Among The Best and The Worst

I find it interesting that in the past month, we have stories of best and the worst of our area. I find it even more interesting we have a top 400 hospital competing with one of the bottom two worst hospitals, and in the ranked in the same categories.

Yes I know, they are different finding and different reports. Having a high ranking and being pointed out as one of the worst rankings are worlds apart, no matter the source of the data.

3 regional hospitals named among best in nation | The Herald - Rock Hill, SC

Chester Regional Medical Center, Springs Memorial Hospital in Lancaster and Carolinas Medical Center – recently picked to build a Fort Mill Hospital – were selected among the top 405 best performing hospitals in the national by the Joint Commission.

Springs Memorial and Carolinas Medical Centers in Pineville and downtown Charlotte were selected for the care in heart attack, congestive heart failure, pneumonia and surgical care.

Report: Piedmont Medical worse than U.S. average for 3 causes of death | The Herald - Rock Hill, SC

Piedmont Medical Center scored worse than the national average on three key medical measures - deaths by heart attack, heart failure and pneumonia - according to a report just released by Medicare.

Piedmont's Medicare rating, along with Southwest Mississippi Regional Medical Center in Macomb, was among the worst of 4,600 hospitals reviewed by the Centers for Medicare and Medicaid Services. The centers reviewed Medicare patient data from mid-2007 to mid-2010.

"This should be a big red flag you've got a problem," said Dr. Mary Tyrell, a former health care management professor at Lander University.
Tyrell said poor performance in one area might be explained, but poor outcomes in three of the six areas measured shows "there are some systemic problems at this facility.
It points to management and patient care problems."

Appeals Deadline

The Rock Hill Harold reports:

Sept. 26 is the deadline for Piedmont Medical Center and Presbyterian Hospital to appeal a state regulator’s decision to award a certificate of need for a Fort Mill hospital to Carolinas HealthCare System.

Read more at the Harold.

 SC DHEC has posted their official press release of the CON notice here.

Charlotte Observer Asks About Appeals

Saturday, the Charlotte Observer posted the article about CMC winning the CON for the Fort Mill Hosptial in a story titled CHS wins bid to build hospital in Fort Mill. The story, written by Celeste Smith, talked to Bill Brandon, who specializes in health policy and politics for the Metrolina Medical Foundation distinguished professorship at UNC Charlotte.

Before deciding whether to appeal this most recent decision, each losing side might consider how another potentially lengthy round could affect their overall business plans, said UNCC's Brandon.

And to appeal, the other sides also might have the burden of proving that CHS does not meet the certificate of need regulations, said Steve Graybill, principal and senior health care consultant with Mercer, a New York-based human resources consulting firm with offices in Charlotte.

Or, the other sides might argue that their own information was misinterpreted, and they in fact can meet all parts of the regulations, Graybill said.

"I think it was a dogfight in the beginning with three very competent competitors," Graybill said. But, "maybe this has gone on so long that this decision is finally going to move forward.

Read more at the Charlotte Observer.

Statistics from SC DHEC Analysis

I read the entire SC DHEC Project Review Criteria Analysis of the Fort Mill Hospital. Here is some interesting Statistics from the report.

Public Feedback Breakdown:
10,004 supporting Presbyterian
5,753 supporting Carolinas
>5,400 supporting Piedmont
34 directly opposing Piedmont *see full text below
1 directly opposing both Carolinas and Presbyterian

Also received from each applicant:
45 letters of support from independent physicians “significant” letters of support on postcards and duplicated form letters Support also submitted via e-mail

*“The Department directly received thirty-four (34) letters of opposition to Piedmont from the community. This was significant in that most were lengthy and detailed. In contrast, one letter opposing both Carolinas and Presbyterian was received directly by the Department.”

 
Charity Care projections
Facility       Cost in Year 3     % of projected gross
PH-Y          $16,525,574        6.5%
CMC-FM    $12,770,574        6.3%
FMMC        $7,012,201          3%


**Sections 3f and 3g are met equally by Presby and CMC. The analysis continues to say that while they both met equally, noted that Presby “has the most generous charity care policy.”

Analysis of SC DHEC Analysis

Here is the short version of the full SC DHEC Fort Mill Hospital Analysis. The full document is available here.

From the Background section:
"According to U.S. Census data from 2000 and 2010, York County's population grew by 61,459 or 37.3%. The Fort Mill area (Northern York County) [Fort Mill CCD as used by the U.S. Census] is also projected to grow more rapidly than the Rock Hill Area and Western York County." The projected growth for those over 65 years old is predicted to be 45% for Northern York County, which is higher than Rock Hill (36.9%) and South Carolina (20.7%).

From the Written Findings section:
Only 2d applied to Piedmont, which serves ZIP Codes 29730 and 29732 and has 69.3% market share and 64.6% market share for total discharges for these areas. "Historical utilization for [PMC] has declined from 75.1% in 2003 to 57.1% in 2009. Yet, the projected Inpatient Medical/Surgical and ICU Market Share is projected to a combined (FMMC and PMC) Market Share of 65.7% in 2015, 70.4% in 2016, and 72.7% in 2017, with market share for FMMC to be 19.4%, 22.8%, and 26.1% respectively. The Department is concerned that the high level of projected market share is not reasonable.”

