ChildrenâÄôs Hospitals and Clinics, St. Paul . Gillette ChildrenâÄôs Specialty Healthcare . ChildrenâÄôs Hospitals and Clinics, Minneapolis . Shriners Hospitals for Children. When the University of Minnesota Amplatz ChildrenâÄôs Hospital opens in 2011, a fifth major childrenâÄôs hospital will be added to that list. Critics of the multimillion dollar expansion believe the new campus will only contribute to duplication of services and increased costs âÄî at a time when health care spending has never been higher. Russ Williams, vice president of the University of Minnesota Amplatz ChildrenâÄôs Hospital , said the new facility on the West Bank campus of the University Medical Center, Fairview wonâÄôt add capacity in terms of hospital beds. âÄúWeâÄôve lived as a hospital within a hospital,âÄù he said. âÄúWe wanted to create an environment completely dedicated for children.âÄù But opponents say the Twin Cities doesnâÄôt need a fifth childrenâÄôs hospital and quite frankly canâÄôt afford one. During talks with ChildrenâÄôs Hospital in 2006 about possibly combining efforts, the community wasnâÄôt included effectively, according to former Sen. David Durenberger, R-Minn., who is currently the head of the National Institute for Health Policy . âÄúThe presumption that just building a new hospital is a community benefit is a contestable presumption,âÄù he said. âÄúAt some point, it adds unnecessary cost to the community.âÄù But specialty pediatric care is business of heavy returns. In 2007, the âÄúbottom lineâÄù revenues in excess of expenses for both ChildrenâÄôs campuses and Gillette combined were nearly $57 million, according to Minnesota Department of Health Care Cost Information System data . Shriners did not report data for 2007 and the University of Minnesota Medical Center, Fairview did not break out information specifically for pediatric care. In 2006, officials met to discuss the possibility of a joint venture between the University of Minnesota, Fairview and ChildrenâÄôs. âÄúWe just were not able to come up with a financial model that all parties could feel comfortable with,âÄù Williams said. The University and Fairview then moved forward on what is currently the new West Bank facility. The University and Fairview are still in the âÄúsilentâÄù phase of fundraising for the new facility, Williams said, but he noted a $50 million gift from Caroline Amplatz in honor of her father, former University professor and medical device inventor Dr. Kurt Amplatz . Both Durenberger and representatives from the Citizens League say they are unsure as to whether the community can even afford to house a fifth major center for pediatric care. A 2006 report by the Citizens League, âÄúDeveloping Informed Decisions,âÄù concluded a new process âÄúmust be established where Minnesota defines âÄòneedâÄô for medical care in medical facilities.âÄù âÄúOne of the things that really concerns us is that the research shows that if you have groups of hospitals competing in metropolitan areas that the cost goes up in medical care,âÄù said Bob DeBoer, director of policy development for the Citizens League. âÄúAnd you donâÄôt necessarily get a correlating increase in quality in anything else.âÄù ThereâÄôs no way of knowing in the existing system whether the Twin Cities would benefit from the expanded capacity to perform certain pediatric specialty procedures, he said. But Williams said each of the five pediatric facilities have different areas of focus: Minneapolis and St. Paul being more community-based hospitals, Shriners focusing on pediatric orthopedic procedures, Gillette emphasizing on specialty procedures, and the University, Fairview on academic and high-end specialty work. âÄúThere are definitely areas where we compete with ChildrenâÄôs,âÄù Williams said. âÄúWe also have unique services.âÄù Whether the Twin Cities needs more childrenâÄôs hospitals may be indeterminable, but Dr. Sydney Spiesel , a longtime pediatrician in private practice and clinical professor of pediatrics at Yale University School of Medicine, said communities do need them. âÄúOne of the reasons why we have childrenâÄôs hospitals is that general hospitals do a terrible job with children,âÄù he said. âÄúThe values of most hospitals are focused on illness and disease, and they often lost track of the patients.âÄù Normal development of the patient is part of the big picture in pediatric care, Spiesel said. âÄúMuch of the time we donâÄôt see ourselves in a great battle with death.âÄù Additionally, specialty facilities have become increasingly needed as âÄúmedicine has become more complex,âÄù he said. âÄúItâÄôs just too vast for people to know everything.âÄù But specialty care is more expensive, largely because it is driven by procedures like surgeries and diagnostic imaging. At Minneapolis and St. Paul ChildrenâÄôs, for example, more than 18,000 MRI and CT scans were performed in 2007, according to the HCCIS data. The two facilities share about 275 beds between them. Spiesel said another major factor in rising health care costs is the amount of administrative costs that hospitals carry, such as costs to prevent against fraud and costs to meet hospital accreditation regulations. âÄúIâÄôm often critical about the evidence that the care we give is based on,âÄù he said. âÄúBut the evidence that the general system is based on is even weaker.âÄù Durenberger said overtreatment of patients is just one more concern about the number of pediatric facilities. âÄúThe cost of unnecessary surgery, diagnostics and medical care generally is expressed in hospital admissions, diagnostic procedures, surgery, all that kind of stuff that doesnâÄôt have to take place,âÄù he said, adding that the costs get passed on to the entire community in the form of insurance premiums. Durenberger said he worries that if the economic conditions donâÄôt improve soon, the cost of the new facility and the equipment to fill it could turn out to be a bad decision. âÄúThatâÄôs the business of the arms race, and itâÄôs all over the country,âÄù he said. âÄúPeople here at least spent many months trying to negotiate, but in the end they couldnâÄôt reach an agreement and so weâÄôre paying the bill.âÄù Because specialists in pediatric care could end up at one of five places, DeBoer said thereâÄôs possibility for dilution of the quality of care. âÄúIn hospital work you want people who are doing the procedures fairly regularly; thatâÄôs a key issue in quality of care,âÄù he said. âÄúIf IâÄôm going to go to a surgeon, do I want somebody who does it a handful of times a year or a hundred times a year?âÄù As health care moves toward a more consumer-driven model with patients being encouraged to make informed decisions, more information needs to be available to consumers, he said. âÄúWe came to this very fundamental conclusion that if we donâÄôt make a serious change in the availability of information at the right level for people to use, that weâÄôre going to keep having these increase cost problems without necessarily getting quality,âÄù DeBoer said. The problem may be there are just too many areas to try to compete in medicine, said Durenberger. For the University, having a multidisciplinary approach to invention and innovations, on top of entering a competitive environment in clinical enterprise, âÄúthereâÄôs some of those things you donâÄôt want to compete at, and you shouldnâÄôt have to compete at.âÄù Still, âÄúGood old Dr. Amplantz was a great guy,âÄù he said. âÄúBut his name ought to be associated with invention and not replication.âÄù âÄî Emma L. Carew is a senior staff reporter