CLEVELAND — It’s difficult to imagine that a seven-story glass building will soon take the place of what’s now a vast hole near the corner of Carnegie Avenue and 105th Street in Cleveland. But Cliff Kazmierczak, who is with Turner Construction and overseeing the transformation, points to the gray sky, tracing a silhouette with his fingertips. In two years, he says, the Cleveland Clinic’s nearly $300 million cancer center is slated to open here.

“The big thing is to make the patient comfortable with the treatments that they’re going through,” he says of the building’s design. “So lighting, light colors, [and] as much natural light as possible are always very important to cancer patients.”

Kazmierczak came to this project after overseeing construction of the cancer hospital at Ohio State University a few hours south of here. All around the U.S., the health care industry is building up to take care of an expected influx of cancer patients.

Ohio is not alone in this building boom. The Advisory Board Company, a firm that does health care consulting, works with hospitals and doctors. Last year it found that about 25 percent of its members that have oncology departments were either constructing a cancer center, or had built one in the past three years. The Advisory Board’s Deirdre Fuller says people are more likely to get cancer as they get older.

“Now that everyone is looking forward and seeing the aging of the baby boomers,” she says, “it’s certainly adding some fuel to that fire.”

And most boomers will get health insurance through Medicare — which is a steady paycheck for hospitals.

Dr. Brian Bolwell heads the Cleveland Clinic’s cancer institute. He says hospitals have to meet the need.

“In the past five years, volumes go up, depending on location, between 5 and 10 percent a year,” Bolwell says. “And there’s no end in sight to that volume of growth.”

The Cleveland Clinic, along with its local competitor, University Hospitals, treat about 70 percent of the region’s cancer patients. And when the Cleveland Clinic opens its new center, the two will be located within a five minute drive of each other.

Historically, state governments have required hospitals to meet a certificate of need before building a hospital. But beginning in the late 1980s, states across the country began deregulating. Ohio’s certificate of need requirements for hospitals ended in the late 1990s, though it still requires it for long-term care facilities.

Dr. Nathan Levitan, who heads the cancer center at University Hospitals, doesn’t seem worried about the competition. His 4-year-old hospital, he says, is mostly full every day.

“We discharged over 11,000 patients with cancer in 2014,” Levitan says, “which is about a 20 percent increase over just a few years beforehand.”

He says that’s because both hospitals employ and contract with thousands of doctors. And in the world of cancer care, doctors have a lot of influence.

People usually don’t shop for cancer treatment until they are diagnosed, and at that moment their doctor’s advice on where to go matters a lot.

Bill Ryan leads a hospital advocacy group in Cleveland. He says that with so many expected patients, building is good for a hospital’s bottom line and good for patients.

“If you can run enough procedures through a facility, you’re going to get some economies of scale that will generate [a profit] margin,” he says. “The other thing you get when you run enough procedures through a facility, is a level of expertise that improves the quality of care that the individual gets.”

And when talking about the future of cancer care, hospital leaders tend to talk about quality. They insist that focusing on the quality of care will eventually lower the cost to patients, too.

This story is part of a reporting partnership with NPR, WCPN and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Recovering from pneumonia is an unusual experience in the 10-bed intensive care unit at the Carolinas HealthCare System hospital in rural Lincolnton, North Carolina. The small hospital has its regular staff in Lincolnton, but Richard Gilbert, one of the ICU patients, has an extra nurse who is 45 miles away.

That registered nurse, Cassie Gregor, sits in front of six computer screens in an office building. She wears a headset, and her voice is piped into Gilbert’s room via computer speakers.

A doorbell sounds before the camera turns on, alerting Gilbert that the nurse is looking in. They chit-chat as Gregor monitors Gilbert’s vital signs. The nurse asks how he’s feeling and if there’s anything he needs.

Carolinas HealthCare System monitors ICUs in 10 of its hospitals from this command center near Charlotte. The command center is staffed 24-7 with a rotating crew of seven to nine nurses and doctors who specialize in critical care. Everyone on the team also does bedside shifts.

Carolinas HealthCare started this project about two years ago and says it’s good for staff and patients.

For one thing, medical staff at the command center can maintain a constant focus on patients. The command center is quiet — none of the alarms are going off that most ICUs need to alert nurses and doctors down the hall that they’re needed. Dr. Scott Lindblom says it’s a nice change of pace.

The peace, he says, “makes it a much more pleasant environment actually to work in than what we’re used to — the usual chaos of the ICU.”

Nurse Kimberly Purtill agrees.

