As the health care dynamic of the Kenai Peninsula shifts from being focused primarily on in-patient treatment to out-patient, providers and facilities are adjusting to meet the change.
"In 1994, 60 percent of the hospital's revenues were generated by in-patient services," said David Gilbreath, chief executive officer of Central Peninsula General Hospital in Soldotna.
"In 2000, it was 50-50, and now, 60 percent of our revenue comes from out-patient and 40 percent from in-patient," Gilbreath said.
Surgical procedures such as gall bladder operations and hernia repair that once required a one week stay in the hospital are now being done in less than a day and the patient is sent home.
Gilbreath also said modern diagnostic capabilities have become more non-invasive which also contributes to shorter hospital stays for patients.
However, while periods of time spent by each individual patient are getting shorter, the number of people served is increasing dramatically.
In 1971, when the hospital opened, it counted 5,000 people in its service area. Today, it's more than 35,000.
In response, the largest medical care facility on the Kenai Peninsula is more than doubling its surgery department and expanding its out-patient pre- and post-op areas to include 16 patient bedrooms, up from five.
Additionally the number of employees at the hospital is now 400, nearly double what it was just 15 years ago.
Overall, the number of people employed in health services on the Kenai Peninsula is approximately 2,500 including 400 at CPGH and 247 at South Peninsula General Hospital in Homer.
The total includes 202 employees in offices and clinics of medical doctors and 125 in dentists' offices, according to statistics provided by the Kenai Peninsula Borough Community and Economic Deve-lopment Division.
In 2003, the number of physicians and osteopaths here totaled 46; dentists numbered 22; and psychologists five, according to Jeanne Camp, economic analyst for the borough.
Mean wage rates for medical and public health social workers in Alaska was $18.50 per hour with licensed practical and licensed vocational nurses earning $17.87 on average and registered nurses earning $26.26.
Gilbreath said the current annual payroll at CPGH is $20 million.
Unlike most states, Alaska lists cancer as its number one killer, according to Gilbreath. Elsewhere, heart attacks rank first.
"When our oncology department (the department that provides care for cancer patients) started six or seven years ago, we had a handful of patients," Gilbreath said.
"We're treating over 100 patients now."
In fact, in 1997, when the oncology department opened at CPGH, it started with six patients a month.
In December 2003, the department treated 123 people and averages 120 to 130 per month.
"Besides reducing the cost to the patient by doing chemotherapy here instead of them having to go to Anchorage or Seattle, we're improving the quality of care for the patient," said Gilbreath.
He said some patients simply cannot endure the discomfort of travel when they need chemotherapy, and most respond better to the treatment regimen if they can have family members nearby.
"Our oncology department is getting good credibility ratings and we're getting more and more referrals from all over Mayo (Clinic) and Anchorage," said Kathy Lopeman, oncology nurse at CPGH.
With one-fourth of its staff being nurses, the hospital's top executive is keenly aware of the current national shortage of trained nurses and certified nursing assistants.
One strategy the hospital chief is employing to address the situation is adapting the Planetree philosophy of care, which provides more patient-focused health care, he said.
"When patient satisfaction goes up, our market share goes up, but as importantly, our staff satisfaction goes up in all areas," Gilbreath said.
"The result is our turnover rate goes down."
He said the turnover at CPGH has been as high as 20 percent and recently has dropped to 17 percent.
"At one Planetree hospital, turnover is 5 percent, and they have a waiting list for nurses," he said.
The hospital is also working closely with Weber State University, which operates a nursing training program on the Kenai Peninsula, and with the University of Alaska-Anchorage to help train and hopefully hire nursing graduates.
To meet a shortage of trained radiologists, CPGH also has become a clinical training site for radiology.
Gilbreath also points to the hospital's large group of volunteers who fund a health care scholarship fund through sales of gifts and sundry items from its newly built gift shop at the hospital.
"Our hope, of course, is that the students receiving those scholarships will come back and work here after they graduate," Gilbreath said.
This year, the hospital's volunteers have begun taking a cart around to patient rooms, offering snacks, beverages and reading materials.
"I think the hospital, with its primary care and specialized care, is a wonderful service this community deserves," Gilbreath said.
"People do better if they receive health care and recover in their own community."
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