LEBANON — Still struggling to address a backlog of surgical cases amid the COVID-19 pandemic, Dartmouth Health is seeking site plan approval from the Lebanon Planning Board for an expansion of its 40,000-square-foot outpatient surgery center on the campus of Dartmouth Hitchcock Medical Center.
The phased plan includes more than 13,000 square feet of additional space in order to accommodate increasing numbers of patients needing outpatient surgery, free up space for inpatients at DHMC and decrease wait times for patients.
“As more and more surgeries can safely be done in an outpatient setting, we are seeing an increase in the amount of equipment and instrumentation that is needed,” said Audra Burns, a DH spokeswoman. “We currently have two (operating rooms) that are being used as storage space; this expansion will allow us to have proper storage space and address the growing demand of patients requiring outpatient surgery.”
The first phase, scheduled to begin this fall, would add about 3,300 square feet for a cost of $3 million. The second phase would add another nearly 10,000 square feet for a cost of $10 million, including additional medical equipment, Burns said.
“Phase 1 is to allow us to open the unused ORs quickly to address the backlog created by the COVID-19 pandemic,” Burns said. “Phase 2 provides more efficient operations into the future which will allow for additional types of outpatient surgery.”
The Lebanon project follows a larger expansion to DH’s ambulatory surgery center on Hitchcock Way in Manchester completed last spring. The 90,000-square-foot expansion in Manchester, which cost $62 million, included six extended-stay ambulatory surgical center rooms with space to add more. The facility also includes space for medical infusions, an expanded medical office and a fixed magnetic resonance imaging system. It allows DH to capture some revenue associated with hospital-based services in southern New Hampshire even though it doesn’t have a hospital in the region.
Overall, DH continues to struggle to recover from the COVID-19 pandemic. It remains reliant on federal stimulus funds to achieve a positive operating margin, DH Chief Financial Officer Dan Jantzen said in a May 25 filing with bondholders.
Without $88.3 million in stimulus funds for the first nine months of the fiscal year, ending March 31, the health system would have had a $58.6 million loss on a total operating budget of $2.1 billion. That’s a larger loss than what would have been a $10.8 million negative margin, without stimulus funds, for the same period the prior year.
While the health system saw an increase in outpatient appointments of 3.5% in the first nine months of this year compared with the same period the prior year, it struggled to increase surgical cases and hospital discharges. Jantzen, in the filing, cited “significant challenges with inpatient capacity and throughput over the past several months, in part due to ongoing difficulties securing adequate nurse and clinician staff to support inpatient care and operative procedures.”
He also noted that nursing homes and rehabilitation facilities have had trouble accepting patients following hospital discharge because of their own staffing shortages and COVID-19 outbreaks.
To address the staffing issues, DH members are all working to adjust pay to “address market-related wage pressures and mitigate staffing challenges,” Jantzen wrote.
DH members include Alice Peck Day Memorial Hospital in Lebanon; Cheshire Medical Center in Keene, N.H.; Mt. Ascutney Hospital and Health Center in Windsor; DHMC and Dartmouth Hitchcock clinics in southern New Hampshire; New London Hospital; and the Visiting Nurse and Hospice of Vermont and New Hampshire.
The staffing shortage has implications beyond surgeries and inpatient hospital stays. The health system still is struggling to provide primary care. New London Hospital recently resumed accepting new pediatric patients, but continues to be unable to accept new adult patients for primary care, New London Hospital CEO Tom Manion wrote in a message to the communitym last week.
“Even with the addition of several nurse practitioners, we continue balancing the recent departures of other providers,” he wrote.
The proposal to expand the Lebanon outpatient surgery center comes as DH is already well underway with a project to construct a new patient tower at DHMC. In the May 25 filing, Jantzen said the $150 million project is 64% complete. Though the project is on budget, its schedule has continued to be challenged by the limited availability of skilled construction workers, he wrote.
In spite of that challenge, DH plans to begin providing care in the new tower next spring.
The Lebanon Planning Board is slated to hear DH’s request for site plan review of the expansion of DH’s outpatient surgical center at its meeting on Monday at 6:30 p.m. in Council Chambers at City Hall. Instructions for participating online or by phone are online at LebanonNH.gov/Live.
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
