HomeMy WebLinkAbout750512.tiff Application for
CERTIFICATE OF PUBLIC NECESSITY
and
P.L. 92-603, Section 1122
October 7, 1975
WELD COUNTY GENERAL HOSPITAL
Sixteenth Street 8 Seventeenth Avenue
Greeley, Colorado 80631
_ I.
750512
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e!� el "t 9 �I�,raaw,r!Tin
t4bat L2�,.� � L e
sixteenth street and seventeenth avenue-greeley,colorado 80631 - phone 303-352-4121
October 6, 1975
Mr. Allan Drum, Acting Exec. Dir.
North Central Comprehensive Planning Assoc. , Inc.
256 East Mountain Avenue
Ft. Collins , Colorado 80521
Dear Mr. Drum:
•
We are submitting herewith our application for a Certificate of
Public Necessity and certification under P.L. 92-603, Section 1122. The
project is to establish Radiation Oncology/Therapy Services at Weld
County General Hospital by constructing a new facility and providing equip-
ment for a 4 MEV linear accelerator radiation therapy treatment capability.
The requested informational data is attached and identified in accord-
ance with the numbering system on the application. In addition we have
provided in the Appendix, letters of endorsement from the American College
of Radiology's Committee on Regional Therapy Centers; The Weld County
Hospital Board of Trustees; The Medical Staff of Weld County General Hospital ;
and Chairman of the Board of Weld County Commissioners.
We appreciate the importance of the review process and offer our full
participation to facilitate your work. Please call us if we can be of
assistance.
Sincerely,
Ric—chard H. Stenner
Administrator
RHS/rmm
board of trustees
I. kent reitz, president hiroshi tateyama,vice-president william f. allnutt,secretary
john g. chlanda charles w. meyers charlotte beeten michael neighbors
CERTIFICATE OF PUBLIC NECESSITY - SECTION 1122 APPLICATION
(Note: Please prepare an original and five copies) .
A. Name and Address of Applicant: Weld County General Hospital
16th St. at 17th Ave.
Greeley, Colorado 80631
B. Project Location (include county) : 16th St. & 17th Ave. ,
Greeley, Weld County, Colorado 80631
C. Brief Description of Project: Radiation Oncology/Therapy Services.
New facilities and equipment to provide 4 MEV linear accelerator
radiation therapy (An up-grade from present ortho-voltage capability) .
D. This Project is subject to the Colorado Certificate of Public
Necessity Act and Section 1122 and involves:
(Please check items below that apply) .
1. A new facility requiring licensure by the Colorado Department
of Health pursuant to Section 66-1-7(13) C.R.S., except Resi-
dential Care Facilities.
2. A modification or lease of a hospital or health care
facility which involves a capital expenditure of one hundred
thousand dollars or more. X
3. A real property leasing expenditure of an equipment lease
expenditure of ten thousand dollars or more per year.
AND
4. , Involves a change in health care service. X
5. Will provide a ten percent or greater increase in the
number of beds.
6. Involves a change in licensure category.
7. Involves the purchase, lease, or acquisition of diagnostic
or therapeutic equipment, when such purchase, lease, or
acquisition is for other than replacement of existing
equipment. X
8. Involves the replacement of beds or bed facilities not
conforming to federal, state, or local standards, with
beds or bed facilities so conforming.
•
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CERTIFICATE OF PUBLIC NECESSITY - SECTION 1122 APPLICATION -- Page 2
E. This Project is subject only to Section 1122 (where applicant
anticipates reimbursement under Titles V, XVIII, or XIX for expenses
related to the capital expenditure) and involves:
(Please check items below that apply) .
1. A capital expenditure exceeding $100,000. for any purpose. X
OR
2. Any capital expenditure resulting in a change of bed
capacity (including increase or decrease in beds) of the
facility with respect to which such expenditure is made.
OR
3. Any capital expenditure resulting in a substantial change
in services of the facility (including addition of a
clinically related service not prcvicusly provided or
termination of such a service which had previously been
provided) . X
F. Estimated Total Cost: $1 ,330,000.00
•
G. Detailed Narrative: (Please answer questions 1 through 13 with
attachments as required) .
1. The general geographic area to be served (e.g. , radial miles,
medical trade area, census tracts, zip codes) .
2. The population to be served, including its characteristics, as well
as, projections of population growth supplied by the Division of
Planning, Department of Local Affairs.
3. The anticipated demand for the facility or service to he provided
by the project. (Where appropriate attach waiting lists of
potential patients who cannot be accommodated due to lack of
space in existing facility, overcapacity of existing services, etc.
Specify name and address of potential patient, date of application
for admission, and some indication that patient has not been
accommodated in another facility) .
Give a description of comparable services existing in the area
• and utilization of those services during the past five years
or since they have been in existence.
4. A description of the construction or modification in reasonable
detail, including:
a. The capital expenditures contemplated; •
b. The estimated annual operating cost, including the anticipated
salary cost and numbers of new staff anticipated by the project;
c. Previous costs per diem as shown in budgets of applicants
operating health care facilities in the same region.
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CERTIFICATE OF PUBLIC NECESSITY - SECTION 1122 APPLICATION -- Page 3
5. • The manner of financing the project, including the specific sources
of funding and the estimated date of commencement and completion of
the project, and written verification from the funding source
executed by the principal executive thereof in behalf of such source,
6. A description of the plan for operating fund demands and budget
factors, including:
a. Sources of operating revenue (direct pay, insurance, Medicare,
Medicaid, federal grants, etc.) .
b. Plans for meeting operating deficits that may occur.
c. Plan for funding of depreciation.
7. The economic impact of your project on the community, including
cost per patient day by type of care at various levels of
occupancy, and a comparison of such costs with facilities in use.
8. The feasibility of shared services, both management/administrative
and health delivery, with other health care institutions and
• organizations.
9. The availability of technology and manpower to implement the
proposal, including the operational phase. Number and kinds of
additional personnel required to implement the proposal. List
specific source(s) for each discipline of personnel.
10. Is the zoning for the site presently compatible with this proposal?
(Attach supporting statement from appropriate zoning official) .
11. Are utilities such as water and sewer available? If not, attach
statement from public works official indicating feasibility of
providing same, including a timetable for completion.
12. The relationship of the proposal to any priorities which have
been established for the area to be served.
13. , A written statement of purposes and goals.
TYPE NAME OF PERSON PREPARING APPLICATION: Richard H. Stenner A inittrator
SIGNATURE:
DATE OF APPLICATION October 6, 1975
OWNERS: Weld County, Colorado
Office of Comprehensive Health Planning (2-22-74) •
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G. Detailed Narrative:
Colorado Certificate of Public Necessity and Section 1122
Application of: Weld County General Hospital for Radiation Oncology/Therapy Services.
