Finding another way

County has prescription to cure bureaucratic block on hospitals

  • Follow Editorials

The irony is enough to cause cardiac arrest.

In blatant disregard of the free market, Georgia’s Certificate of Need requirement (coincidentally abbreviated as CON) allows the state Department of Community Health to imperiously decide where certain medical facilities can be built, no matter where private or public funding otherwise would build them in response to consumer demand.

That includes hospitals, and back in January the DCH decreed that neither Doctors Hospital nor University Hospital, headquartered in Richmond County, could step into hospital-less Columbia County to build free-standing emergency rooms.

That’s despite the fact not only that Columbia County is the largest county in Georgia without a hospital, but it flies in the face of free-market economics for there to be an arbitrary restriction on the number of any enterprises that investors can undertake.

But here’s the irony: Columbia County officials believe they’ve found a way to bypass the DCH and its market-restricting regulations – but it involves using public money.

Here’s how it works. The CON law includes a provision
allowing a county to apply for an exception “if the facility is an existing teaching hospital,” or if “the facility is a sole community provider” – and the county itself provides more than 20 percent of the capital for the project.

So, it seems, Columbia County hopes to circumvent the DCH restrictions on the medical free market by priming the pump with public funding – thereby also finagling with free enterprise. A request for proposals to that effect is drawing significant interest from the major medical players in the market, each of whom want a bigger footprint in the lucrative Columbia County market. Taxpayer funding would be the icing on the cake.

Indeed, University Hospital’s board voted last week to pursue a proposal to build a $150 million hospital in Columbia County.

The good news is that the ends seems to justify the means, for a couple of reasons. The most obvious, of course, is that Columbia County can make an excellent argument for needing its own hospital.

With one of the state’s fastest-growing populations – more than 135,000 people now call the county home – it makes as much sense for the county to have more major medical facilities as it does for it to have more stores and restaurants to service that population, as dictated by the free market.

In addition, that proposed government funding toward a new hospital, roughly one-fifth of the total cost or an estimated $30 million or so, would come from the sales tax. That means Columbia County voters next year would have the opportunity to approve or reject the proposal based on whether they agree or disagree with the request for the use of their money.

County officials, then, have a two-fold obligation: first, to look out for the best interest of the county by pursuing top-notch services for their citizens; and then, to spell out why taxpayers should invest their money in vital community services that, if not for a monopoly-protecting bureaucracy in Atlanta, would attract funding for those services without their help.

Any irony aside, that’s a debate worth having.

Comments (25) Add comment
ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Posts and comments do not reflect the views of this site. Posts and comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Flag as offensive" link below the comment.
Riverman1
81498
Points
Riverman1 12/26/13 - 06:49 am
5
3
County Contribution Not Needed

I have a point about whether Columbia County would receive a CON for a hospital. Some seem to think it wouldn’t since a free standing emergency room was turned down. I disagree. A free standing emergency room is such a new and different idea, that I believe it’s much more difficult to receive a CON for this questionable innovation. GA and SC have NOT APPROVED ANY. So it’s a stretch to say because the stand alone ER was turned down that a full hospital wouldn’t be approved in one of the fastest growing counties in the nation.

The trend is away from CON review for hospitals. In 2008 Georgia law streamlined the CON process, exempting more hospital projects from review. I feel certain a hospital would be approved.

Some are far too ready to throw tens of millions of dollars at this thing when it is very likely, not a dime of taxpayer funding would be required. It appears the local hospitals are already jousting about which one gets the prize. Hospitals covet the high income populations who have insurance.

Let the hospitals pursue the CON before we start talking taxpayer money. There is little reason for the state not to grant a CON for a HOSPITAL in Columbia County with its fast growing population continuing to shift away from Augusta.

Little Lamb
44971
Points
Little Lamb 12/26/13 - 10:32 am
3
2
Exactly

Riverman took the words right out of my mouth. The facilities (one proposed by Doctors Hospital and one proposed by University Hospital) that were rejected by the Department of Community Health were stand-alone emergency rooms, not full-service hospitals.

Now we see that University Hospital has proposed a small, full-service hospital for Columbia County. They should be allowed to submit that proposal to the Department of Community Health as a non-governmental project first. Only if the Department of Community Health rejects University's proposal should Columbia County government come to the rescue.

Little Lamb
44971
Points
Little Lamb 12/26/13 - 10:41 am
2
2
Some other observations:

It is kind of silly to talk about "the free market" and "health care" in the same paragraph. State governments have been regulating much of the health care industry for over a hundred years; and, with the passage of the Affordable Care Act, the federal government took over the rest of it.

