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Columbia County Board of Commissioners struggles with complexity of hospital decision

Friday, March 7, 2014 8:20 PM
Last updated Saturday, March 8, 2014 12:25 AM
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The more information they get, the more complex Columbia County commissioners said they find the task of picking a partner from among three Augusta hospitals to build a new hospital in the county.

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Columbia County Board of Commissioners Chairman Ron Cross said Friday that officials will take more time to research the three hospitals' proposals.  JIM BLAYLOCK/STAFF
JIM BLAYLOCK/STAFF
Columbia County Board of Commissioners Chairman Ron Cross said Friday that officials will take more time to research the three hospitals' proposals.

And while two health care professionals at a public hearing Friday endorsed University Hospital as their choice, Chairman Ron Cross said he has heard just as many folks argue for the other two bidders, Doctors Hospital and Georgia Regents Health System.

In the invocation, Cross offered up a prayer for guidance through the “complexities” of picking one of the three to apply for state permission to build a hospital in the county, the state’s largest county without one.

“We actually are becoming more and more confused as we get further into this pertaining to the process of choosing one entity to partner with,” he said.

Fellow commissioners echoed that sentiment.

“It’s kind of, the more that you learn, the more you realize you don’t know,” Commissioner Trey Allen said.

It is also the gravity of the decision that is weighing on them.

“This is a massive investment in our community, hundreds of millions of dollars for something that will be a cornerstone of our county for lifetimes, hopefully decades and centuries to come,” Allen said.

“It’s sort of like getting married,” Commissioner Bill Morris said. “You’re going to be with her for the rest of your life, hopefully.”

The commissioners are getting an earful from the public on what the choice should be and what the choice should not be.

“I’ve had supporters for all of you,” Morris told hospital leaders sitting in the audience. “(Others said) ‘Whatever you do, don’t choose so-and-so.’ I think the community itself is trying to decide what is best for Columbia County.”

“It is so difficult in these situations to not have a popularity contest because that’s what we have run into from a lot of the citizens,” Cross said.

After earlier declining as a member of a special committee to recommend one of the bidders to the commission, retired ophthalmologist Allan Stocks offered his idea of an ideal hospital for the county and who best fits that mold, having practiced at all three Augusta bidders.

“It should have patient care as its primary mission, if not its only mission,” he said, in the most efficient and cost-effective manner and be open to any physician who wants to practice there. “Ownership, management and governance should where possible be local. The administration should be folks who have Columbia County’s interest as their primary interest.”

For that reason, Doctors, which is part of the large hospital chain HCA, would not fit the bill, said Stocks, who owned stock in an HCA surgery center.

“I can tell you that local decisions are always kicked upstairs and final decision rests with HCA on local matters in many cases,” he said. Georgia Regents is a “large institution,” Stocks said. “It is a bureaucracy unto itself. It already has spread across the state to many other facilities. Their focus is not here, on just this community. And they don’t answer to Columbia County. They answer to the (University System of Georgia) Board of Regents in Atlanta.” He also said the “town/gown split” would prevent community physicians from practicing at a GRU facility.

But David Hefner, GRU executive vice president for clinical affairs said the health system is proposing a community hospital with two-thirds of the physicians from the community.

University is the best choice, Stocks said.

“Its sole mission is to provide the highest possible quality of patient care delivered in the most efficient and cost-effective manner,” he said. “They’re not concerned about their stockholders. They’re concerned about their patients.”

Jodi Lott, who worked as a nurse at Georgia Regents and University and had surgery at Doctors, said there is already a “great medical community in Columbia County” and the commission should ask the physicians where they are sending their patients and who patients are choosing. For her, it is University, even though its proposed presence across the street from her physical therapy practice might hurt business.

“That takes precedence over losing a few patients,” Lott said.

Some of the commissioners seemed to hint that “outside experts” would be needed to help them make that choice.

“I do not feel qualified to make this decision just on my own,” Morris said. “I need some direction. I would like to put more thought and study into this and listen to what some others have to say.”

Cross said there might be some talk about consultants when the commission meets March 18 to take up the bids. But there won’t be a long delay on making a decision.

“We’re not going to drag it out forever,” Cross said. “We will have some information and some plan ready for our next commission meeting. We’ve got a lot of talking to do and I guess a considerable amount of research to do.”

