Developer Brian Hoyle an Inspiration

The Maui News

The Maui Chamber of Commerce Wednesday heard an experienced small-hospital developer very much on top of his game. Brian Hoyle stopped by The Maui News Tuesday to explain his plans for a rural, critical-access hospital.

The engaging hospital developer from Newport Beach, Calif., said the 25-bed hospital planned for West Maui is being designed to meet state and federal requirements for operating and funding. "Follow the reimbursement," he said. As the state's first rural, critical-access hospital, it will be in line for 101 percent cost reimbursement from Medicare and Medicaid.

Hoyle explained the rural, critical-access designation was put into law in order to encourage the establishment of feeder, or satellite, hospitals in far-flung rural areas of the United States. In the case of Lahaina, it qualifies because it is separated from the regional hospital, Maui Memorial Medical Center, by a single, two-lane road - Honoapiilani - that is vulnerable to being closed. The size of the hospital was also carefully chosen. Hoyle said 25 beds is the limit for the financially essential rural, critical-access designation.

Hoyle has developed other rural, critical-access hospitals in Oklahoma and Arizona. In addition to his experience and obvious erudition, Hoyle's dedication to making the hospital "a consensus project" for the community was impressive. He had nothing but good things to say about Maui Memorial and, surprisingly, the often-criticized State Health and Development Agency, which must approve the hospital by issuing a certificate of need.

Hoyle said the $25,000 CON application is, in reality, "a business plan" that must consider the entire island, and the SHPDA staff has been cooperative and helpful in developing the plan.

The West Maui Improvement Foundation and its president, Joe Pluta, have been working on getting a hospital to serve the Lahaina-Kapalua area for a decade. It was fortunate the effort now includes Hoyle, a man who puts his ducks in a row and is determined to make his latest development a success. "I've never failed," he said convincingly.

Research, Technology Center Touted with West Maui Hospital

Hospital developer Brian Hoyle addresses Maui Chamber of Commerce members Wednesday at the Maui Tropical Plantation. He announced the possibility of adding a medical research and technology center as well as elderly housing to the medical facility project planned for nearly 15 acres in Lahaina. The Maui News / MATTHEW THAYER photoWrite here...

Hospital developer Brian Hoyle addresses Maui Chamber of Commerce members Wednesday at the Maui Tropical Plantation. He announced the possibility of adding a medical research and technology center as well as elderly housing to the medical facility project planned for nearly 15 acres in Lahaina. The Maui News / MATTHEW THAYER photoWrite here...

By CLAUDINE SAN NICOLAS Staff Writer, The Maui News

Hospital developer Brian Hoyle addresses Maui Chamber of Commerce members Wednesday at the Maui Tropical Plantation. He announced the possibility of adding a medical research and technology center as well as elderly housing to the medical facility project planned for nearly 15 acres in Lahaina. The Maui News / MATTHEW THAYER photo