1. General geographic area to be served.
Weld County General Hospital is an acute short term public general hospital oper-
ated by Weld County Colorado and governed by a public Board of Trustees. This 334 bed
facility, located in Greeley, Colorado, provides inpatient, outpatient, emergency and
preventive health services. It is a secondary level hospital providing a comprehen-
sive range of health services supported by a medical staff of 107 members with nct7
than 80% of these members board certified or board eligible in a medical specialty
or subspecialty. The population of the medical trade area to be served by this rad-
iation oncology/therapy facility includes the following:
I. Colorado Planning & Management Region II which includes Larimer and
Weld Counties.
II. Morgan County in Colorado Planning and Management Region I .
Exhibit A is a map designating the nominal boundaries of the above geographic area.
It must be fully recognized that such boundaries are for planning purpose only and
this assumes that the majority of the time the referring physician and individual
patients make reasoned decisions based on accessability, appropriateness , and quality
of the radiation therapy facility they will utilize. For example, a portion of radia-
tion therapy patients living in the extreme north central Larimer and Weld Counties
area may access to Cheyenne for treatment. Significant numbers of patients from this
same area now receive and will continue to receive most other primary and secondary
health care in Greeley. However, the time, mental and physical commitment associated
with a typical treatment program of 20 consecutive daily treatments places a higher
than usual premium on the matter of travel time for access.
- 4 -
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.mein°machines,la Personal or company use or resale without written permission is illegal. S_
Thus, much of Morgan County would be categorically included in the geographic
area associated with the medical trade area for this radiation therapy facility.
The defined medical trade area for this radiation oncology/therapy facility gives
consideration to multiple elements of regional effectiveness in meeting the
radiation therapy needs of consumers. Factors considered include: Existing
medical referral patterns ; modifications of referral patterns specific to radiation
therapy; increased importance assigned to ease of access by patients in the series of
radiation treatment days ; the pattern of highways and implied travel time; alterni `' c2
resource locations ; implications of future population growth for expanded patient
loads; patient' s concerns with time, mental & physical commitments; non-duplication
of resources at appropriate service levels ; etc.
2. Population to be served.
_. (a) . The total 1975 population of Comprehensive Health Planning Region II , Larimer
and Weld Counties, is 233,647. The two major cities in the region contain 48.2%
of the total population. Ft. Collins has a population of 58,501 and Greeley's
population is 54,135. Based on these 1975 populations, each county has been
designated as a Standard Metropolitan Statistical Area (SMSA) as of July 1 , 1975.
While Larimer County grew more rapidly than Weld County between 1950 and 1970,
the 1970 population of the two counties were nearly equal as is shown in Exhibit B .
The regional growth rate of 42.6 percent during the decade of the Sixties is
significantly higher than the 25.8 percent growth rate for Colorado as a whole.
Sixty-eight percent of the growth can be attributed to net in-migration and 32
percent to natural increase as shown in Exhibit C.
The regional male-female distribution of 49 and 50 percent respectively is
statistically the same as the state ratio of 49.3 and 50.7 percent. The median age
for Region II is 24.5 compared with 26.2 for the state.
-6-
EXHIBIT "B"
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The racial and ethnic proportion of identified minority groups to the total pop-
ulation is lower in the region than that of the state. The one significant
minority group in the region is the Spanish surnamed. In Exhibit D, it should
be noted that Weld County, with 15.4 percent, has a higher percentage than the
state as a whole and over twice that of Larimer County. The total non-white
population of the region is only 1 .6 percent of total population as compared to
4.3 percent in the state.
The population density of the region, 27. 1 pn'sons per square ui10 , is h':r t
the state density of 21 .3, but lower than the National Average of 57 . 5. Note in
Exhibit E that Larimer County has a significantly greater population density
than Weld County, 34.4 per square mile compared to 22. 3 per square mile.
Morgan County's west and north boundaries are contiguous with Weld County and has
similar descriptive population parameters to those for Weld and Larimer counties
in CHP Region II. The population of Morgan County in 1970 was 20,105 and it
has increased to 23,728 in 1975. The two major cities contain 55.7% of the total
county population in 1975. Ft. Morgan has a population of 9,150 and there are
4,070 citizens in Brush.
Projection of the medical trade area population growth through the year 2000 reflects
a higher rate than the Colorado average but at a decreasing rate. The 1965 to
1975 decade provided an exceptionally high rate of population growth and this
cannot be assumed to be repeated. Taking into consideration some of the intervening
variables of the Colorado Population and Employment model , the growth rate used in
the year 2000 is approximately 25% less than for the 1970 to 1975 period. While
it may be true that the reliability of population projections are inversily
related to the time span covered, consideration of the decreasing growth rate should
minimize the possibility of a gross overstatement of future population. Exhibit F
shows the medical trade area population growing to 327,721 by 1980 and just over
-9-
EXHIBIT "D"
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-10-
EXHIBIT "E"
POPULATION DENSITY BY COUNTY
Population 1970
Area in Per Sc,.; re
County So. Mile Total Mile
Larimer 2,611 89,900 34.4
Weld 4,002 89,297 22.3
Region II Total 6,613 179,197 27.1
Colorado Total 103,086 2,207,259 21 .3
National Total 3,536,855 203,211 ,926 57.5
Source: U.S. Bureau of the Census, 1970.
-11-
EXHIBIT "F" -
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-12-
one half million, 506,643 in 1990.
It is significant to note that it will be nearly 30 months after approval before
this project is finished and ready to take its first patient. Thus, we would
already be 3 years toward needing to serve the 1980 patient population.
(b) . Identification of the specific population needing radiation oncology/
therapy treatments.
The National Cancer Institute's summary, "Advances in Cancer Treatment 1974"
reports an increasing body of evidence that, "in patients whose disease is
detected early, radio-therapy is successful in extending survival for five years
or more in at least 90 percent of men with seminoma of the testis, in at least
80 percent of children with retinoblastoma and about 75 percent of patients with
early Hodgkin's disease and in about 50 percent of patients with squamous cancer
of the cervix or cancer of the nasopharynx." The most definitive methodology
for predicting the annual number of cancer patients who will benefit from receiving
one or more series of radiation therapy treatments is a percentage of the yearly
projection of newly diagnosed cancer patients. This two step process first
requires predicting the incidence of newly diagnosed cancer patients in the general
population and secondly the percentage of this categorical population which can
benefit from receiving radiation therapy.
The National Cancer Institute, thru the Third National Cancer Survey, established
county data on newly diagnosed cancer patients for the three years, 1969 - 1971 .
