The Columbia County Commission will likely pick a partner this month from the three Augusta hospitals vying to help it build the county’s first hospital. At least one loophole the county hopes to exploit to get state permission has been used by two other Georgia hospitals for expansion, according to a document obtained by The Augusta Chronicle.
At a work session Friday, commissioners reviewed questions and answers from Doctors Hospital, Georgia Regents Health System and University Hospital about their bids.
Chairman Ron Cross said the commission will hold another work session next week and then take up the matter at its March 18 meeting for a possible decision.
About half of the points it will use to score bids concern costs, Vice Chairman Ron Thigpen said.
Of the three, only University is asking the county to contribute 20 percent of the cost of building its 100-bed hospital, which would be about $26 million to $28 million of the $130 million to $140 million cost. That request targets one of the exceptions in the state’s need standard for building a hospital.
Because Columbia County is next to Augusta and its four acute care hospitals, it will need to get an exemption to obtain a Certificate of Need, Cross acknowledged.
According to calculations by The Chronicle, using the average daily census for inpatients in the four hospitals in 2012, the average daily number of patients in hospital beds in Augusta was 853 out of the 1,644 beds the hospitals are licensed to operate.
The Certificate of Need law has an exception that could allow a county’s sole provider to build or expand beyond what it can
prove is needed by contributing 20 percent of the total cost.
Henry Medical Center in Henry County used that exception to justify its request to expand by 91 beds, from 124 to 215, though the need calculation said only 48 additional beds would be
allowed, according to a 2003 decision by the Georgia Department of Community Health in upholding the request.
The request was upheld despite the objections of two competitors. The decision noted that Rockdale Hospital and Health System also used the 20 percent contribution rule to get approved
for a 31-bed expansion when only 12 beds were justified under the needs methodology.
University structured its bid to take advantage of the exception, “not because we need the money,” said Ed Burr, its senior vice president for legal affairs.
Georgia Regents would rely on two of the other exceptions, which allow existing trauma centers or teaching hospitals to bypass the need requirement, and would not require county funds, said Shawn P. Vincent Sr., its vice president of partnerships, international
health care and strategic alliances.
“Taxpayers are burdened enough,” he said.
Doctors Hospital also hopes to use the trauma center exception to avoid asking the county for the $30 million that might otherwise be required to get permission to build its $150 million, 108-bed hospital. It is not yet been designated by the state as a trauma center.
“We anticipate being a Level III (trauma center) by this summer,” CEO Doug Welch said.
Neither of those two exceptions has ever been used to get a Certificate of Need, officials have said. Conversations with state officials did not provide clarity on that, Columbia County Administrator Scott Johnson said.
If the county is contributing, that would be the “No. 1 item” on the next special purpose local option sales tax program, Cross said.
However, Commissioner Bill Morris said that might take away from other projects the county might want to do.
“That’s going to eliminate some other quality of life projects,” he said.
Many of the commissioners’ questions concerned the most ambitious proposal, from Georgia Regents, to create a $280 million to $310 million “health campus” with a 144-bed hospital that would need up to 100 acres.
While the health system owns land in the county, it is not sufficient for the idea and commissioners questioned where the hospital would go.
Vincent said the health system would work with the county on what site would be best, but it is looking in a corridor along Interstate 20 west of Belair Road because that is where future needs will be increasing.
“The growth largely seems to be west of the Belair Road area,” Vincent said.
University would put its hospital on its Evans campus off North Belair Road. Doctors Hospital owns a site nearby that it could use but has an option on another.
Cross questioned Georgia Regents about whether its deal with Phillips Healthcare, which is touted in its bid, really offered a clear advantage over the other two.
“It’s more than just an equipment deal,” Vincent said.
Through the 15-year, $300 million partnership, the health system gets access to new equipment in its developmental pipeline and has a research agreement, he said.
It’s not really an advantage to be “locked into technology that is not always the best,” Burr said. “Our philosophy is to buy the best technology at the time.”
University can leverage its buying power through a deal with Novant Health. Doctors has had an arrangement with General Electric since the 1990s but can go out and buy the best available technology if it is not with them, Welch said.
Thigpen asked the bidders to provide more detailed financial records and projections on how their proposed hospital would do over the next five to six years.
The decision will be about the future of the county, and commissioners are focused on that, Cross said.
“It’s just a matter of being sure that what is promised will take place,” he said.