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DHEC might regard ratings in hospital decision

Piedmont Medical Center's performance on a Medicare quality of care study can be considered in evaluating who builds a hospital in Fort Mill, a state health department spokesman said Tuesday.

In a recently released Medicare report, Piedmont scored worse than the national average for deaths by heart attack, heart failure and pneumonia. Piedmont and Southwest Mississippi Regional Medical Center were among the worst of the 4,600 hospitals studied, according to the Medicare report.

Some health care analysts said Piedmont's rating, as well as those of applicants Carolinas Health Care System and Presbyterian Healthcare, should be considered by the S.C. Department of Health and Environmental Control as it determines which hospital should be awarded the certificate of need to build in Fort Mill.

The ratings "should affect DHEC's decision," said William Brandon, a professor at the University of North Carolina at Charlotte, especially considering Piedmont's poor performance in the Medicare report. While hospitals have been slow to look at health care quality from a system's approach, he said, "we do care about quality of care."

In decisions where it's hard to get data everyone can agree upon, analysts turn to a "satisfies" standard, Brandon said - what information satisfies the decision maker. Specific to the Fort Mill certificate of need, DHEC could set a "no worse than average" standard in evaluating applications, said Brandon, the Metrolina Medical Foundation Distinguished Professor of Public Policy at UNCC.

Columbia health care analyst Lynn Bailey said she expected the Medicare report will be considered by DHEC. "It's going to get mixed up in the soup," she said.

The weight given to the data, however, might be minimal, said Daniel Sullivan, an Atlanta-based health care consultant who has experience with South Carolina certificate of need applications.

"It is one of the comparative factors, but in the pecking order, it is not a significant factor," Sullivan said. Hospitals can point to a number of health care grades, he said.

Typically, Sullivan said, this kind of information is used by applicants to affect competitors. "There is no question that opponents exploit this kind of information and will parade it before DHEC," he said.

Sullivan said it would be given more weight if the ratings represented a pattern over several years.

Piedmont, in a statement released Monday, disputed the methods used by the Centers for Medicare and Medicaid Services. The centers' data includes any death, from any cause, within 30 days of hospitalization, according to Piedmont. PMC said it prefers measures used by the S.C. Hospital Association and Healthgrades.com, which only count deaths "while in the hospital, the time when hospital performance has the most direct influence on outcomes."

Piedmont's rating by those two groups was "expected" or "better than expected." The American Heart Association has given Piedmont a gold award for its heart failure care. Blue Cross/Blue Shield of South Carolina has given Piedmont a "blue distinction" award for its cardiac care.

Regarding its current application for a Fort Mill hospital, Piedmont spokeswoman Katie Norwood on Tuesday said, "We do not believe it is our place to comment on how DHEC should consider data."

Paula Vincent, a senior vice president for Presbyterian Healthcare, said, "We absolutely believe that quality is a major factor in making the decision regarding health care. We understand that DHEC has the prerogative to take this into consideration and trust their process."

Chris Hummer, president of Carolinas Medical Center-Pineville, said, "We believe the CON (certificate of need) process has been very thorough and deliberate," and that DHEC should consider "all pertinent information in making the final decision to bring a new hospital to Fort Mill."

DHEC is expected to release its staff decision by Sept. 9. That decision can be appealed to the entire DHEC board, which does not have to automatically hear an appeal. The decision also can be appealed to an administrative law judge.

That's what happened the last time the three hospitals filed applications for a Fort Mill hospital. When DHEC awarded a certificate of need to Piedmont, the others appealed and an administrative law judge ordered the process to start over with newer data.

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