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Just My Opinion
6270
Points
Just My Opinion 03/07/14 - 08:46 pm
6
5
Hate to say it, but I think

Hate to say it, but I think Dr. Stacks makes 3 excellent points toward his choice. In my business dealings with Doctor's, I also have seen how ridiculously slowly local decisions are made, due to the many channels they must go through. And GRU..well, who in the world would want to become involved with Azziz for decades??? We all know where that would lead.
Well, I think the next obvious step would be to get advisors. I just hope they can find some who aren't financial bedfellows with these three.

Gardencity1
92
Points
Gardencity1 03/08/14 - 12:50 am
8
3
Disappointing

They are going to punt again. They apparently don't value the tremendous investment that any of these hospitals would make in the county. Let the three hospitals figure it out and get a CON on their own. Leave government out of this and practice what you preach....the free market will resolve the issue. This looks like a Richmond county debacle. Whoever gets a CON without county money should be our choice, end of story. As republicans we should let the market work itself out. I could give you good and bad experiences at each hospital. As for Azziz, who cares because it is clear he won't be here much longer. This is about a once in a lifetime opportunity......health and economic. I wonder if our county leadership would act like this if we were recruiting Starbucks, Google, or other major companies. Very disappointing and demonstrates a lack of leadership trend just like they showed with Kay Allen.

WillyWanker
109
Points
WillyWanker 03/08/14 - 02:55 am
5
1
Get ready taxpayers. Bent

Get ready taxpayers. Bent over yet? After the wheeling and dealing,wineing and dining, back room nods, and checking with attorneys that all is in order, you're going to be footing the bill.

seenitB4
97713
Points
seenitB4 03/08/14 - 08:55 am
4
3
They need to take their time

Why rush...this is very important.

It seems the people in the know are pointing toward University...

Riverman1
93813
Points
Riverman1 03/08/14 - 08:56 am
10
3
Sure It's Confusing...Keep A Hands Off Position

GardenCity1 summarizes what I’ve been saying. Let the three entities apply for their CONs with the county backing each of them or backing none. Where did this idea come from that the county had to decide which one to support? Is it related to two of them wanting county money? The county should not contribute partial funding.

Keep in mind, when the goal of University is for the county to contribute tens of millions, they will find ways to have their position supported. Follow the money always.

Because I point that out, it does not mean I’m against University applying on its own merits. They teach residents and that can be used for a loophole if they want, although I don’t think the loophole theory is accurate. As far as interests outside the county controlling the hospitals, all three have that negative aspect. University is owned by Richmond County when you cut through the subterfuge, GRU is state owned and Doctors is private.

Tell those who want the county money no and see what happens. If the two hospitals requesting partial county funding want to continue, great. The county should take a hands off approach and let whichever one wants apply for the CON and fund its hospital.

crc
156
Points
crc 03/08/14 - 09:05 am
6
1
Apples, Oranges and Pears

The question should be, what does Columbia County need? We have 3 bidders with 3 very different plans. I don't think they should rush into anything but the more time it takes, the more time there is for the decisions makers to be "persuaded". I agree that letting the free market work it out is the best option and leaving the government out of it as much as possible.

ColCo
927
Points
ColCo 03/08/14 - 09:23 am
4
1
Think of it another way

Which is better for the long term benefit of the county, a hospital or a hospital that will become an economic engine for our community? All three entities are qualified, all three can do the job, all three have their drawbacks and problems. They all want to deliver a higher standard of patient care, but just this week I had two friends have negative experiences at two of the three hospitals, one at a facility that proudly advertises short emergency room waits. Their name was taken by the 30 minute mark, which I guess satisfies the advertised wait time, but then waited four hours for a doctor to see their sick family member. The other was at a facility that according to Dr. Stocks makes it's decisions locally. A family member was in ICU, was trying to pull out their drain tubes and IV's and get out of bed. The family had to physically restrain the patient for twelve minutes before an ICU nurse bothered to assist. What happened to one on one or one on two nursing care in the ICU? Azziz is obviously the villain at the third, but if you remove Azziz and his personality from the equation, which proposal is better? He won't be here forever, but the facility will. I don't envy the commissioners this decision, or the county the lawsuit that is sure to follow from the two institutions that are not chosen.