From this data it has been established that the average rate per thousand population
in CHP Region II is 3.6 newly diagnosed cancer patients per one thousand population.
Current Cancer Registry records of the general hospitals in Greeley; Ft. Collins
and Loveland indicate a somewhat lower incidence rate. Discussions and corres-
pondence relating to this rate discrepency included the following specialists:
Robert D. Moreton, M.D. , Chairman, ACR Committee on Cancer Management.
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R.L. Scotte Doggett, M.D. , Regional Consultant, ACR Division of Cancer Management.
F. Bing Johnson, M.D. , Chief, Radiation Therapy University.
Norman 0. Aarestad, M.D. , Radiation Oncologist, St. Luke's Hospital , Denver.
M. Weston Reynolds , M.D. , Radiation Oncologist, St. Joseph Hospital , Denver.
Concensus would seem to agree with the analysis expressed in National Cancer Institute's
report, "The Role of Radiation Oncology".
If a radiation oncologist is not available for
consultation at the patient' s point of entry
into the system, the benefits of irridiation
are often lost to the patient.
At the primary care level in the proposed medical trade area, this collaborating
relationship has had minimal existance. Thus the diagnostic and treatment
incident rates would tend to be lower until there is the regional stimulation of
interest associated with having a radiation oncologist permanently in the region
and the improved access to supervoltage radiation.
No one was able to identify any unique social or economic variable for the medical
trade area that would ultimately inhibit a rate in the range of 3.2 per one
thousand to 3.6 per one thousand. Ranges of diagnostic frequency in similar
social and economic enviornments makes it reasonable to proceed with a conservative
base of 3.0 per one thousand population. Exhibit G shows an expected 762 newly
diagnosed cancer patients within the medical trade area in 1975. This is pro-
jected to 2170 patients by the year 2000.
Steps two of the methodology involves calculating the portion of these newly
diagnosed cancer patients who may be expected to receive some kind of radiation
therapy treatment during the course of their illness. This determination is a
summation of patient outcomes of: cured, 5 year survival benefit, and general
palliative treatment. The National Cancer Institute indicated that a minimum of
40 percent of these patients can benefit from radiation therapy alone. The
-14-
EXHIBIT "G"
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-15-
Colorado Cancer Registry confirmed for 1972 that approximately 40 percent of
Colorado's new cancer patients receive radiation therapy during the course of
their illness. F. Bing Johnson , M.D. and William Hendee, M.D. of the University
of Colorado Medical Center believe that technical and process improvements of
the past 2 to 3 years raise the reasonable expectation to fifty percent of the
newly diagnosed cancer patients who will benefit from a radiation therapy series.
Mr. H.O. McKenzie, Consultant to the A.C.R. Cancer Management Program indicates
that some recent studies make a 60 perccat benefit rate a reasonable expectation.
There is little reservation for such a projection when radiation therapy is a
treatment of choice in conjunction with cancer surgery or chemotherapy modalities.
A primary underlying element of justification for adding regional access to
radiation therapy within this proposal 's medical trade area is the statistical
evidence that cancer patients in this area are getting less of the benefits of
radiation therapy than the average citizens of Colorado and the United States.
Cancer Registry figures of Weld County General Hospital report that in 1974,
only 27 percent of the newly diagnosed patients received radiation therapy.
Similary figures for Poudre Valley Memorial Hospital show only 16 percent of their
newly diagnosed cancer patients received radiation therapy.
This despite an established Red Cross transportation pool offered for Larimer
County patients going to Denver for radiation therapy. Morgan County is reported
to have less than 20 percent receiving the benefits of radiation therapy. Thus
we presently face the discouraging fact that in this medical trade area only
about one half the cancer patients who could expect to benefit from radiation
therapy, consider they have reasonable access to allow them to take advantage of
it. Physicians report that many of their patients refuse to commute to Denver
or quit after the first few treatments because of the time, mental and physical
commitments involved in accessing to Denver.
3. Specific demand for this radiation facility.
(a). As previously indicated, the benefit rate used in predicting the proportion of
newly diagnosed cancer patients that can be expected to benefit from radiation
therapy varies between 40 percent and 60 percent. To assure substansive
planning, we have used the 40 percent benefit rate. This has been noted in the
projections used in Exhibit H for the gross number of newly diagnosed cancer
patients who can benefit from a radiation therapy treatment series.
A further refinement of the gross number of patients needing radiation therapy has
been incorporated by an adjustment to reflect the number of patients treated at
this facility. As indicated in the purposes and goals for the project in
Section 13, vie do not plan or purport to be in a position to provide the most
appropriate treatment regimen for the very complex cases. These patients must,
and we fully support the concept, be referred to the comprehensive radiation
facilities in Denver. The comprehensive resources of mega voltage equipment;
treatment simulators; full-time radiological physicist; radiation biologists; and
full staff research capability are the dimensions of refinement they provide.
Consistent with the judgement of major oncologists, 5 percent of the radiation
patients have very complex profiles. Thus, in no case would more than 95% of the
radiation patients be treated at this proposal 's radiation oncology/treatment
facility.
Patient choice; physician referral preference, patient access alternative and
associated intervening variables may further affect the net patient need that
emerges within the medical trade area. ' In the case of Weld County, these considerations
were defined as reducing the expected local treatment population by an additional
5 percent. This means Weld County would project the net need for radiation
therapy treatment at this facility to be 90 percent of the calculated gross
radiation therapy demand.
Assessment of these same intervening variables resulted in the use of a net
percentage of 80 for Larimer County and 70 percent for Morgan County.
-17-
EXHIBIT "H"
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-18-
1978 would be the expected first full operation for the radiation oncology/
treatment facility and as may be noted from Exhibit H, total patient demand
would then be at approximately 300 cases.
(b) . No duplicate supervoltage radiation therapy capability exists in the
medical trade area for this project. This lack of a regional facility is a prime
access consideration of the proposal . Based on current Cancer Registry
documentation, approximately one half of the projected demand is now being served
by the eight existing or approved out-of-region facilities. Namely: Logan
County Hospital ; Colorado General Hospital ; Porter Memorial Hospital ; Presbyterian
Medical Center; St. Anthony Hospital System; St. Luke Hospital , St. Joseph Hospital
in Colorado plus Memorial Hospital in Cheyenne.
Currently, a maximum of 128 patients may be utilizing these eight facilities for
an average of 16 patients per facility. Thus approximately 5.3 percent of each
facility' s capacity is utilized to treat patients from this medical trade area.
