Outpatient expansion

`A new front door' for downtown UM Medical Center

$200 million ambulatory care center is to be built at edge of downtown


Seeking to catch up with a trend of booming outpatient services, University of Maryland Medicine is completing plans for a $200 million, eight-story ambulatory care center on the western edge of downtown.

The hospital sees the center as a way to draw more patients. "Outpatient services, if they're well organized, become the front door to everything," said Trent C. Smith, senior vice president and chief operating officer for ambulatory care for University of Maryland Medical Center.

Plans for the center are scheduled to go before the city's Urban Design and Architectural Review Panel next week. The hospital and medical school hope to begin construction this summer, for an opening in late 2009 or early 2010.

The ambulatory care center will fill most of the block bounded by Greene, Lombard, Pratt and Paca streets.

In addition to the eight stories above ground, with 500,000 gross square feet of space, there would be three levels underground with 530 parking spaces.

The ambulatory center represents the fourth phase - and last that's on the drawing board - of a decade-long effort to reshape the hospital that has included a new Shock Trauma Center and two major inpatient buildings, Gudelsky and Weinberg.

The Weinberg Building, which has been opening in phases since 2003, had a ribbon-cutting for its final three floors last night.

The new facilities include a 29-bed medical intensive care unit, a 30-bed cardiac surgery intensive care unit, and a 32-bed surgical acute care unit for patients recovering from major operations.

While the other expansions were designed for patients who are admitted to the hospital, the new facility is aimed at those who get treatments without an overnight stay. That's been a growing segment of the hospital market, as insurers apply pressure to hold down costs and as less-invasive procedures have made outpatient surgery more common.

Twenty-five years ago, 80 percent of all surgeries done in hospitals included an inpatient stay. Now, that's down to 22 percent of hospital surgeries, according to American Hospital Association data. And that doesn't count same-day surgery performed in a growing number of freestanding surgical centers that account for 47 percent of all surgery today, said Smith, the University vice president.

As a result, many academic medical centers, and many community hospitals, have constructed ambulatory care buildings. Baltimore's other academic medical center, Johns Hopkins, opened an eight-story outpatient center in 1992 at a cost of $140 million.

At University, outpatient services grew, too, but not in their own center. Rather, ambulatory care has been mixed in with inpatient treatment. For example, cancer patients receive outpatient chemotherapy in the same area of the hospital as cancer patients who have been admitted.

The policy resulted in outpatient care being delivered in 40 different locations in 13 different buildings spread over several blocks. "While the quality of care is excellent," Smith said, "we're limited in our ability to deliver care in a way that's well-integrated, efficient and convenient for the patient." Patients now may have to go from building to building to see different doctors, or for tests.

The new building will include parking. Scheduling will be coordinated to allow patients to see doctors in different departments on the same trip.

When Edmond F. Notebaert was named as chief executive officer of University of Maryland Medical System in 2003, he quickly identified a new outpatient center as his top-priority project. And in 2004, he hired Smith to help develop it.

Notebaert and Smith had worked together to create a similar, and highly successful, "front door" when they were executives at Children's Hospital of Philadelphia.

The new building will group outpatient services into "clinical neighborhoods." For example, the "cancer neighborhood" will include chemotherapy, radiation oncology, bone marrow transplants and medical oncology. Other neighborhoods will include digestive, heart-vascular, pulmonary and diabetes.

It will include eight operating rooms. Dr. Stephen T. Bartlett, chief of surgery, said trying to schedule outpatient and inpatient procedures for the same operating rooms can make things slower and less convenient for the patient. The schedule, he said, has to be built around complex inpatient procedures, such as heart bypasses, valve repairs and transplants, that can take two to three hours each.

"The surgical volume at University of Maryland has been growing so fast - about 12 percent a year - that it won't be possible for us to handle the volume," he said.

Smith said the outpatient project should pay for itself with increased patient volume, but won't make the hospital any more profitable. Separating the outpatient from inpatient services will require about 160 new staff members, adding to the 6,100 already employed at the medical center.

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