Stunned 2
6296
Points
Stunned 2 03/08/14 - 09:39 am
6
2
Here's an Idea: Biggest Revenue potential

Compare the clientele that each serves and the needs of most of Columbia County's citizens. If one serves more Medicaid patients - strike it out. CC doesn't need to attract more people that live off the government dime and their visitors. Columbia County is already in the hole for over $80,000 because of the former Tax Commissioner - Plus, no telling how much CC citizens might be facing in a wrongful termination lawsuit related to that big mess. (I hope that guy would sue his former boss & leave the taxpayers out).

soapy_725
44121
Points
soapy_725 03/08/14 - 09:49 am
1
0
The decision is how much each has for "under the table $$$"
Unpublished

The decision is how much each has for "under the table $$$"

soapy_725
44121
Points
soapy_725 03/08/14 - 09:50 am
1
0
CC commissioners/CC building contractors need a new hospital
Unpublished

CC commissioners/CC building contractors need a new hospital

soapy_725
44121
Points
soapy_725 03/08/14 - 09:51 am
1
0
These hospitals are already struggling with empty beds&overhead
Unpublished

These hospitals are already struggling with empty beds&overhead

soapy_725
44121
Points
soapy_725 03/08/14 - 09:58 am
1
0
Every time I see XX Cross is get sick. Wasted voting process CC.
Unpublished

Every time I see XX Cross is get sick. Wasted voting process CC.

soapy_725
44121
Points
soapy_725 03/08/14 - 09:59 am
1
0
A great and wise leader because he can spend other's $$? NOT
Unpublished

A great and wise leader because he can spend other's $$? NOT

justputtin
1527
Points
justputtin 03/08/14 - 10:09 am
3
2
Really?

" I think the community itself is trying to decide what is best for columbia county". Uh, yeah, we are. Putting our trust in this group making decisions is scary. I hope they make the right choice.this group has the same mindset as the potus. We the people elect you guys to make decisions that WE elected you to do but WE don't know what's best for us.

seenitB4
97713
Points
seenitB4 03/08/14 - 10:09 am
2
3
stunned

I bet they are thinking about that..

Compare the clientele that each serves and the needs of most of Columbia County's citizens. If one serves more Medicaid patients - strike it out

Gardencity1
92
Points
Gardencity1 03/08/14 - 10:43 am
4
2
Stunned 2

If you looked only at profit then the clear winner would be Doctors Hospital, or maybe GRU since the hospital does apparently fund a large portion of the budget for the University before they show bottom line earnings. So the clear winner would be Doctors, but that money goes to shareholders. If it's just Medicaid you are looking at then GRU would lose because children's hospitals often have a huge number of Medicaid patients. University touts strong income off of their investments, which lead to another question. The foundation was built off the backs of Richmond County taxpayers....remember when part of your property taxes went to University as Richmond counties indigent hospital? Perhaps citizens of Richmond county would sue to get this money back since it would clearly be used at some level, even small level, to fund hospital care in Columbia county. As far as the biggest positive economic impact that would clearly have GRU as the winner by number of employees, salaries, local investments, area sponsorships et cetera. I guess you would want to evaluate other measures that might give your personal favorite an edge over the other two. Bottom line is smaller government is better. Let the market determine the winner.

Dixieman
17425
Points
Dixieman 03/08/14 - 11:20 am
6
2
Dixieman doesn't like...

...politicians making economic marketplace decisions. I say let anyone build any hospital anywhere they like. If they succeed, good for them. If they fail, tough luck -- but it won't cost the taxpayers anything. Why does government at ANY level have any say in this decision???

Sweet son
11651
Points
Sweet son 03/08/14 - 11:28 am
4
2
Riverman is right as usual!!!!

Where in the world would anyone think it advisable for a county commission to be bartering with hospitals. Let the CON people and the three Hospitals work it out and look to the CON people for a nod and also a recommendation!

Stunned 2
6296
Points
Stunned 2 03/08/14 - 11:51 am
2
3
LOL! I was using sarcasism. Unwind..take a breath....