Shifting that utilization level from them to our regional facility would appear to
do no more than provide timely release of capacity to meet their own growth in
service demand. -
4. Description of the construction
(a). This proposal involves the construction . and equipping of a separate new
subterrranean building specifically designed to house and support the operations
of a 4 MEV linear accelerator used for radiation therapy. Exhibit I shows the
building site in relationship to the existing patient care areas at Weld County
General Hospital in Greeley. This site is separated from the main hospital by
Sixteenth Street but would be connected by an underground tunnel for all-weather
access by in-patients, physicians and hospital personnel . The location would
occupy a parcel of land already owned by the hospital and used as a parking lot.
Since the majority of radiation therapy patients are outpatients, the availability
-19-
l EXHIBIT "I"J. 1 f _.T r_r .!...i_.
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-20-
of already existing parking adjacent to the new building is highly desirable.
Likewise, the separated location avoids adding to the congestion and circulation
difficulties at the main hospital .
The unit is planned as a subterranean type structure, thus , providing protection
from the large amounts of radiation used with the minimum structure. In addition
to one linear accelerator room space is provided for exam rooms , dressing room,
toilets, dosimetry planning, therapist station, offices and storage. Above ground
space would be provided for an entrance lobby for both ambulatory and non-
ambulatory patients with access to the therapy unit by both stairs and elevator.
(b) . Capital expenditures for this proposal are estimated to total $1 ,330,000. and
. consist of the following components:
Builidng: $ 990,000.
Includes: Construction, architectural and
engineering; construction management.
Equipment: $ 340,000.
Includes: 4 MEV linear accelerator with
accessories ; operational equipment; furnishings.
TOTAL $1 ,330,000.
In addition, there is a one time expense of an estimated $30,000. for a county
election for bond authorization.
- (c). Exhibit J shows the projected annual operating costs to be $237,000. This
presumes the Radiation Oncology/Therapy Department will be administered as a
separate cost center with full funding of depreciation. All staff will be new
personnel and we have had preliminary contact with certified personnel as
assurance that the specialty people can be recruited.
(d). There is no direct impact of this proposal on the per diem costs of the
hospital . As indicated in subsection (c) above, this will be administered as
a separate cost center.
-21-
. EXHIBIT "J"
PROJECTED ANNUAL OPERATING COST
Operational Cost componets:
Personnel :
1 Chief Technologist/docimitry planner $ 12,500.
_ 1 Radiation Technician $ 10,500.
1 Aide (patient prep & in-patient $ 6,000.
transport)
1 Receptionist/typing/billing $ 6,600.
2 Secretary (Medical Records/correspond- $ 3,900.
ence)
1 Custodial Service $ 6,000.
Total Personnel Cost $ 45,500.
Employee Benefits
Supplies, including linen, records , etc.
Machine maintenance
Utilities - Heating/AC; electricity; etc.
Total Indirect Cost $ 37,500.
Overhead distribution $ 21 ,000.
Total Service Cost $ 104,000.
Depreciation: $1 .3 million @ 10 years $ 133,000.
Projected Annual Operating Cost $ 237,000.
-22-
5. Financing the Project:
Weld County General Hospital is a county public hospital owned by Weld County
and administered through delegated authority to the Hospital Board of Trustees.
Capital funding is recommended by the Weld County Commissioners and will require
submission of a bond issue ballot to the citizens of Weld County.
6. Plan for Operating Fund Budget.
The five year projected operating budget covers the years 1978 thru 1982. In
Exhibit K, two additional years , 1983 and 1984 have been added to show the
crossover of full funding of depreciation.
The projected gross operating income for the first year of operation will cover
the out-of-pocket expenses. Thus on an annual cash flow basis it is not
expected to require internal funding of operating expenses. There will be a
funding deficit in the depreciation account through 1983 as shown in Exhibit K.
(a). Operating revenue will be generated from billings for direct services to
patients. As with other institutional health service cost reimbursements, third
party payors can be expected to constitute the major source of payments. Cap
amounts and exclusions on insurance coverage will create some private pay in
addition to private pay from uninsureds. It is expected that a significant part
of the patients will be covered under Medicare simply because of the morbidity
characteristics of the patient populations receiving radiation therapy. No
application has been made for categorical federal funding of the operations of
this project.
(b). As indicated above we do not anticipate any cash flow deficits. Even during
the first year with as little as 12 patients per day, Exhibit K shows a small
funds flow to depreciation.
-23-
•
EXHIBIT "K"
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(c) . Exhibit K shows the depreciation reserve being fully funded by the end
of 1984.
7. Economic and Societal Implications.
For consumers of the medical trade area served by this project, the total fiscal
liability of a treatment series would be reduced. The essential change in the
parameters of the treatment series is the improved geographic access. This
reduction in travel time & distance makes possible a significant reduction or
even elimination of elements of expense that are always personal out-of-pocket
costs. Such items as mileage expense and meals are reduced and where lodging
cost may have been necessary before, they might be eliminated.
We have made no attempt to assign economic value to the reduced time commitment
that comes from improved access of having radiation therapy in this medical
trade area. It is , however, a very significant consideration from the social cost
point of view for the patient receiving radiation treatment. Since most patients
must have someone accompany them for the treatment appointment, at least for some
segment of the treatment series, they must create a personal social liability
for the time increment of transport and treatment. While the escorting time
commitment is usually from family or close friends, a treatment series of 20
consecutive days creates an obligation that the patient is acutely sensitive to
and often is reluctant or even refuses to solicit. Thus a reduction in the time
a patient must ask of another is significant in that they- are more likely to
ask for and receive the commitment of one-half a day than if it takes a full day.
.This is particularly true for senior citizens since they tend to have fewer .
family members and personal friends who are immediately available to provide them
with escort service to radiation therapy treatments.
The radiation oncology/therapy treatment facility will be a separate operations
cost center and will not have direct impact on the hospital 's daily room rates.
-25-
The service charges for a radiation therapy treatment series is a summation
of individual daily treatment charges plus special service charges that occur
initially and during the course of the treatment series. This might include:
initial work-up including history & physical plus lab work; case evaluation;
field setting; treatment docimetry; treatment port verification; physics
services; shielding design and fabrication; simulation; treatment progress
evaluation; etc.
There is no established criterian or pattern for setting patient charges and
as a result there is a wide range of charges for similarly titled procedures
and services. The most common charge category is: Supervoltage radiation treat-
ment, daily, simple. This nominally implies the patient receives one measured
radiation dose to a single body site through a single axis port . . . . one treatment.
Our proposed charge for this service will be $35.00. At other presently
operating facilities in Colorado the charge varies from $17.00 to $35.00.
Our approach to service charges to the patient for this proposal considers two
principle concepts. Namely:
I. Use of a utilization rate that is within the constraints of a
realistic statement of units of service to be demanded and
consistent with appropriate medical utilization.
