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.”