Illustration by Drew Bardana
Drive through the Main Line area, and they pop up everywhere: hospitals, outpatient centers and doctors’ offices, all sporting logos from the region’s healthcare systems.
During the past five years, health-system expansion has occurred at an astounding rate. Hubs have been established in Bryn Mawr, Radnor, Valley Forge, Newtown Square, Exton, Collegeville and, soon, Broomall. Last year, Nemours Children’s Health System opened a new facility in Villanova, and Thomas Jefferson Health System will do the same this coming fall. It’s not unlike the classic board game Risk, with area health systems angling forterritory in what has become a medical Game of Thrones.
As the rest of the Delaware Valley—and the country-—grapples with staff shortages and aging medical centers overrun with patients, an abundance of expertise and state-of-the-art facilities puts us in a rare and privileged position.
For their part, the region’s healthcare executives believe they’re delivering extensive, carefully planned systems that offer exceptional medical care where it’s most needed.
The region’s two largest stakeholders are Crozer-Keystone Health System and Main Line Health, and a dissection of their empires shows that they’re following different expansion strategies. Both have invested in outpatient centers, but Crozer has done so more extensively and more recently. Main Line Health is making a major investment in its hospitals
by making additions to the campuses that surround them.
In 2013, Main Line Health opened the Heart Pavilion at Lankenau Medical Center in Wynnewood. The three-year, $465-million project includes 96 patient beds, a catheterization lab and state-of-the-art equipment. Its team of cardiologists form the Lankenau Heart Institute and provide care at other local hospitals.
Main Line Health’s Bryn Mawr Hospital is also in the middle of major expansion. A $200 million investment will result in a new pavilion on County Line Road, with 54 private patient rooms, 11 operating rooms and other features. A new medical office building on Bryn Mawr Avenue will house an ambulatory surgical center and provide other services. Projected completion for the latter is 2017; the pavilion should be done toward the end of 2018.
Meanwhile, Crozer has the most outpatient centers of any health system in the region. They offer a range of services, including surgeries, dialysis, imaging, cancer treatment, endoscopy, primary care and urgent care. “Like all healthcare providers, we’ve seen the shift toward providing care in outpatient settings,” said Grant Gegwich, Crozer’s vice president of public relations and marketing, in a written statement. “This is based on trends in insurance reimbursement, as well as patient preference.”
Crozer dominates Delaware County, and it’s about to go head-to-head with Main Line Health in Broomall. MLH opened its first outpatient center there in 1998, offering cancer care, imaging, primary and family care, physical therapy, dentistry, neurology, and more.
Later this year, Crozer arrives in town with a 55,000-square-foot facility just a mile and a half from the Main Line Health outpost. It will include a full-service cancer center, infusion and CyberKnife radiosurgery, urgent care, imaging, an integrated women’s health center, primary care, physical therapy, cardiovascular and orthopedic physicians’ offices, and laboratory services.
That’s a whole lot of healthcare for Broomall. But the services are needed, say reps from both systems, which track patients’ hometowns by zip code. “We noticed the migration of residents to certain portions of our service area,” said Gegwich in a statement. “This is why we opened our Crozer Brinton Lake facilities in Glen Mills. And it’s why we have continued to add services to our Media Medical Plaza center, which is located in the most populous zip code in the county.”
The same goes for Main Line Health. “We put facilities in those neighborhoods to provide the Main Line Health brand via ambulatory services,” says Lydia Hammer, its senior vice president of marketing and business development.
MLH outpatient centers also have Nemours duPont Pediatrics. Its hospitals use pediatric specialists from Nemours, along with Rothman Institute orthopedic and sports-medicine physicians, and Jefferson neurologists.
Crozer staffs its facilities with specialists from its own health system. It also has partnerships with Fox Chase Cancer Center and Premier Orthopaedic & Sports Medicine Associates. (Affiliated with both Crozer and Main Line Health, Premier is an interesting case in itself. A number of its physicians in private practice have privileges at hospitals from both systems.)
The arrangements are different at Main Line Health. Nemours, Rothman and Jefferson are part of its brand. And that, Hammer says, only enhances the system’s reputation.