II. To the fullest extent possible, each separable revenue service
should be a self supporting service unit.
The 100 percent utilization rate is judged to be 30 patients per eight hour day.
Adjustments in this utilization rate must be made for:
I. Weekly down time to service the linear accelerator and supporting
equipment which assures patient safety. One half day per week for
scheduled and unscheduled service is considered usual .
II. Patients cancel appointments on short notice or fail to show.
• III. Extended treatment cycle time due to patient discomfort,
sickness or psychic resistance.
IV. Non-productive time-out for employee's lunch, breaks and personal
• time.
-26-
We expect to treat an average of 25 patients per day with a fully experienced
staff. This would indicate that 6,250 treatments would be provided in the 250
operational days per year.
As indicated in Exhibit J, the projected annual operating cost to be absorbed
by this cost center is $237,000. This calculates to $37.92 per treatment.
An adjustment was made to credit an estimated income from special service charges.
This results in a planned charge of $35.00 per treatment.
8. Shares Services
The concept of Shared Services will be utilized in the operation of this facility.
We expect to use a consulting arrangement with the personnel associated with
existing facilities in Denver for at least the following:
I . Radiological Physicist.
II. Radiation Biologist.
III . Radiation Oncology for complex cases or special treatments.
IV. Computer programs and processing for treatment plans.
V. Radiation electronics technician.
VI. Research project definition and coordination.
In addition patient referral for treatment on all cases which may benefit from
radiation above the 4 MEV energy level plus those cases which involve complex
treatment plans, simulation or frequent treatment plan modification.
9. Personpower.
We anticipate the need to recruit two categories of special personpower for this
project. Namely, a physician specializing in Radiation Oncology and Therapy plus
two radiation therapy technologists. One technologist should be experienced in
docimetry procedures.
-27-
We have had contact with several physicians who have indicated a personal interest
in establishing a practice of radiation oncology in Greeley when we have the
new radiation therapy facility.
Availability of radiation therapy technologists has been discussed with several
of the major facilities in Denver and it is their belief that we can recruit
qualified personnel .
Interest in providing the consulting services described in Section 8 above have
been discussed with personnel at the major facilities in Denver and all have
expressed a willingness to fully cooperate with us.
10. The parcel of land for the proposed site is already owned by the hospital
and the radiation therapy facility is a conforming use within the present zoning.
Mr. Galen Kane, Chief Inspector for the City of Greeley, confirms that the site
is classified R-4 Transitional District and under Category 16, Treatment of
Humans, unrestrained, the proposed use would be conforming.
11 . Necessary utilities from franchised agencies are installed and immediately
available at the property line.
12. We are 'unaware of any officially adopted priority rating of additional
health services on a regional basis.
13. Project Goal and Purposes.
The primary goal of this project is to improve access to supervoltage radiation
therapy so that the same relative proportion of newly diagnosed cancer patients
in this medical trade area benefit from radiation therapy as is typical of
populations in medical trade areas which already have supervoltage radiation
oncology/therapy services.
-28-
Among the purposes of the project are;
I. Provide equipment, facilities and personpower to establish a
supervoltage radiation therapy treatment service.
II. Establish and maintain a supportive working relationship between
the radiation oncologist for this project and personal physicians
of patients at their point of entry into the health services system.
III. Improve the consulting relationship with professional personnel of
Denver radiation therapy centers and assure our appropriate use of
this person power resource for all patients who may benefit.
IV. Be knowledgeable about specialized equipment and higher energy
radiation capability in Denver so that there is appropriate and
prompt referral of patients who may benefit from these resources.
V. Provide the alternative treatment modality of supervoltage radiation
therapy within the medical trade area. This realistically permits
physicians of this medical trade area a choice of the single most
appropriate treatment or an effective combination of radiation,
chemotherapy or surgery for each individual patient.
-29-
APPENDIX A
•
!Iasi tra.
v.!tenth street and seventeenth avenue-greeley,colorado 80631 -phone 303-352-4121
October 6, 1975
:r. All : Drum, Acting Executive Director
North Central Comprehensive Health Planning Assoc. , Inc.
256 East Mountain Avenue
Fort Collins, Colorado 80521
Dear Mr. Drum:
The Board of Trustees of the Weld County General Hospital, at its
regular meeting }lel:. April 28, 1975, voted unanimously in favor of support-
ing the need for a deep radiation therapy unit at this hospital and to pro-
ceed to apply for a Certificate of Need.
Very truly yours,
,424.17 ✓��
Kent Reitz, President
Board of Trustees
•
LKR/rtb -
board of trustees •
I. kent reitz, president hiroshi tateyama,vice-president william f. allnutt, secretary
john g. chlanda charles w. meyers charlotte beeten michael neighbors
APPENDIX B
Weld County General Hospital Medical Staff
EXECUTIVE COMMITTEE PHONES (303)353.2596 AND 352-4121 EXT:650
16TH STREET AT 17TH AVENUE-GREELEY, COLORADO 80631
Patrick J.Sullivan,M.D.,Chief of Staff
Charles E.Westrup,M.D., Vice Chief of Staff CLINICAL DEPARTMENT CHAIRMEN
Theron G.Sills,M.D.,Secretary
John D.Cooper,M.D. James R.Wheeler,M.D.,Surgery
— Jerry Weil, M.D. Robert M.Spurgat,M.D.,Medicine
Richard B.Osborne,M.D. Wayne E. Livermore,M.D.,OB-Gyn
Donald E.Cook,M.D., Pediatrics
DIRECTOR, FAMILY PRACTICE TRAINING PROGRAM Charles C. Chesley,M.D.,Family Practice
— David E. Bates,M.D. Jerry Weil,M.D., Pathology
• E.G. Schaumberg,M.D., Radiology
EXECUTIVE SECRETARY
Roberta Good DIRECTOR OF CONTINUING EDUCATION AND
PLANNING SERVICE
Robert H. Drennan, Ph.D.
October 6, 1975
Mr. Allan Drum
North Central Comprehensive
Planning Association, Inc.
256 East Mountain Ave.
Ft. Collins, Colorado 80521
Dear Mr. Drum:
The Medical Staff of Weld County General Hospital has officially endorsed
the critical need to establish a radiation therapy facility at this hos-
pital to serve the cancer patients of North Central Colorado.
Since February 1975 we have had an active ad-hoc committee assisting in
development of the information necessary to receive a Certificate of
Public Necessity and proceed with construction of the facility.
A fund raising activity of the Medical Staff payed for an engineering
feasibility study which has now been completed.
