It has been several months since Cheshire Medical Center disclosed plans to purchase the former Peerless Insurance building on Keene’s Maple Avenue and launch a primary care residency program there. At the time, hospital officials mostly emphasized the plans for the residency program, but they indicated the facility purchase would also lead to expansion of other services. With the building purchase completed and the residency program planning well underway, officials are now fleshing out their ideas for what the added space can enable.

The vision CEO Dr. Don Caruso and other hospital officials have discussed is exciting and offers promise for a meaningful enhancement of available services and care at Cheshire Medical. Though plans are as yet preliminary, in broad concept it appears certain services at the Court Street main campus, such as pediatrics, physical therapy and some administrative functions, could be relocated to join the new primary care residency program at the former Peerless site, freeing up space in the Court Street facility.

Among the expanded capabilities officials say this will enable are more extensive surgical offerings — particularly for high-demand orthopedic and spinal procedures. They also are considering establishing an ambulatory surgical center to provide outpatient procedures. Because surgeries at such a facility are preferred by health insurance companies, the lack of one is currently forcing some patients to travel considerable distances for day surgeries.

There are also space and facility upgrading needs that Cheshire Medical hopes to address through its expansion into the Maple Avenue site. The hospital’s operating rooms are too small and need modernizing to accommodate greater demand and the latest technology. And its patient wings need attention, as the current lack of private rooms at the hospital has proved particularly challenging in providing isolated patient care during the pandemic.

Though the plans are focused on facility needs, a common denominator of them is the imperative of recruiting more physicians to serve the region’s medical needs. Cheshire Medical has long faced an acute need for more primary care physicians — its 10 current practitioners are averaging a caseload of about 2,300 patients each, double or more than national standards. As we’ve noted here before, the proposed primary care residency program is an inspired initiative to address the shortage by adding, when the program is fully up and running, up to 18 residents and a staff of six physicians to oversee the residents. And it will increase the likelihood the residents will stay nearby once their three-year residency is completed, which should help reduce the turnover issue Cheshire Medical, like many health providers, is experiencing.

But officials hope to address even broader recruiting needs. Cheshire Medical’s ability to attract surgeons to meet the demand for orthopedic and other specialized practices is limited in part because of the inadequacy of its earlier-generation operating rooms and limitations on the technology they can accommodate. One stark case in point Caruso cites: surgical training for urologists now involves the use of robots and, with operating rooms that aren’t large enough to incorporate one, Cheshire Medical has been unable to recruit to meet the region’s demand for urology services.

As promising as the plans are to better position Cheshire Medical to meet the health care needs of the area’s population into the future, they also reflect some of the shortcomings of the nation’s healthcare system. As noted, the consideration of an ambulatory surgical center is being driven as much by demands of health insurers as by medical need. Further, advances in technology, which are undeniably beneficial, can create a medical arms-race that contributes to rising health-care costs, as providers are pressured to find ways to add expensive new technology to keep up and to attract professionals whose training requires that technology. It’s similar to the pressures that have driven up higher education costs so starkly, as colleges strive to upgrade academic, residential and athletic facilities as much to keep up with the academic Joneses as out of need.

Cheshire Medical estimates its expansion plans will carry a $100 million price tag. No doubt some of that, though certainly not all, will have to be absorbed in the myriad ways health care is paid for — private insurance borne by employers and employees, Medicare and other government programs and direct patient payments. Cheshire Medical’s plans are bold, but seem well-tailored to enhance the quality of service it can provide the community. It’s a shame that the planning is also being driven by the patchwork quilt system by which the country pays for health care.

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