, poor, disabled, or otherwise medically fragile. While most are resilient, this community deserves a viable solution for its healthcare needs. 

From what I understand, much of the hospital structure is aging and needs to be torn down, however it is possible there are recently remodeled sections which may be viable.  If a structural evaluation yields favorable results, I propose we maintain those sections and complete a targeted demolition where appropriate.

My ideal vision would be construction of a Harrison Community Campus, to include a micro-hospital for short-stay admissions, an emergency department, and a primary care clinic.  Micro-hospitals are defined as independently licensed facilities with 8-25 inpatient beds, a fully equipped emergency department, and ancillary services, such as pharmacy, lab, and imaging studies.  Micro-hospitals can handle acuity levels comparable to those of any standard community hospital and already exist in nineteen states.

The idea of micro-hospitals is gaining traction because costs of construction are far lower than that of more traditional hospital facilities –costing anywhere between $7-$30 million, depending on the range of services available, according to Advisory Board statistics.   Micro-hospitals can meet 90% of the community healthcare needs.  They seem to flourish best in markets with critical service gaps.  Ideally, micro-hospitals are located within 20 miles of a full-service hospital, facilitating the transfer of patients to larger facilities if higher-acuity needs arise.  Hospital stays anticipated to be longer than 48 hours are sent to higher-acuity facilities.  

To date, micro-hospitals are only found in states without certificate of need (CON) laws.  Washington State has strict CON regulations.  Depending on the Silverdale Hospital expansion timeline, by 2023 Bremerton may have an opportunity to recover 74 beds; however, if CHI completes Phase II on time, a micro-hospital in Bremerton will require a certificate of need (CON) approval. While this obstacle may prove difficult, it is not insurmountable. 

Emerus is the nation’s largest operator of micro-hospitals, with 22 facilities in operation and 25 currently under development.  Structures range from 15,000 to 50,000 square feet in size and function as “healthplexes,” including primary care clinics.  According to Vic Schmerbeck, executive VP of business development at Emerus, the goal is to provide care “in a place where people work, live and play.”  Some experts worry their small size is not adequate to serve large populations, however, remaining slight in scale allows for versatility within unique communities to provide a comprehensive array of services.

Most experts believe micro-hospitals are a cost-effective healthcare delivery option for those in urban, suburban, and rural areas.  An associate director of policy development at the American Hospital Association (AHA), Priya Bathija said “We [the AHA] really think they have the potential to help in vulnerable communities that have a lack of access.”  Peggy Sanborn, Vice President of strategic growth for Dignity Health, a hospital system considering a merging with Catholic Health Initiatives said “micro-hospitals have a shorter build time, allowing the health system to bring healthcare services to patients in the community faster.”

Micro-hospitals are becoming a small giant of healthcare—a highly successful model in the new era of value over volume.  Healthcare costs at a micro-hospital are slightly higher than those of an urgent care center, yet lower than a more traditional hospital setting.  As the healthcare industry trends towards greater emphasis on the health of communities, micro-hospitals are a perfect fit, delivering care close to home, while suitably sized to meet the evolving needs of the community. 

Bremerton is a community at risk of losing access to basic healthcare services.  Building a Harrison Community Campus would be an innovative solution to deliver care that is cost-effective and efficient.  With careful planning and conservative execution, a micro-hospital could benefit patients, providers and insurers, who are crumbling under the weight of increasing costs.  Our community needs primary care, plus inpatient, urgent, and emergency care services which are accessible to everyone.  If we are ever going to contemplate passing a bond for capital improvements, a micro-hospital is one plan worth serious consideration; it would be a worthwhile investment in our children, our neighbors, and ourselves.