The Staff feels it is urgent that we move ahead rapidly to provide a
radiation therapy facility here for cancer patients in North Central
Colorado.
Sincerely, guietteetz
Patrick J. Sullivan, M.D.
Chief of Staff
PJS:rjg
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a +
ri APPENDIX C
V •
a .
r ; "" OFFICE OF BOARD OF COUNTY COMMISSIONERS
P PHONE(3031 353.2212 EXT.221.222& 223
t r n r P.O. BOX 758
y ,J II ` - GREELEY,COLORADO 80631
COLORADO
March 14, 1975
Mr. Richard Stenner, Administrator
Weld County General Hospital
Greeley, Colorado 80631
Dear Dick,
Recently I have heard a little about some costly, highly sophisticated
diagnostic or therapeutic machines, among them the MEV Linear Accelerator,
CTT Scanner and EMI Scanner.
Since only one such machine is being allowed per area due to state level
decision making and if one of these machines would be beneficial for Weld
and Larimer (Region II) residents, I wonder if we would not be wise to begin
applying for a certificate of necessity for such a machine immediately.
Even if we do not have funding adequate for such a machine now, we probably
would by the time the many months have passed for an application for a
certificate of necessity to go through channels and, if we are approved, for
a machine to be delivered. Swedish Hospital in Denver just received one of
these machines although it received its certificate of necessity a year ago.
Unfortunately, trends at the federal level in health planning are becoming
increasingly geared to federal decision making in health services so I feel
it best we take advantage of state and regional decision making now. If the
machine would be of value to our region's citizens, we should make application
now for a certificate of necessity to have one.
Regards,
Glenn K. Billings, Chairman
Board of Weld County Commissioners
ck
copies: Wendell Fuller, Kent Reitz, Dr. Pat Sullivan
_32_ WELD COUNTY COMMISSIONERS
HARRY S. ASHLEY
GLENN K.BILLINGS
•
APPENDIX D
MEMORANDOM
TO: Patrick J . Sullivan, M.D.
Chief of Staff
Weld County General Hospital
Greeley, Colorado
FROM: R. L. Scotte Doggett, M.D. /' c' _
Committee on Regional Therapy Center
Division of Cancer Management , Cancer Commission
American College of Radiology
DATE: March 20, 1975
RE: Megavoltage Radiation Therapy at Weld County General Hospital
Physicians on the staff of the Weld County General Hospital have
requested that consideration be given to the establishment of a
megavoltage radiation therapy facility at their hospital. The request
for this consultation is a result of action taken by the Board of
_ Directors of the Weld County General Hospital and Dr . E. G. Schaumberg,
Director of the Department of Radiology. Drs. Patrick J. Sullivan,
Chief of Staff, and Schaumberg have subsequently requested this report
and other communications be sent to Dr . Sullivan directly.
Weld County General Hospital (WCGH) has 350 general beds, with a
census rate of 80% and psychiatric patient bed occupancy of well below
10% of total. A full time Director of Medical Education is appointed
with responsibility to direct the internship program in Community Medicine.
There is an active tumor registry, currently being "computerized"; a
total of 326 new cancer diagnoses were made at WCGH over the past 12 months.
A consultative Tumor Board meets weekly, Saturday mornings. WCGH has
had American College of Surgeons cancer program accreditation for 15 years.
Essentially all of the surgical subspecialties are represented on the
staff of the hospital. At the time of this survey there was only one
hematologist who referred most patients with solid tumors to Denver for
medical oncologic consultation.
Radiotherapy at WCGH is administered by each of the five general
radiologists utilising kilovoltage (250 KVP) and superficial x-ray sources.
The treatment units are situated in a small portion of the diagnostic
department; no patients were under treatment at the time of my visit. The
great majority of patients requiring megavoltage radiation therapy in the
Weld-Larimer region are sent to Denver with a few patients traveling to
Cheyenne and Colorado Springs (Penrose Hospital) .
WCGH is situated in Greeley (population 50,000) and is the only
hospital in Weld County (population 105,000) . Greeley is 54 miles north
of Denver and 51 miles south of Cheyenne, Wyoming, the closest available
sources of megavoltage radiation therapy. The patient catchment area for
WCGH includes Weld, Larimer, and Morgan Counties. There are well established
referral patterns to WCGH throughout this large area except in the
Fort Collins area, 30 miles northwest of Greeley, where the great majority
•
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APPENDIX D
•
2 _
of patients are referred to Fort Collins General Hospital (approximately)
150 beds) . At this time, there are no plans for megavoltage radiation
therapy at Fort Collins General Hospital. Weld and Larimet Counties
(total population 180,000) are growing rapidly with Kodak and IBM having
recently established major plants near Greeley. The Weld County population
alone is predicted to reach 180,000 by 1980.
The incidence of newly diagnosed invasive cancer arising from other
than skin is reported to range between 2.73 and 3.2 patients per 100,000
population per annum. On the basis of the current population in Weld and
Larirer Counties, between 486 and 576 new patients will he diagnosed annus ) ly .
Forty to fifty percent of new patients undergo radiation therapy during;
the course of their illness, i.e. hits,een 194 and 283 patient: rill regaira
irradiation annually. There are a significant number of patients who rcgnire
more than one course of treatment , so that the anticipated total courses of
therapy/year would be 405 (Herring*) . This would result in approximately
32 patients requiring therapy daily which is adequate for an economically
viable megavoltage radiation facility.
There are sufficient numbers of cancer patients requiring megavoltage
radiation therapy within the WCGH catchment area to support a unit at WCGH,
providing the great majority of patients requiring megavoltage irradiation will
be referred for therapeutic radiologic consultation and providing that the
majority of patients so referred will be referred to WCGH. The figures used
to justify the installation of a megavoltage facility are based on there being
a well established recognition of the importance of therapeutic radiology in
curative and palliative management of cancer patients. This awareness is
dependent on there being a fully qualified therapeutic radiologist available
to stimulate interest in the new program through regularly scheduled teaching
and consultative services. Tumor Boards at WCGH and elsewhere could provide a
good forum for such services. I understand that it is not now the intent
(nor would I think it possible) of the radiologists at WCGH to recruit a full
time, on site therapeutic radiologist, nor is it planned to designate a general
radiologist to "retrain" in therapeutic radiology. In a megavoltage facility,
one radiologist should be responsible for radiation therapy rather than having
a number of general radiologists "rotate through" as is now being done in the
kilovoltage unit. Dr. Sullivan indicates that cooperative arrangements between
Drs. M. Weston Reynolds, St. Joseph's Hospital, Denver and Norman 0. Aarestad,
St. Luke's Hospital, Denver, both full time therapeutic radiologists, enable
them to be able to provide consultative services directly to patients and to
. • give indirect support by overseeing treatment administered by the designated
general radiologist at WCGH. The radiation therapist from Denver would also
arrange appropriate support for machine calibration, beam alignment, treatment
planning, etc. by qualified radiologic physicists currently available in Denver .