It is also silly to make hay about Columbia County being the largest county in the state without a hospital. Let's face it, somebody has to be at the top of the list. As soon as Columbia County gets its hospital, then some other county will automatically become the largest county without a hospital. The designation is meaningless.

So Ron Cross and cronies propose to fund the county's “contribution” from SPLOST money. Well, of course SPLOST money can fund construction costs and investment in equipment; but I would guess that the county would be on the hook for continuing operation expenses of the hospital, and these cannot be paid for by SPLOST money. Operation and maintenance costs must be paid from the general fund.

countyman
19545
Points
countyman 12/26/13 - 12:28 pm
1
4
Where is this magical shift

Where is this magical shift away from Augusta?

Riverman1
81498
Points
Riverman1 12/26/13 - 12:35 pm
5
1
Ask the Richmond County Hospitals

Ask the Richmond County hospitals. They are the ones trying to open a hospital in Columbia County.

But, Countyman maybe you are right. We have schools closing every day in Columbia County because there just aren't enough students. We have empty houses boarded up and the income level of the residents is dropping so fast pretty soon all the kids will be given free lunches and breakfasts. The woods are gradually taking over former neighborhoods as the population shifts into Richmond County school districts.

harley_52
22831
Points
harley_52 12/26/13 - 02:10 pm
2
0
"Where is this magical shift away from Augusta?"

Aside from Riverman, is anyone suggesting a "magical shift away from Augusta?" Is it a zero sum game? Why can't Richmond County hospitals continue operating at full speed, even with the addition of a hospital somewhere in Columbia County?

I doubt Richmond County hospitals are offering to open a hospital in Columbia County because they FEAR the competition. I suspect they are astute enough to look at population trends and have become convinced there's enough sick people to go around.

Riverman1
81498
Points
Riverman1 12/26/13 - 02:38 pm
2
1
Whoa, My Comment Was This...

"There is little reason for the state not to grant a CON for a HOSPITAL in Columbia County with its fast growing population continuing to shift away from Augusta."

Everyone who is honest knows Columbia County is growing by leaps and bounds. It just so happens the growth continues to take it out from Augusta. It's toward Grovetown and out Columbia Rd toward Appling. That was my point. Countyman read too much into that comment. I really wasn't trying to slam Richmond County.

Sweet son
9988
Points
Sweet son 12/26/13 - 03:05 pm
4
0
The 'coveted' hospital is just that because most of those

seeking medical attention in Columbia County would actually pay with private insurance!

Loved the 'tongue-in-cheek' Riverman prepared for countyman!

David Parker
7923
Points
David Parker 12/26/13 - 03:34 pm
4
0
True stuff River, the folks

True stuff River, the folks going to a CC hospital will use a method of payment instead of "promise-to-pay". Whenever the word free-market is used it is profoundly important to distinguish the difference in one actually paying for service and the other promising the same. For me it's really simple. I see no advantage in driving to another county for hospital care. I see no advantage to paying into another county's hospital system. I see alot of benefit in having hospital service within our county and establishing itself in our economy. I see plenty of benefit in letting capitalism work and building to accomodate the folks who make the capital. The use of tax is a fail but aside from that, it's about time.

Riverman1
81498
Points
Riverman1 12/26/13 - 04:24 pm
3
0
David, exactly. University

David, exactly. University Hosp. is the Richmond County owned hospital that works through a convoluted system appointed by the Richmond County Commission. Why wouldn't Columbia County want to keep the profits made from THEIR taxpaying, insurance paying residents? The big problem for Richmond County is what happens when they lose the insurance paying patients from Columbia County?

harley_52
22831
Points
harley_52 12/26/13 - 04:44 pm
2
0
"True stuff River, the folks going to a CC hospital...

....will use a method of payment instead of "promise-to-pay". "

Please be kind enough to explain that comment. Please help him out, Riverman, since you seem to agree.

harley_52
22831
Points
harley_52 12/26/13 - 04:50 pm
2
0
"I really wasn't trying to slam Richmond County."

Indeed.

Maybe you can explain this non-slam...."It just so happens the growth continues to take it out from Augusta."

Count me as one of the "honest" ones who freely admits Columbia County is growing. Matter of fact, count me as one who is happy about such growth and as a matter of further fact, count me as one who is part of that growth.

What I don't understand is....1) your assertion that Columbia County's gain is at the expense of Richmond County and 2) the relentless "theme" you posit that Richmond County is a horrible place to live.

David Parker
7923
Points
David Parker 12/26/13 - 05:20 pm
2
0
Harley, you're a smart cookie.

Harley, you're a smart cookie. You'll get it. Read it again.

