April 3, 2014

Piedmont CEO learns from Fort Mill hospital decision

When Bill Masterton took over as the chief executive officer for Piedmont Medical Center in June 2012, he knew he faced a divisive issue – who should build a new Fort Mill hospital.

When Bill Masterton took over as the chief executive officer for Piedmont Medical Center in June 2012, he knew he faced a divisive issue – who should build a new Fort Mill hospital.

The shouts of “anyone but Piedmont” left him confused and disappointed. Why was a portion of the community so adamantly against a hospital that had a “proven track record of quality?” he asked.

“I knew the Fort Mill hospital situation was divisive, but I didn’t realize the depth of the division,” Masterton said Thursday.

Two days earlier, the Administrative Law Court awarded the certificate of need to Piedmont.

It was almost a year ago that Masterton stepped into a small, stuffy courtroom of the state’s Administrative Law Court in Columbia to explain why Piedmont should get permission to build the Fort Mill hospital.

The trial was an education for Masterton. He heard the history of the more than 10-year battle over who should build the hospital.

It started about 2000 when PMC talked with Piedmont Clear Springs Development Co. of Fort Mill, the developer of Baxter Village, about bringing health care to the rapidly expanding area of northern York County.

In 2006, the state’s Department of Health and Environmental Control gave PMC permission to build a 100-bed hospital in Fort Mill. Losing applicants, including Carolinas HealthCare System, successfully appealed and the case went back to DHEC.

In 2011, DHEC awarded permission to Carolinas HealthCare. PMC and Novant Health, operator of the Presbyterian hospitals in Charlotte, appealed.

With the decision, PMC has begun updating its plans, including making the patient rooms larger. New regulations in the Americans With Disabilities Act require larger rooms, Masterton said.

While PMC updated its plans, Carolinas HealthCare is considering its options which include asking Administrative Law Court Judge Phillip Lenski to reconsider his decision, appeal that decision to the state’s appeals court, or – given the uncertainty over the state’s certificate of need process – apply with DEHC to build a Fort Mill hospital. It also could end its efforts to build a York County hospital.

Last year, Gov. Nikki Haley vetoed funding for the certificate of need program, advising health care facilities to move forward with projects without a certificate. The state Supreme Court has heard arguments on her decision, but has not issued its opinion yet.

The uncertainty hasn’t stopped Masterton from reading and re-reading Lenski’s 40-page opinion. It provides Masterton with detailed statistics about how competition from Carolinas HealthCare cut into PMC’s market share and profits.

According to Lenski’s decision, PMC’s occupancy fell from a high of 75.1 percent in 2003 to a low of 57.1 percent in 2009 during the middle of the certificate fight. The drop at PMC came when York County’s population grew by 22 percent.

Lenski wrote there was a “direct correlation between Piedmont’s York County patient loss and CHS’ gain – 80 percent of Piedmont’s decline went to CHS from 2005 to 2010. He noted by 2011 that more than 50 percent of the most serious health cases in York County were seeking treatment outside the county.

Lenski said that such competition would economically harm Piedmont with losses “in the millions” and also affect the hospital’s, and other York County physicians’, ability to offer quality health care.

Economic harm, Piedmont’s desire to build a 100-bed hospital – Carolinas HealthCare proposed 64 beds – and PMC’s commitment to York County were reasons on which Lenski based his decision.

While building a new hospital should do much to keep York County residents from traveling elsewhere for care, Masterton knows it will take more to gain people’s trust.

Getting permission to build a Fort Mill hospital was part of a three-pronged strategy to keep PMC competitive, he said Thursday. The first is the ongoing, $20 million expansion of the emergency room at the Rock Hill hospital. Currently, about 70 percent of the hospital’s patients are admitted through the emergency room.

Masterton said the new emergency room should increase that percentage to 80. New construction on the emergency room is expected to be finished in June. Reworking the existing emergency room is expected to be finished by December.

Piedmont also has increased its number of primary care practices in York County from eight to 20, and may add more, Masterton said. Physicians – and health insurance companies – play a large role in determining which hospitals people go to for care. Lenski said Carolinas HealthCare referral patterns were responsible for the drop in PMC use.

Masterton said the two efforts should help people get to know the “new” Piedmont better.

“If you haven’t been to Piedmont recently you haven’t been to Piedmont,” Masterton said. “There are a lot of new things from a new attitude to new relationship with the community.”

What Masterton is most proud of though was Lenski’s conclusion that either PMC or Carolinas HealthCare “would be capable of providing high quality healthcare services at its proposed Fort Mill area hospital.”

Masterton said that’s what has been lost in the Fort Mill hospital debate, meeting the health care needs of northern York County residents – regardless of where they go for treatment.

“This is not Coke vs. Pepsi,” Masterton said. “It about the people of Fort Mill having a choice, having something closer to home. Compassionate care is the No.1 thing.”

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