I have been in telephone communication with both Drs. Reynolds and Aarestad,
who indicate their willingness to support the program at WCGH. It is predicted
that there are sufficient numbers of trainees to recruit a full time therapeutic
radiologist by the time the patient load will provide a full time professional
salary. Drs. Reynolds and Aarestad would:,asstst in recruiting and supporting a
full time therapeutic radiologist when available at WCGH.
* Herring D.F.; Pruett. C.D. The Planning of Radiology Programs and Facilities;
Part II Some Factors of Interest in Planning Therapeutic Radiology Programs
and Facilities, presented in Refresher Course, presented Radiological Society .
of North America, 11/30/72.
_1a_
APPENDIX D
•
3 - . '
It is important that cooperative arrangements be made by hospital
staffs and administrators if the megavoltage facility is to be self-
supporting. Such arrangements should include the understanding that
additional megavoltage units would not be developed in the area and that
patient-physician community within the Weld-Larimer-Morgan region. This
could possibly be accomplished through tumor boards and conferences being
held regularly at hospitals in addition to WCGH. Fort Collins General
Hospital is of particular importance in this regard. Additional support
for the WCGH radiation therapy facility could result from cooperative
efforts aimed at implementing regional concepts supported by the American
Cancer Society, state and national cancer control programs, The importance
of utilizing medical and radiation oncologists from Denver in these efforts
is emphasized.
Though the estimate has been made that there is the potential to
treat in excess of 30 patients daily, it should not be anticipated that
this volume will be realized before two years. There will be a significant
loss of money during this growth period. The amount lost will be dependent
on the initial expenditure for the facility and equipment and the rate of
patient accession. Both of these should relate to a great extent on the
recommendations and commitment of the Denver radiation therapists, who I
understand were on a committee which conducted a state-wide assessment of
radiation therapy needs in Colorado within the past year. They could make
specific recommendations better than I regarding equipment, personnel,
and space. Some general comments might' be of assistance: I do not feel
strongly in support of the 4 million volt linear accelerator over a Cobalt
60 unit because of maintenance problems, which are more troublesome when
there is no back-up megavoltage unit should the accelerator be down. I do
not think that financial considerations are as important as the disparity
in initial cost would suggest (linear acclerator $150,000; satisfactory
Cobalt unit $75,000). There is unquestioned appeal of linear accelerators
to both patients and referring physicians which has been generated through
' the press and scientific literature. This could serve to shorten the patient
accession interval which would defer some of the additional costs of the
linear accelerator; Cobalt units also require new sources ($15,000-35,000)
every three-four years. Whichever source of radiation is purchased should
have an isocentric amount, preferably without a primary beam stopper. Should
the decision be to install a Cobalt unit, it would be advisable to design
the treatment room to take a linear accelerator in the future. Though treatment
simulators are extremely helpful in design of treatment programs, they are
' costly ($65-150,000) ; the same can be said for small, task specific computers
(PDP 11-40, $65,000). Consideration should be given to utilizing treatment
planning units (simulation, dosimetry, field shaping devices, etc.) available
in Denver. I would predict 30-50% of patients would require simulation and
computer treatment planning and that almost all of these patients would be in
generally favorable condition, easily able to undergo the single trip to
Denver prior to starting therapy in Greeley. Accuracy of treatment planning
• and treating at different facilities results from use of isocentric techniques
and the involvement of the same...
•
•
•
• •
-35 •
-
•
APPENaIX D
•
• -
4 -
therapeutic radiologists and radiologic physicists at each facility.
Kilovoltage (250 KVP) and superficial (100-150 KVI units are necessary.
There should be one American Registry of Radiologic Technology certified
therapeutic radiologic technologist at the outset, two when the patient
load increases. Recruitment of the technologist could prove difficult and
may require the hospital paying for the additional year training necessary
for an ARRT certified diagnostic technologist to become qualified for
therapeutic technologist certification. I do not see the need for a large
facility, anticipating a single megavoltage unit will suffice; it would be
wise to design the department so an additional megavoltage unit room could
be added as such construction is extremely difficult if not planned for from
the beginning. Similarly, I would favor including a room which could
receive a treatment simulator in the future.
In conclusion, I feel the following recommendations pertaining to the
Weld-Larimer region can be made:
. 1. There is justification for the development of a megavoltage
radiation therapy facility.
2. Within this region, the Weld County General Hospital is the most
. appropriate site for the facility.
3. The degree of success of the facility in terms of numbers of
patients benefitting therefrom will depend on the implementation
of cooperative arrangements within the Weld-Larimer region and
the strong support of radiation therapists in Denver.
RLSD:jh •
cc: E. G. Schaumberg, M.D.
F. Bing Johnson, M.D.
Norman 0. Aarestad, M.D.
M. Weston Reynolds, M.D.
Stuart Patterson, M.D.
•William K. Melton
Alfred Popma, M.D.
Robert Moreton, M:D.
Antolin Raventos, M.D.
Chahin M. Chahbazian, M.D.
•
•
-36-
... APPENDIX• E • .
2T . . . . . . .
AMERICAN COLLEGE OF RADIOLOGY: 20 NORTH WACKER DRIVE CHICAGO, ILLINOIS 60606 (312)236.4963
WASHINGTON OFFICE: 6900 WISCONSIN AVENUE CHEVY CHASE, MARYLAND 20015 (301)654-6900
COMMITTEE ON CANCER April 9, 1975
MANAGEMENT .•Robert D.Moreton.M.D..chmn. •
—.D.Anderson Hosp.&
umor Inst.
723 Bertncr
nonstop.Tea.77025
Antolin Ravensos,11.D..vice-chmn. Dr. Patrick J. Sullivan
opt.of Ra3'o"'`y Chief of Staff
niv.of Cat.School of Med.
avis,Cal.95616 Weld County General Hospital
William E.Powers,V.D.,rice.chmn.
Sid S.Kingshighn ay Greeley, Colorado
mot.Louis,'.to.63110
R. Scone Dogrel,M.D.
adialion Therapy Cir.of Sutter Hosp. Dear Doctor Sullivan:
1215 Twenty.eight St.
Sacramento,Cal.95616 •
Re '"°fChairmen: I have just recently received the memorandum from Dr. Scotte
RI ION I
nerman D.Suit,11.D. Doggett, dated March 20th, concerning the megavoltage radiation
Massachusetts General Hospital
Boston.Massachusetts 02114 therapy at Weld County General Hospital.