“We might see a trend up with their white blood cells,” Purtill says, or “a trend up with their temperature, and their blood pressure going down.” All those symptoms might be warning signs of an infection.

“If you were off yesterday as a bedside nurse, and you’re on today, you don’t have the picture from yesterday,” she continues.

But the command center staff has easy access to medical histories and other data on the computer screen, she says, so it’s easy to give the bedside staff a heads up.

Lindblom oversees critical care for Carolinas HealthCare System and says there are clear signs the virtual ICU is working.

“We’re taking care of more patients than we were two years ago,” he says, “and across the system, our mortality rate is dropping … and our length of stay is dropping. It’s almost the perfect storm of good care.”

Among the 10 hospitals in the program, ICU mortality is down 5 percent and length of stay is down 6 percent. Lindblom says virtual care doesn’t get all the credit. He notes the hospitals have also rolled out a program to better manage sepsis, which is a leading cause of death. But Lindblom says that virtual care helps with that program and nearly everything else in the ICU.

Leah Binder is president of The Leapfrog Group, a national advocate for better hospital care. She said the gold standard is to have critical care doctors on-site, not on-camera.

“However, that’s not always possible for every hospital and particularly in rural areas,” Binder says, “so second to that is a virtual environment.”

As technology leads to better care, she says, it could also lead to lower costs.

In the Midwest, Avera Health estimates its virtual ICU has resulted in $70 million worth of savings over the past 10 years. Deanna Larson, who oversees the project for Avera, says that from one hub in South Dakota, Avera monitors patients as far away as Minnesota and Wyoming.

“I think we quit calculating miles a while back,” she says, and laughs. “It’s a very vast area of land.”

Before virtual care, Larson says, complicated cases were often transferred to major medical centers. Now some of those patients can stay closer to home, and that’s good for them, their families, and the town’s economy.

“Keeping 10 or 12 patients more … means another nursing job that stays local,” Larson says, “maybe another lab tech job. What the technology is really doing is keeping those economics closer to home and helping them maintain viability.”

In other words, it may help the hospital in a small community stay open.

In Lincolnton, a town of about 11,000, Dr. Jessica Fox said her ICU has been much busier.

“The unit went from basically having a couple patients, and closing all the time because we were having to transfer so many patients, “to now being almost full all the time because we’re able to keep patients here, ” Fox says.

From his ICU bed, lifelong farmer Richard Gilbert says the more people looking after him, the better.

“That’s sort of like me and farming,” Gilbert says. “If I’ve got a five-man job, and I go out there with two people, [I] might miss something.” But if you have your whole crew working, he says, “you don’t miss anything. You get it done.”

This story is part of NPR’s reporting partnership with WFAE and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Requiring patients to get blood work and other tests before undergoing cataract surgery hasn’t been recommended for more than a dozen years. There’s good reason for that: The eye surgery generally takes less time than watching a rerun of “Marcus Welby, MD” — just 18 minutes, on average. It’s also incredibly safe, with a less than 1 percent risk of major cardiac problems or death.

Yet more than half of Medicare patients received at least one pre-operative test in the month before undergoing surgery to remove cataracts in 2011, a recent study found.

Some doctors were much more likely than others to order a complete blood count, urinalysis, cardiac stress test and the like. Thirty-six percent of ophthalmologists ordered pre-operative tests for more than 75 percent of their patients, according to the study, which was published last month in the New England Journal of Medicine.

“Their patients were no sicker or older,” says Catherine Chen, an anesthesiologist at the University of California, San Francisco, and the lead author of the study. “It suggests that it’s habit or practice patterns.”

The study compared the prevalence and cost of pre-operative testing in the month before 440,857 Medicare beneficiaries had cataract surgery. Testing expenditures for Medicare patients during the 30 days prior to cataract surgery were 42 percent higher than the average monthly Medicare spending for testing on those patients during the previous 11 months, a difference of $4.8 million.

Cataract surgery used to take a few hours and require general anesthesia. In those days, preoperative testing made more sense, says Chen. Now people often receive only a topical anesthetic eye drop to numb the eye or sometimes a local anesthetic that may include a sedative for relaxation.

But research shows that today, pre-operative testing for cataract surgery doesn’t result in fewer adverse events or better surgical outcomes, regardless of a patient’s health, says Chen.

“It’s so low risk it’s almost like saying you’re going to get your nails done,” she says. “There’s always a chance you’ll get hit by a car or have a heart attack on the way,” but it’s unlikely to happen at the nail salon.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.