2e. “Carolinas’ projections are based on a high level of current market share, and Carolinas proposes to serve only its existing base of patients at CMC-Fort Mill. Carolinas capture 56.8% of Northern York County in 2010, as compared with 44.2 in 2005. Carolinas projects that 75% of its 2009 market share for [Fort Mill], 80% of 2009 market share for Rock Hill, and 50% of its 2009 market share for Western York County will shift to the proposed CMC-Fort Mill. These Projections appear reasonable [to SC DHEC].”

“Presbyterian’s projections meet the need of the target population, but in order to meet its projects, it has to capture a high level of market share that is held by other providers, even in light of updated projections which reduced the total number of discharges by approximately 9% as compared with the October 2010 submission. Presbyterian projects to provide 62.5% more MRIs in 2015 than Carolinas and 294% more than FMMC, …is significantly higher than the number performed in 2010 by several exiting S.C. hospitals with more licensed beds.”

“Carolinas has almost as much market share for the entire York County as Piedmont.”

Piedmont currently serves Rock Hill and Western York County which projects to continue to be largest York County population area. “Relocation/replacement of 36 beds in Northern York County does not appear to equitable distribute beds within the County and reduces accessibility to Great Rock Hill and Western York County. Piedmont has not documented the need for a capital expenditure of over $40 million more than the other applicants.”

“Information provided by Piedmont indicates a substantial reduction in utilization, from…75.1% occupancy in 2003 to…2009 with 57.1% occupancy.” With 268 beds (excluding 20 psyc beds) the most recent Joint Annual Report (JAR) indicated they have 249 beds set up and staffed (excluding the 20 psyc beds). In 2010, the daily occupancy equaled 58%. “Based on this information, there are currently 94 unused beds at Piedmont on an average Daily basis.”

Piedmont JAR data also showed a 60.2% decrease in outpatient endoscopies, 10% decrease in  inpatient operations, and total operations decreased 10.6%. “Total heart catheterizations have decreased…15%. Open hear surgeries have declined…22.6%.

Project Review Criterion: 22 – Distribution: “Carolinas best met this criterion because it is the only applicant that proposes to successfully shift its current market share. The Department is concerned with the cost-effectiveness of Piedmont’s proposal and the balance of the distribution to the target population. Presbyterian’s application would require a substantial change to the existing market shares of both Piedmont and Carolinas to be successful.”

“In a response dated December 3, 2010…Piedmont states that ‘without a hospital location in the northern portion of the county, Piedmont will continue to lose patients to providers in the north.’ The Department feels this could result in the recapture of some patients who currently travel out of state for care, but not to the extent proposed by Piedmont.”

23a and 23b.
“Piedmont projects around 18% of its admissions will be redirected from Piedmont to FMMC with the remainder of its patients coming from N.C. providers.”

“Piedmont projects that it will lose over 3,500 cases and some $13.8 million in net revenue by the third year if a Fort Mill facility owned by either Carolinas or Presbyterian is built.” According to the numbers provided to SC DHEC and their review of the numbers, “the Net Income for Piedmont was projected to decrease from $4,881,595 to negative $18,613 if there is a N.C. provider in Fort Mill.”

Carolinas Medical Center Wins

CMC posted this response to the SC DHEC announcement:We are delighted to share with you a recent announcement from the South Carolina Department of Health and Environmental Control (DHEC).  Carolinas HealthCare System has been selected to build and operate the new hospital in York County, South Carolina.

It looks like Piedmont hurt their own chances since they would be taking patients away from their current base of customers.

"The Department is concerned with the declining utilization at PMC, the heavy dependence of recapturing significant lost market share which would require a significant reversal of market trend, the impact of redirecting existing patients away from PMC, the substantial cost of the project, and the ability to finance the project."

"...the heavy dependence of recapturing significant lost market share..." that sounds like the heavy advertising and use of the phrase "we're taking you to Piedmont" by Piedmont EMS.

"CMC - Fort Mill proposed project adequately demonstrated that its current significant level of market share and utilization will be sufficient to justify the implementation of the project, appears to be financially feasible and proposes to shift current market share to a facility in SC, resulting in less adverse impact to existing facilities."

CMC's campaign included York county has been coming to use for years, now we can come to you. Will CMC pull some of Piedmont's customers away from Rock Hill? Probably, but a majority of non-Piedmont bound ambulances are bound for CMC-Steel Creek or CMC-Pineville.

Concerns with Presbyterian:

"The Department is concerned with [the] fact that it would be difficult for Presby to meet proposed utilization projections, and if they are not met, this will affect the financial viability of the project. Presby will also have to capture a high level of market share that is held by other providers, resulting in adverse impact to these providers, primarily PMC."

 

Overall comments appear that the State of South Carolina is concerned about Piedmont's future in York county. According to the State, Piedmont's utilization is on a decline. Adding another Piedmont hospital would reduce the number of Fort Mill area patients at the Rock Hill complex. CMC provided the number of current patients it has in York county and how many York county residents that visit their hospitals. 

 

Truthfully, I didn't hear any good arguments for Presby, other than some wish there was a Presby, but are glad that Piedmont did not win the hospital bid.

I expect to hear about appeals for the next few weeks, but I honestly don't think that Piedmont has a leg to stand on for winning an appeal. I also don't know that Presby has been vocal enough in the hospital fight to get any real support from the public for an appeal.