For Nemours Children’s Health System, northwest seemed to be the way to grow. “At Alfred I. duPont Hospital for Children, our service area includes Delaware County and Chester County, which we see as part of our primary market,” says practice administrator Pauline Corso. “Judging by the zip codes of our patients, 65 percent of the kids who seek care at AID live in Delaware and Chester counties. Main Line Health had joined the Jefferson Health System, and Jefferson and Nemours were long-standing academic partners. That opened the door to discussions. When we looked at that health system, we saw its Montgomery County presence and an opportunity to expand our footprint.”
For years, Nemours has grown right alongside Main Line Health, expanding its presence at Bryn Mawr, Lankenau and Paoli hospitals and the Newtown Square outpatient center. Then, in 2014, it made an alliance with Phoenixville Hospital and now provides pediatric services there. Nemours also moved out of its offices on the Lankenau campus and opened its own 7,100-square-foot center in Villanova. The cost: about $1 million.
The new facility solely offers pediatric primary care and includes a host of new amenities. “The family area of the center is spacious and comfortable, with more activity tables for children to play,” Corso says. “Nursing moms appreciate the privacy of a breastfeeding room, and there’s a multi-use community-education room to hold classes and events.”
Corso and Hammer both say Nemours’ move had to do with needing more space and doesn’t signify any rift. “Bryn Mawr is specialty care, and Villanova is primary care,” Corso says. “We wanted to be closer to it, but also separate from it—and that points to how we decide on the distribution of services.”
For its part, Main Line Health continues to have access to Nemours specialists—physicians whom they would otherwise have to recruit. “For us to go out and recruit a cohesive army of pediatric subspecialists would’ve been undoable—or at least not the best use of our resources,” says Hammer. “There’s a shortage of those specialists—that’s why they’re called specialists. And they’re already employed by Nemours.”
The arrangement predates Hammer’s tenure with Main Line Health, and she doesn’t know exactly how the decision was made. But it’s a fair guess that, while a partnership with Children’s Hospital of Philadelphia would’ve meant big-time credibility, it would’ve also brought the specter of Penn Medicine.
While CHOP is a separate entity from the Hospital of the University of Pennsylvania and its affiliates, bringing its pediatric specialists to Main Line Health may have been too close for comfort for some execs.
No matter. Penn Medicine came to the Main Line anyway. From Bala Cynwyd to Radnor to Valley Forge (where CHOP has its own pediatric specialists), Penn has established a network of primary-care practices, internists and other physicians. Last year, it made Chester County Hospital part of its brand. CCH’s satellite locations in Exton, West Goshen, New Garden, Jennersville and Kennett Square are also part of the Penn Medicine family. In addition, Brandywine and Phoenixville hospitals have Penn affiliations.
And then there’s the matter of Penn Medicine’s biggest competitor: the equally prestigious Jefferson Health System. According to its president and CEO, Jefferson is about to get its own reboot. Why? Because it has to.
When Dr. Steve Klasko took over at Jefferson in June 2013, he faced what might be called a difficult situation. “We were financially coupled before I got here, and that limited what Jefferson could do in terms of expanding services and its brand,” says Klasko. “We’re now in a far better situation, and we’re about to get in the game in a big way.”
Stay tuned for more angling.
In January, Jefferson merged with Abington Health, creating a system that now includes seven outpatient centers, along with Abington Memorial and Thomas Jefferson University hospitals, Jefferson Hospital for Neurosciences, and Lansdale and Methodist hospitals.
In February, Jefferson announced the new Marcus Integrative Health at the Myrna Brind Center in Villanova, made possible by a $14 million grant from a foundation established by Home Depot cofounder Bernie Marcus. Set to open in late 2015, the 14,000-square-foot center will focus on alternative health services, including holistic medicine, nutrient-infusion programs and acupuncture, and a $6-million PET-MR that’s the first of its kind in the region.
“You’ll see Jeff more in the Main Line area—but in concert with Main Line Health,” says Klasko. “It’s an incredibly important alliance to us. We’ve talked to Mr. Lynch about being more involved in the outpatient center in Bryn Mawr and in a host of other ways. There’s more to come—much more.”