This week, state regulators will select who gets to build Fort Mill's new hospital - but don't expect to make an emergency room visit or schedule surgery anytime soon.
The earliest the hospital could open is the fall of 2014 - likely later, assuming the losing applicants appeal. History shows most losers for the state's certificate of need appeal, adding years to the process and increasing final costs.
Carolinas HealthCare System, Piedmont Medical Center and Presbyterian Hospital have applied to the state Department of Health and Environmental Control to build and operate a Fort Mill hospital. The deadline for DHEC's decision is Friday.
It has been a spirited competition that officially began in 2004. Interest in a Fort Mill hospital dates to 1999, when Piedmont discussed health care needs with the developers of Baxter Village.
The stakes are high. Construction costs range from $76 million to $119 million, depending on the number of beds. Each applicant proposed hiring more than 300 people, with initial payrolls in the $25-million range.
Regardless of who builds it, the hospital will have a 24-hour emergency room and offer surgical services, labor and delivery and diagnostic services.
Initial use estimates range from 3,000 to 4,450 discharges annually, with emergency room and other visits ranging from 26,000 to 47,000. All applicants project making a profit - Carolinas HealthCare System in the first year of operation. Presbyterian projects $3.2 million in net income by the third year, and Piedmont's net income estimates are $2.8 million by the fifth year.
The winner also will play a pivotal role in shaping health care in York County for years to come - especially in the fast-growing areas of Fort Mill and Tega Cay. Each applicant anticipates bringing more doctors to the county and adding services over time, as demand dictates.
DHEC will consider 33 factors in making its decision. Factors it says are "most important" are:
The applicant's record of providing health care
Its financial ability to build and maintain a Fort Mill hospital
The impact a new hospital would have on existing facilities
It is a competition that has played out as much publicly - with thousands of letters of support submitted, as well as newspaper ads and highway billboards - as it has through DHEC's review process.
At numerous meetings, applicants have made their case why each is the best qualified.
Piedmont has said it is solely committed to York County and is the only for-profit applicant. It would pay about $4.1 million in property taxes on a Fort Mill hospital.
Carolinas HealthCare System has cast itself as the people's choice. More than 50 percent of York County residents come to Carolina HealthCare System's doctors for treatment, according to CHS data. Much of that treatment is at the system's North Carolina hospitals.
Presbyterian Hospital argues it is the only applicant that would bring competition to the market.
Quality of health care has also been a contentious issue, with each applicant pointing to ratings that put their care in the best light.
A recent analysis of Medicare data from June 2007 to June 2010 showed Piedmont Medical Center had above-average death rates for heart attack, congestive heart failure and pneumonia.
Piedmont disputes the method used to calculate the findings and points to its awards from Blue Cross-Blue Shield of South Carolina and the American Heart Association as evidence of its quality of care. Piedmont has won the S.C. Distinguished Hospital of the Year award for patients with cardiovascular disease and stroke.
Presbyterian highlights twice receiving the Ernest A. Codman award for outstanding quality initiatives and its "magnet designation" from the American Nurses Credentialing Center for excellence in nursing.
Carolinas HealthCare Systems points to being ranked 12 times as Charlotte's most preferred hospital for quality by the National Research Corporation, a health care research and quality improvement firm.
Health care info
To review quality of health care measures go to:
hhs.gov - compiled by U.S. Department of Health and Human Services
healthgrades.com - compiled by independent health care ratings organization
Hospital time line
November 2004 - Piedmont announces plans to build a 64-bed hospital in Fort Mill with projected cost of $107 million, creating 250 jobs, opening 2008.
May 2005 - Carolinas HealthCare System, Presbyterian and Hospital Partners of America apply to build Fort Mill hospitals.
May 2006 - DHEC approves certificate of need for Piedmont, saying it is the best to meet growing populations demands, and because of its contract to provide 24-hour ambulance service to York County and pay the county's indigent care tax to the state. CHS and Presbyterian challenge.
December 2009 - An administrative law court judge rules DHEC misinterpreted state's health plan in awarding certificate of need to Piedmont.
April 2010 - State Supreme Court orders applicants for Fort Mill hospital to re-file certificate of need applications.
October 2010 - Applications re-filed by Carolinas HealthCare System, Piedmont, Presbyterian.
Friday - Deadline for DHEC to announce decision, which can be appealed to the full DHEC board, which does not have to hear the appeal, or to an administrative law court judge.