If and when the dust settles in the hospital industry here — from the material swirling around ambitious construction projects to the dirt thrown in bitter lawsuits — Greater Cincinnatians will see more clearly how much has changed so rapidly and radically in hospital alignments and locations, services and specialties.

The shifting directions of hospitals —geographically and strategically — carry significant consequences on everything from patient care and healthcare costs to regional economic impact, especially the creation of new jobs.

Consider just some of those recent changes:

• Christ Hospital wins a legal battle to split from the Health Alliance, and now the Alliance might try to acquire Jewish Hospital to keep it in the Alliance family.

• Mercy Health Partners of Southwest Ohio announces it plans to close Mercy Mt. Airy and Mercy Western Hills hospitals, and build a new hospital somewhere in western Hamilton County.

• St. Elizabeth and St. Luke medical centers get approval to merge, which would create a hospital monopoly for growing Northern Kentucky.

As suburban hospitals bloom and grow, city hospitals are realigning their investments in profitable specialties, including a growing stake in medical research.

The allegiances, practices and reach of doctors are changing with the times, too. Members of UC Physicians, the largest doctors’ group in the area and closely tied to University Hospital, now perform heart surgery at Fort Hamilton Hospital — some 30 miles away.

Just as world markets become globalized, this decade may be remembered as the era when Tristate healthcare market became regionalized.

MONEY MACHINES

Aside from the new projects, hospitals and healthcare businesses are helping carry Greater Cincinnati through this recessionary economy. A just-released report confirms how Children’s Hospital Medical Center is the hottest economic engine in the Tristate, with total economic impact of $2.7 billion annually and a payroll exceeding 10,000.

“Children’s is now the single biggest job generator in the region,” observes Doug Moorman, vice president of economic development for the Cincinnati USA Regional Chamber. “Any community would be thrilled to have a company create 700 jobs in a single year. Children’s is creating that many new jobs every year.”

The chamber’s Cincinnati USA Partnership, CincyTech and the Greater Cincinnati Health Council (GCHC) are awaiting results of a regional assessment of the economic impact from hospitals, conducted by researchers at the University of Cincinnati and scheduled for a September release.

The last time those numbers were crunched, in 2003, UC researchers concluded that 32 hospitals in our 14-county metro region produced $7.55 billion in annual economic activity and 93,500 jobs

Moorman points to Atrium Medical Center as an example of how hospitals spur other activity and job creation. Beyond the anchor campus and nearby medical office buildings, Atrium is fueling growth of dining, entertainment and retail development. “You look at Atrium and the growth around it, and you’re seeing the rebirth of Middletown east of Interstate 75,” Moorman says. “It’s a tremendous catalyst.”

SUBURBAN BOOM

After a near-decade long drought of waning investment, all of Greater Cincinnati is experiencing a healthcare boom, including expansions and record investment in new facilities and biomedical technologies.

The hot growth is in the suburbs, with a spurt of million-dollar growth outside the traditional medical mecca, the ring of hospitals Downtown surrounding UC known as “Pill Hill.” In just five years, the I-75 corridor between Cincinnati and Dayton stepped into the spotlight:

• Atrium Medical Center, which opened last year, is a $195 million facility on 190 acres on state Route 122 just east of I-75, replacing the Middletown Regional Hospital.

• The $83 million Liberty Campus of Cincinnati Children’s Hospital Medical Center, which opens later this summer on 50 acres in Liberty Township, will be one of the largest outpatient centers for children in the country.

• UC Physicians at University Pointe began in 2002 with the opening of an 80,000 square foot medical office building on the 75 acre campus in West Chester. Partnering with the Health Alliance, the University Pointe complex now includes an ambulatory surgical hospital and a linear accelerator for cancer radiation treatments.

•Coming next year is West Chester Medical Center at University Pointe, a $225 million, five-tower community hospital. WCMC is expecting patient volume of 40,000 annually, and WCMC planners already are pondering expansion before the doors first open.

• Scheduled to open within two years is TriHealth’s $31 million Bethesda Medical Center at Arrow Springs in Lebanon, extending the reach of new suburban healthcare facilities even farther north.

“We’re certainly in a dynamic time,” marvels Colleen O’Toole, president of the non-profit Greater Cincinnati Health Council, which monitors hospitals and healthcare industry issues.

BIG TURNAROUND

To fully appreciate the current atmosphere, O’Toole says, you have to recognize the lull that preceded it. Historically, the bulk of health spending was centered at Pill Hill. Stalwarts such as Cincinnati Children’s Hospital Medical Center, University, Christ and Good Samaritan hospitals got the lion’s share of medical dollars, but that fiscal pool began to dry up in the early 1990s, even though hospitals pumped nearly $600 million dollars into medical projects.

