Changing the insurance claims process would help increase bed space and allow the hospital to better serve an ageing population, according to a Johns Hopkins Report.

The report, which is phase one of a two phase process, was released by the Health Minister Nelson Bascome in the House of Assembly on Friday, six months after it was completed. Concern about the report had been raised in the Saturday group, which is a meeting of the Premier, Health Minister and health chiefs.

Leaked notes on the meeting by the former Health Minister Michael Scott stated: "Hopkins Report must be managed, it must be written so that it suits the Government and does not become a document that embarrasses GOB."

On Friday, Mr. Scott denied his notes accurately reflected what happened during the August meeting of the group and Mr. Bascome said the report had not been rewritten.

The 63-page document, which was commissioned to review a 2006 report by Cannon Design, an architectural company, recommended billing insurers case-by-case in order to increase nonacute bed space — a charge made by the previous report.

The Johns Hopkins Report stated: "Our assessment identified multiple issues, such as ageing, occupancy rate, patient and insurer preference, nonacute patients and average length of stay that will have a significant impact on the future infrastructure and facility needs of the Bermuda Hospitals Board (BHB).

"These key factors are working independently as well as collectively and will influence the size and therefore the cost of a new facility.

"Among those, the following two are the most important: The appropriate handling of nonacute patients, especially the so-called "alternative level of care" or ALC. patients

"And the change from a per-diem to a per-case reimbursement system that will allow but not guarantee the significant improvement of the average length of stay."

These changes are necessary, the report said, because right now the average stay in the King Edward VII Memorial Hospital is 17.3 days.

The average in the United States is only 5.1 days and in the United Kingdom it is 6.9 days.

Quick turnarounds in these countries is attributed to the case-based billing done by the providers, rather then Bermuda's system, which charges per day for patients.

Charging per day, according to the report, leads to needless tests and longer stays, and these nonacute patients taking beds needed for others.

There are only 525 beds available outside KEMH for long-term care, but this will not be enough by 2012 when hospital use will be up 5.2 percent.

By 2017 it's even worse with hospital usage up another 9.8 percent.

However, making space in the hospital and creating centres for nonacute care is not only a BHB problem, but one for the larger community.

The report states that: "While some of these decisions are related to KEMH operations and therefore can be made by the leadership of the BHB, others require an integrated, collaborative approach and must involve the government, insurers and other healthcare stakeholders."

Government announced in the budget this year that two urgent-care centres were scheduled to be built at both ends of the Island, with Southside's breaking ground this year.

And a spokesperson for the BHB said yesterday that the hospital had already changed the billing model for their outpatients and would be implementing the inpatient changes by April 1, this year.

The spokesperson echoed the reports warning that billing changes would not change hospital stays until there was adequate rooms elsewhere for nonacute care patients.

The spokesperson said: "From 1 April 2009, we will be moving to an international standard of billing for inpatient services, rather than charging a per-diem rate.

"This is the second phase of a project that went live last year, when outpatient services moved to an international standard of coding.

"However, the change in reimbursement model will not in itself resolve issues around length of stay. For example, the number of long term care patients in the hospital impacts our average length of stay statistic.

"Many senior patients end up staying in hospital longer than necessary as they do not have a safe care environment to be discharged to, such as a residential care place.

"This is one of the reasons we are adding 16 places in our Continuing Care Unit, and we are working closely with the Ministry of Health to further increase options.

"The importance of reducing length of stay for these patients is not purely financial, it is about housing them in an appropriate care environment."