Suburban Los Angeles' Grossman Burn Centers is launching a controversial expansion trajectory to bring its brand of burn care 100 miles away to Bakersfield, and 1,800 miles away to Lafayette, LA, this fall.
And, while they're at it, Grossman hopes to add to two to four more burn units in hospitals in the next two to four years, says business development director, Roy Forbes.
"There's about 130 burn centers in the country, but their numbers are dwindling, because they're usually loss leaders, centers that require public subsidy or a university or municipal backing," Forbes says. "We're definitely going against trend."
Grossman Burn Centers, a for-profit venture, is able to get around the losing aspect of burn care by treating burns quickly, and by insisting on working only in hospitals that have dedicated units to provide surgical and other care as soon as possible, Forbes says. Its affiliated surgeons are specialists in plastic surgery for burns as well, he says.
For the last 11 years, Grossman has also operated another seven beds at 283-bed Western Medical Center in Santa Ana, CA, and plans to remain.
But two months ago, Grossman opened a four-bed unit at 255-bed San Joaquin Community Hospital in Bakersfield.
And in October, it plans to open six burn beds at 267-bed Our Lady of Lourdes Regional Medical Center in Lafayette, LA.
At the same time, Grossman is transferring its entire 30-bed burn unit from Sherman Oaks Medical Center, where it has operated for the last 40 years, to a 212-bed West Hills Hospital in West Hills, which is 13 miles away.
Prime Health Services, which purchased 153-bed Sherman Oaks a couple of years ago, has a business model that focuses on the emergency room, Forbes says. "They don't want to be in the burn business." So Grossman is moving on.
Forbes says the business model is to contract with hospitals to either take over their burn units or create a new burn unit business within the hospital's existing license. Patients are stabilized in the hospital's emergency room or trauma center, sometimes at another facility, and then transferred to the Grossman surgical units.
Forbes explains that many hospitals are closing their units because "they aren't making money. In the last five years, there have been perhaps 25 burn centers around the country" that have closed down.
His efforts are preventing more units from closing down, he says.
But business models like Grossman's are not without controversy. Some burn specialists around the country say they worry that operations like Grossman's, which don't undergo verification credentialing by the American Burn Association and American College of Surgeons, may siphon off profitable burns and leave the unprofitable ones to others.
The ABA/ACS has granted verification status to some 60 burn centers around the country, but Grossman isn't one of them.
"Burn units have a slim narrow margin to stay viable; you wouldn't want to see the little burns siphoned off—that would be an equation that would end up hurting some programs," says Robert Sheridan, chief of burn medicine at Shriners Hospital for Children in Boston and president of the American Burn Association.
Sheridan acknowledges that for many smaller, non-academic hospital centers, "It's not cost-effective to maintain beds waiting for burn patients to come in."
How does Grossman Burn Center care make money with burn patients when hospitals can't?
"For lack of better term, we market our services to the community, not just, say, at a community safety fair. But we also market to self-insured companies, and to payer referral sources. And let them know we have a service for them," Forbes says.
Forbes says Grossman doctors specify that they be given dedicated units to care for their patients, so wounds can be closed quickly. "We attack big burns with a whole team, to get them in and out quickly with minimal anesthesia," he says.
Why are there fewer burn beds?
David Greenhalgh, chief of burn surgery at UC Davis Medical Center and a member of the ABA/ACS verification team, listed several reasons why the number of burn beds has declined over the years.
For starters, there are fewer burns, because safety and prevention messages are getting through. Second, the trend throughout the country is for burn units to be larger, with more specific expertise available around the clock.
"It's not only having doctors and the beds, but you need the whole team, nutrition and respiratory therapists," Greenhalgh says.
"It's a concern. Burn centers need to take care of all levels of burns and handle all levels of trauma and critical care that goes along with them."
Forbes says that Grossman's policy is to take all types of burn patients, regardless of the extent of their burns.
"We're plastic surgery based. That's a distinction from other burn units in the country. Theirs are general surgery based or resident run. We take a longer-term view of patients care. We're not just about the acute, initial phase, but everything we do is toward a mission of restoring patients to as much of their pre-injury status as possible. Emotionally, physically, functionally. And cosmetically."