RI ION II
hilip Rubin.M.D.
Strong Memorial Hosp. I went over this document and discussed same with Mr. H. O.
Rochester,N.Y.14620
REGION III McKenzie, who is a consultant.with me on the Cancer Manage-
dliam C.Constable.M.D.
University of Virginia School of Med. me nt Program.
Charlottesville,Va.22901
REGION IV
.seen M.Wallace,M.D. As you will note, Mr. McKenzie has prepared an independent
1547 Fairway Dr.
Charleston,S.C.29407 overview of the area, based on information which is available
►J;DankR to us, in reference to the various sources specifically regard-
Ttres yt Hendrickson,M.D.
1453 W.Cn.gres Si. Hosp. ing the Weld County area. As you will note, the findings of Mr. -
chie W.Congress t.
Chieato,111.60612 McKenzie confirmed that data which is presented by Doctor Doggett.
RtUION VI
Seymour H.Levitt.M.D. It is our feeling that the report submitted by Doctor Doggett is
-—Dept.of Therapeutic Radiology
Univ.of Minnesota very realistic and, certainly, we congratulate him on his finite
Health Sciences Ctt.
Minneapolis,Minn.55455 analysis.
REGION VII
_Robert D.Moreton,M.D. ,
M.D.Anderson Hosp.& I am taking the privilege of enclosing this information to you,
Tumor Inst.
6723 Berton which may be of further assistance in your endeavor.
Houston.Tea.17025
REGION VIII .
hahlP nr se Cancer Hosp. If we can be of additional help in any way, please feel free to
The3 sae Cancer Hose.
Colorado Cascade As,nue
Cob
Cobra00Sprinp,Colo.80907 call on us.
REGION IX
—ustin 1.Stein.M.D.
UCLACtr.for Health Sciences . Very sinc erely,
Angeles.boa C.I.90024 • _ •
`/I C! Je
Robert D. Moreton, M. D.
Chairman, Committee on
RDM:dw Cancer Management
, cc: Mr. William Melton
Dr. R. L. Scotte Doggett
Enclosure
-37-
�\ • APPENDIX +•
•
•
.I. D. ANDERSON HOSPITAL AND 'TUMOR INSTITUTE
•
•
-••••""
•
TO: Robert D. Moreton, M. D.
Chairman, Committee on
Cancer Management
American College of Radiology
FROM; H, Q. Mf-1,enzie
DATE: April 7, 1975 f3
SUBJECT: Cancer Care Facilities Within the Weld County Area
Thank you for favoring me with a copy of the report submitted by R. L.
Scotte Doggett, M. D. , to P. J. Sullivan, M. D. , as a result of his survey
of the Weld County cancer situation.
I have prepared an independent overview for that area, based upon informa-
. • tion available to us, and I am attaching copy hereto.
These findings certainly confirm the data contained in Doctor Doggett's
report.
•
We believe the report submitted by Doctor Doggett to be very realistic
and offer our congratulations for his finite analysis.
4
We concur in the conclusion submitted by Doctor Doggett.
•
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•
•
HOM:dw
-38- • .
Enclosure r
APPENDIX F
•
SURVEY
- A study of the cancer patient volume in the Greeley, Colorado -metro
area, and in the potential medical referral area, has been made for
the purpose of determining whether a viable cancer treatment center
could be supported within the area.
The area contained in this study comprises the counties of Larimer, Weld,
and Morgan. The cancer census in Logan County was deliberately left out
of the study; however, it is felt that if a viable treatment center existed in
Greeley, that some referrals could be expected from the Sterling, Colorado
•
area.
The 1974 "Cancer Facts and Figures" published by the American Cancer
Society, indicates the estimated cancer deaths vs. cancer cases in Colorado
to be as follows:
State Deaths New Cases
• Colorado 2, 900 5, 400*
• The above figures were sub-divided by counties, on a population basis,
and then statistically adjusted on the basis of the percent of population in
• the respective counties who are above 50 years of age. -
•
It will be observed from the attached chart that the population above fifty (50)
- years of age within the study area is approximately equal to the state average.
It should, however, be noted that the population above sixty-five (65) years of
age is greater than the state average. This fact suggests the existence of a
higher in,;idence of cancer within the study area than that which exists through-
out the State. i
The estimated number of new cancer cases in the study area, for the year 1974,
was 510 new cases.
Of this number, approximately 306 cases should probably have received super-
voltage radiation therapy.
It has been reported that there are no super-voltage therapy machines nor any
full-time radiotherapists in the study area.
' * Does not include carcinoma-in-situ of the uterine cervix or superficial
skin cancer.
:39-
•
•
APPENDIX"F
•
•
• _2- •
•
Radiation therapy has made a major contribution to the improved quality
of care for the cancer patient.
- —There are many reasons why the cancer patient should receive quality
cancer care within reasonable distance from their home, family, friends,
- --and livelihood.
-_...—._The study area appears to have a sufficient quantity of cancer patients to
support oncologic physicians working together in radiation and medical
-__-oncology.
• -- -Greeley appears to be the optimum location for a cancer facility.
The major consideration would probably be that of determining whether the
physicians in Larimer County would refer their patients to a facility in
Weld County. .
It is believed that an affiliated cancer treatment center in Greeley would
contribute much in improving care to the cancer patient, within the area
- -•-- of this study. - -
•
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•
•
•
•
•
•
S •
j
-40- • - -
I -
APPENDIX -F
POPULATION STATISTICS FOR STUDY AREA
YEAR
COUNTY 1971 1972 1973
Larimer • 98, 300 103,800 111, 600
Morgan 21, 900 22, 700 23, 400
Weld 93, 900 97, 400 101, 000
-214, 100 223, 900 236, 000
•
SOURCE -- 1974 Survey of Buying Power
POPULATION BY AGE (COMPARATIVE METRO AREAS)
Above Above Above •
• 35 Years 50 Years 65 Years
Colorado Springs 32. 7 % 16.4 % 5. 9
Denver - Boulder . 38. 6 20. 9 7. 7
Fort Collins 35. 8 • - 21. 0 9. 5
Greeley 36. 8 21. 6 9. 0
State of Colorado 38. 5 • 21. 7 • 8. 5
•
-41-
•
• / APPENDIX F
ESTIMATED NEW CANCER PATIENTS IN STUDY AREA *
-YEAR
COUNTY --1970 1973 1974
Latimer 194 227 233
Morgan 50 59 64
Weld 173 203 213
Total 417 .489 510
•
*. Cancer Facts and Figures - American Cancer Society.
•
•
•
•
•
• l
-42-
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-43-
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