I haven't looked over any current financial or service records for any of these hospitals. I remember that (many years ago) University Hospital was receiving funds for indigents from governmental sources as the 'County Hospital' and could not 'refuse a patient based on their ability to pay'. But, I don't know if GRU is seeing more Medicaid patients these days or if University Hospital is. I was actually thinking like Dixieman: Give them all a chance & let them battle it out. But, I think that GRU receives a lot of Taxpayer monies to operate - so, governmental officials will probable be in the mix in the decision making.

IBeDogGone
3015
Points
IBeDogGone 03/08/14 - 12:15 pm
2
4
3 choices

I work in the medical field in my opinion there are pro's and con's for each hospital. GRU my have the funds but generally their physcians are not committed to the community for long periods. They are here to train and get certified in a specialty. A physcian group that is hospital based certainly has very little to say in the day to day operations. Doctors has deep pockets and very good providers but like GRU local decisions can be lenghthy. University will require tax payers dollars and will see Medicaid patients like both of the other hospitals. Indegent care is just a fact of life, while many of Doctor's providers do not see Medicaid patients many do. You would be suprized at the number of Medicaid Babies born at Doctor's. As far as University receiving payment for indegent care I can promise you they did not get rich because they were reimbursed at Medicaid or Medicare rates.

I guess my vote would have to go to University because I believe they have the most committed Doctors, this is evident in the number of surgery centers and urgent care centers these Physcians have built in Columbia County. More of these Doctors are heavily involved in the community in areas other than healthcare showing me their presents will be around for quite a while,

pja5529
2726
Points
pja5529 03/08/14 - 12:23 pm
2
2
GRU

I think the commission secretly wants GRU but is afraid they may get backlash. In honesty as far as money goes, it would be better for GRU to build seeing as though they say it wont' take any county funds....plus it appears they will be staffing more people meaning more jobs. BTW Unversity is my main hospital of choice when it comes to my own personal care but I think all facilities do a good job.

puppydog
228
Points
puppydog 03/08/14 - 04:51 pm
0
1
MCG/GRU is the best choice

For one thing, MCG/GRU has the best chance of meeting the CON exceptions. They have the education component, they are a trauma center, they do not require any county funds , they will provide more jobs, more facilities, more amenities. Dr Azziz should not be factored into
The equation. There was an article in
The AC a few months ago stating that University was having a lot of financial difficulties and was looking for solutions. I don't think they are in a solvent enough financial position to
Add on another facility. I am sitting in
The hospital room right now with my mother at University and the parking deck is about empty right now and they are very short staffed nurse wise and patient care wise. We have been here for a week. My sister & I have been taking turns staying here with her around the clock because they are short staffed due to budget constraints. I do not think they are in financial position to take on an additional hospital. I can guarantee you if they were to, this hospital down here would close down because in addition to the CC residents going to University's new CC hospital, a lot of the patients from RC will also venture to the new CC hospital and this one will be left for the Medicaid patients, which cannot possibly support a hospital. Doctors isn't a wise choice, so MCG is the best choice for a lot of reasons.

puppydog
228
Points
puppydog 03/08/14 - 05:19 pm
4
2
Dr Stocks opinion is not objective

Dr Stocks mainly practiced at University so I do not feel he has an objective opinion. He is biased toward University

puppydog
228
Points
puppydog 03/09/14 - 10:33 pm
0
1
what happened to my 1st comment yesterday?

I typed out a long comment yesterday but AC did not publish it. Why?

puppydog
228
Points
puppydog 03/09/14 - 10:41 pm
0
1
MCG/GRU has best chance of a successful CON

MCG/GRU would have a better chance of getting approval from the state of GA for a CON. They meet several of the exceptions- educational institution, trauma center, etc. Also they will foot the whole bill and CC will not have to contribute. More jobs would be created and more more amenities. If University were to try to get it, I believe the state would turn down the CON (as they did a few months ago when University tried to get approved to build an emergency room in CC). University is already having financial difficulties based on a recent article in the AC. If they add another hospital in CC, I think the current UH would go the way of the dinosaur. CON would probably not be granted as they can't even keep their current hospital full or in good fiscal shape. MCG/GRU is the obvious choice. Dr's already has one on the borderline of CC so that wouldn't even make sense. I hope CC makes the right choice so they will have the best chance of getting the hospital approved by the state. Obvious choice is MCG/GRU.

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