Though not a paltry sum, that investment lagged behind national averages and well below what Ohio’s other large markets sunk into projects during that time. The Queen City’s healthcare infrastructure and technological assets went from cutting-edge to behind-the-times.

“From the mid-1990’s until earlier this decade, there wasn’t a lot of reinvestment in hospitals,” O’Toole explains. “Reimbursement rates from third-party providers were tight. There wasn’t money there to reinvest.”

The largest hospital groups spent much of the 1990s losing money. One factor was cost-cutting moves by some of the Tristate’s biggest employers. That cost containment was achieved at the expense of some healthcare services. In ensuing years, Cincinnati lost three acute care centers.

By the decade’s end, hospital groups here were posting annual losses in the $30 to $50 million range. Some observers, including the GCHC, openly worried if the institutions could survive, O’Toole recalls. But by 2002, a reversal of fortune began, spurred by the rising healthcare demands of an aging population.

FOLLOWING THE PATIENTS

“The real thrust to the suburbs, moving the focus away from Downtown Cincinnati, was because the city had been losing population,” explains Greg Ossmann, spokesman for Mercy Fairfield Hospital. In contrast, Butler County saw its population jump from 1990 to 2005 to more than 350,000 residents.

“The bottom line is that healthcare systems serve communities, and they’ll go where the patients are. We used to talk about metroplexes (as population centers). Now we talk about megaplexes — one big city stretching from Cincinnati to Dayton,” Ossmann remarks.

Eyeing the new kids on the block, long-established suburban centers have responded. Ossmann notes how Mercy launched open-heart surgery at its Anderson and Fairfield hospitals and became only the second hospital in the region to offer testing for genetic cancer risks.

TriHealth counts its suburban presence in decades, not years, says Steve Schwalbe, senior vice president of strategy, communications and public affairs. “Bethesda North was in Montgomery 40 years ago,” he notes. That medical complex in Montgomery recently completed a $150 million expansion that added advanced heart services, more intensive care beds, and orthopedics and robotic surgery improvements.

This elevation of services in suburban hospitals has other effects. “Physicians work in multiple hospitals, so oftentimes you’re being seen by the same physicians as you would on Pill Hill,” Ossmann points out. “And more and more, the technology in the suburbs is as good or equal to the Downtown hospitals.”

Similarly, St. Luke Hospitals and St. Elizabeth Medical Centers in Northern Kentucky have kept pace by adding the latest medical technology and high-specialty services such as open-heart surgery. Hospital officials say the planned merger of their two systems, recently approved by the Federal Trade Commission, will further enhance their ability to grow and specialize.

THE CENTER HOLDS

On Pill Hill, the suburban boom hasn’t gone unnoticed. “The Downtown hospitals continue to offer a broad array of services like they always have,” says TriHealth’s Schwalbe. “They remain the centers for sub-specialization, the really high-intensity, highly sophisticated care that you’ll find on Pill Hill more than you’ll find in the suburbs.”

The UC Barrett Cancer Center at University Hospital, for example, is part of a multi-million, four-year plan to totally upgrade cancer services there, including the transition to digital mammography. Good Sam, which remains Ohio’s largest baby hospital with 6,994 births last year, just completed a $122-million expansion project that added more patient beds and intensive care units, along with added labor delivery rooms. With its newly won independence from the Health Alliance, Christ continues to add and broaden its array of services.

Schwalbe predicts that tertiary care, such as highly specialized cardiac care, will keep Pill Hill relevant. “Hospitals evolve and technology evolves. As diagnostic testing gets more sophisticated, doctors find more diseases. The flip side to that is that you need to treat those diseases that, before, could have gone undiagnosed until it was too late. The Pill Hill hospitals are on that front, constantly reinventing how they treat and what they can treat.”

RESEARCH HORIZONS

The prospects are especially bright for medical research. Children’s Hospital has become a renowned science center, attracting millions annually in federal grants. The Drake Center, now operating in the black, is another magnet for investment in research. UC, Children’s and University Hospital committed an initial $60 million to a joint cancer program, with the long-term goal of achieving status as a National Cancer Institute comprehensive cancer center.

And biomedical research is spreading to the suburban hospitals as well. Greg Ossmann notes that Mercy Hospitals are becoming more involved in national trials of new therapies.

The flood of hospital and healthcare investment continues to excite outside observers, including the GCHC’s O’Toole. “We’re thrilled. The ’90s were tough on local health care. Our infrastructure is still behind the national average and we have a way to go, but we’re on the right track.”