WAIKAPU - West Maui hospital developer Brian Hoyle rallied support for his project Wednesday while announcing the possibility of adding a medical research and technology center to the proposed project's 14.9-acre site in Lahaina.
Meanwhile, the State Health Planning and Developing Agency's Darryl Shutter said Hoyle has been making "good progress" on his hospital certificate application targeted for completion at the end of this month.
Hoyle was the featured speaker at a Maui Chamber of Commerce luncheon sponsored by Kaanapali Land Management, which owns the Lahaina property sought for the planned medical facility.
Addressing about 65 people at the Maui Tropical Plantation, Hoyle said he's interested in building a medical research and technology center that would generate new jobs and revenue for Maui County. It would also attract first-class medical professionals who would be lured here by the island's beauty. Overall, the project could bring as many as 150 full-time jobs to Maui, he said.
Hoyle also is considering incorporating affordable housing for the elderly on the hospital campus.
Responding to a question about whether the economic downturn would affect his project, Hoyle said he would be "nervous" if he had to seek a construction loan today.
"Health care is not exempt from a downturn in economy. No one is," he said.
Still, having been involved in building about 50 medical facilities across the country, Hoyle said he has had a lot of success in developing projects in the health care industry.
He reiterated that he intends to keep the West Maui facility small, with only 25 beds enabling it to gain a federal designation as a critical-access hospital and qualify for full cost-based reimbursement.
Hoyle is also pursuing private funding from investors, including doctors and philanthropic organizations that are interested in Maui and the pursuit of quality health care in rural areas.
Once the hospital certificate application is completed, state health planning officials could determine whether it could go forward within 90 days.
A law enacted in 2007 requires the state health planning agency to expedite reviews of proposed medical facilities on Maui and hold all public hearings on the proposal on the island.
Shutter said his agency intends to follow the statute's requirements. He pointed out that the most recent certificate of need application involving an MRI at Maui Medical Group was decided within 60 days.
Based on the certificate application process and the need to seek other governmental approvals, Hoyle estimated the earliest date for the hospital completion would be late 2011.
Hoyle, with the support of the West Maui Improvement Foundation, has proposed to invest at least $50 million in the construction of a 25-bed critical-access hospital in Lahaina and a 40-bed skilled nursing facility.
There are also plans, Hoyle said, to add a 40-unit assisted living complex for senior citizens and a 30,000-square-foot medical clinic.

West Maui Hospital Planned as 'Feeder' to Maui Memorial Medical Center

By CLAUDINE SAN NICOLAS, Staff Writer, The Maui News

Hospital developer and banker Brian Hoyle (left) answers a question while West Maui Improvement Foundation President Joe Pluta looks on Tuesday during an interview at The Maui News. The Maui News / MATTHEW THAYER photo

WAILUKU - A new hospital proposed in West Maui will complement, not compete with Maui Memorial Medical Center, according to its developer, Brian Hoyle.

"We're nothing but a feeder to Maui Memorial," added Joe Pluta, president of the West Maui Improvement Foundation, the nonprofit supporting Hoyle in his endeavor to bring a long-awaited hospital to Lahaina.

The State Health Planning and Development Agency has not yet accepted Hoyle's application for a certificate of need to build a hospital in Lahaina, but he and Pluta are aiming to have the approval by the end of October.

"We've crafted something that is doable and financially viable," Hoyle said Tuesday during an interview at The Maui News.

Today, Hoyle, a hospital developer and banker in Newport Beach, Calif., is scheduled to address the Maui Chamber of Commerce during a noon luncheon at the Maui Tropical Plantation. Hoyle is expected to talk about a new model for the county and state's health system.

In February, Hoyle filed an application to build a 25-bed critical access hospital with a 40-bed skilled nursing facility on a 14.9-acre site adjacent to the Lahaina Civic Center.

With the help of state health planning staff, Hoyle said he's making a concerted effort to ensure his application fulfills all requirements and that it does not face the kind of opposition and eventual failure seen last year in the proposed Malulani Hospital for South Maui.

Unlike Malulani, the proposed West Maui hospital would be small yet still offer services such as angioplasty and orthopedics, Hoyle said. "Maui Memorial will always be the major hospital," Hoyle said.

The key in the proposed West Maui hospital's financial success will be to obtain federal designation as a critical-access hospital. Such a designation would ensure the hospital receives 101 percent reimbursement for patients in Medicare and Medicaid insurance programs.

Hoyle said his experience in the development of about 50 privately owned hospitals and health care facilities on the Mainland has taught him to focus on a community and a rural hospital model.

Successful health care systems also incorporate a "follow the reimbursement" model, which ensures financial viability. Hospitals receive critical care access designations and benefits from the federal government in part because of a facility's ability to provide health care services to geographically isolated places such as West Maui.

Hoyle's certificate application provides for a hospital and nursing facility with a development cost of approximately $50 million. Hoyle said he plans to recruit doctors who will not only work for the hospital, but invest in the facility as well.