David Parker
7923
Points
David Parker 12/26/13 - 05:29 pm
3
0
the relentless "theme" you posit that Richmond County is a horri

I think it's more along the lines of Col. County just does things alot better with better outcomes. ARC is disfunctional at the city gov level unless it's got something to do with someone unloading some land or making a windfall of money. That aside, they can't accomplish much in an efficient manner. There's an element of crime that from the outside looking in, appears to be growing faster than LEO reserves. They lost their baseball team for pete sake.

With regard to losing in ARC when winning in CC, if the ARC hospitals had to make due with just the ARC folks and the CC folks paid into a CC hospital, it does directly take from one and provide to the other. Just a fact sir.

john
934
Points
john 12/26/13 - 05:29 pm
3
0
harley

percentage of insured vs non insured/medicaid etc. is probably higher in CC. They will get paid more and have to eat less.

harley_52
22831
Points
harley_52 12/26/13 - 05:31 pm
2
1
"Read it again."

I did. I still don't get it.

If you're suggesting operating a hospital in Richmond County is a bad idea from a business perspective, I'd suggest you drive along Wrightsboro Road from Daniel Field to Walton Way.

Augusta doesn't have a booming medical industry because hospital CEOs are stupid.

harley_52
22831
Points
harley_52 12/26/13 - 05:38 pm
1
2
"Just a fact sir."

No, it's a series of biased, short-sighted opinions.

The Augusta metropolitan area is not unique in the mechanics of population trends in and around an older, developed, city center versus relatively newer, suburban residential communities. It happens everywhere.

Problems with local government, problems with crime, problems with neighborhoods going "downhill" as they age....none of these things are unique to Augusta.

harley_52
22831
Points
harley_52 12/26/13 - 05:52 pm
2
1
"percentage of insured vs non insured/medicaid etc....

....is probably higher in CC. They will get paid more and have to eat less."

Probably would be. Are you thinking all these medical facilities in Richmond County will pack up and move to Columbia County with the rest of the beautiful people?

As for "eat(ing)" costs, I'd be interested in hearing what that REALLY means. I don't think hospitals actually "eat" any costs. They find a way to get reimbursed instead of taking it out of the CEO's salary, I suspect.

corgimom
30364
Points
corgimom 12/26/13 - 07:52 pm
2
1
"Probably would be. Are you

"Probably would be. Are you thinking all these medical facilities in Richmond County will pack up and move to Columbia County with the rest of the beautiful people?"

Absolutely. Medicare and Medicaid don't pay nearly as much to doctors as does private insurance carriers.

Follow the money, the doctors will.

And then University will be "De Grady" of Augusta.

corgimom
30364
Points
corgimom 12/26/13 - 07:54 pm
2
1
"The Augusta metropolitan

"The Augusta metropolitan area is not unique in the mechanics of population trends in and around an older, developed, city center versus relatively newer, suburban residential communities. It happens everywhere."

Most warm-climate cities are growing at faster rates than Augusta. Any thoughts as to why that is?

SemperParatus
3225
Points
SemperParatus 12/26/13 - 11:37 pm
1
0
Who can tell me about

Who can tell me about indigent care? Right now Richmond County's University Hospital provides indigent care in the CSRA including indigent patients from Columbia County and even across the river in Aiken County and surrounding counties. I don't pretend to know anything about this issue but I have heard that it has been a sore spot for Richmond County taxpayers for many years!

corgimom
30364
Points
corgimom 12/26/13 - 11:51 pm
0
0
That is absolutely true.

That is absolutely true. However, if you look at how many people receive indigent care that live in RC, versus those who live in CC, you will understand my comment about "De Grady".

corgimom
30364
Points
corgimom 12/26/13 - 11:52 pm
0
0
Building a hospital in CC

Building a hospital in CC would be a terrible blow to Augusta and would just make CC even MORE desirable to live in.

corgimom
30364
Points
corgimom 12/26/13 - 11:54 pm
0
0
"The Augusta metropolitan

"The Augusta metropolitan area is not unique in the mechanics of population trends in and around an older, developed, city center versus relatively newer, suburban residential communities. It happens everywhere."

Except in places like Atlanta, which is actually gaining growth.

David Parker
7923
Points
David Parker 12/27/13 - 09:54 am
0
0
Consider actuality.

CC is growing and ARC is floundering in comparison. If you can't acknowledge that then your logic is flawed at the core. Banging out examples on my keyboard to connect the dots for each individual's understanding is pointless and very ARC-like. I, like CC, just try to advance forward in the most proficient manner.

Back to Top

Search Augusta jobs