Once the certificate application is deemed complete, reviews by three separate panels are expected all to be held on Maui, possibly as early as January or February of 2009. If the proposed facility is approved by state officials, Hoyle would seek county land use approvals.

It will take at least two years to construct the medical facility, which puts its earliest completion sometime in 2011.

Revised application for W. Maui hospital filed


LAHAINA — Hospital developer Brian Hoyle said Tuesday that he has filed a revised application for a state certificate of need for a West Maui Hospital & Medical Center, complying with recommendations of the State Health Planning and Development Agency.

"We have tried very hard to demonstrate that the new hospital in West Maui meets all criteria identified by SHPDA as its basis for decision making," Hoyle said in his announcement, adding, "We truly appreciate SHPDA's willingness to provide guidance to assure that our application meets its requirements."

Hoyle is chairman of two California banks and is principal in Southwest Health Group, which invests in, develops and operates health care facilities. His family has been involved in real estate development in West Maui and has supported the efforts to develop a West Maui hospital since 1968, he said.

He joined the efforts of the West Maui Improvement Foundation to develop a West Maui hospital last year, to be operated by Southwest Health Group and financed by Newport Hospital Corp. Hoyle is the sole shareholder in Newport Hospital Corp.

The original certificate of need application was filed in February, but SHPDA responded with a request for additional data.

The plan is for a 25-bed acute-care hospital including emergency room services, with a 40-bed, skilled-nursing facility. Projected cost is $45.75 million. According to Hoyle's announcement, the facility is intended to complement Maui Memorial Medical Center by providing first-responder services for emergency care patients who may be stabilized and transferred to Maui Memorial or other hospitals for specialized care.

"This is an independent project developed in coordination with the West Maui Improvement Foundation and the West Maui Taxpayers Association, with involvement of no other organization," Hoyle said.
But he credited support from 1,500 individuals and businesses that provided $700,000 in donations to the planning effort, as well as Council Member Jo Anne Johnson, who pushed a zoning bill for the project, and West Maui legislators Rep. Angus McKelvey and Sen. Roz Baker.
Maui Memorial Chief Executive Officer Wes Lo said he was aware that the original application was deemed incomplete but said he has not discussed the revisions with Hoyle or the West Maui Improvement Foundation.

"I'm not familiar with this revised application," he said. "I'm anxious to have a look at their proposal."

He said he could not comment on whether the proposed facility would provide a benefit to Maui Memorial without reviewing the complete application.

Hoyle's announcement said the 40-bed, skilled-nursing facility is designed to accept long-term care patients who are held at Maui Memorial when there is no nursing facility able to accept them. The proposed skilled-nursing facility would be operated by Mission Health Services, a nonprofit healthcare service based in Utah.

Hoyle said he believes the long-term care facility would save Maui Memorial $6 million a year by reducing the number of patients held on a wait list for transfer. Reimbursements to the hospital are lower for long-term care patients, even when they occupy high-cost acute-care beds.

The West Maui acute-care facility would provide 19 medical-surgical beds and six critical-care beds, with six bays in the emergency room and three operating rooms.

It would help to reduce the overload at the Maui Memorial emergency room, Hoyle said, and would be a cost-effective facility providing emergency care, acute care and intensive care services for the West Maui community.

Baker, whose Senate district includes South Maui and West Maui, said she has supported a West Maui hospital since she first was elected to the state House in 1988.

"I've supported a hospital on the west side for a long time, because of the isolation," she said. "One thing that distinguishes this proposal from others is that it wants to be part of an overall health care system for Maui, working with Kaiser and with Maui Memorial and with everyone else.

"And it is trying to address the needs of the community with the long-term care component."

Kaanapali Development Corp. has already granted the West Maui Improvement Foundation a 14.5-acre site near the Lahaina Civic Center for the proposed hospital, which was zoned for hospital use in November.