Proceed with care

As Columbia County pursues its first hospital, be aware of the accompanying problems

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We support Columbia County’s desire to have its own hospital.

As the fastest-growing county in the Augusta metro area – and the largest hospital-free county in the state – it appears to be ripe for a full-service health-care facility.

But there are at least two problems with the process required to fulfill that dream. One involves needless red tape. The other has to do with one of the aspiring hospitals.

First and foremost is that, to get someone to develop a hospital, the county must contort its way through the bureaucratic hoops of the state Department of Community Health’s “Certificate of Need” program, which dictates where medical facilities can operate based on its own criteria of “need.” Such programs, known nationally as CONs, are unnecessary in a free-market economy where consumers, not the government, establish the need for goods and services.

Three Augusta health systems are bidding for government permission to build in the county: Doctors Hospital, Georgia Regents Health System and University Hospital.

Again, why is “permission” even needed? What happened to free markets determining where business services, health care or otherwise, are most needed? Thank goodness there’s no Georgia Department of Auto Retailers. Car dealers might have to ask, pretty please, for state certification before expanding to a second location.

While the state will do what it will, Columbia County consumers, the people who actually would end up using the facility, at least will get the chance to have their voices heard. An 11-member citizen committee appointed by the Columbia County Commission will help evaluate the three bids and make a recommendation to the state.

Sadly, there are no CON public hearings, but residents are free to write directly to the state and have their comments become part of the public record.

If there ever was a time for Georgia’s CON program, it passed years ago. The program, and three dozen others like it across the country, is a remnant of a 1970s federal mandate that expired in 1987. Georgia, which decided to continue the Certificate of Need program after the mandate expired, has tweaked the program as recently as 2008.

Ideally, Georgia would join other states, such as California, Texas and Pennsylvania, in repealing it altogether.

CON laws restrict competition. The first health system to win approval to operate in a small or mid-sized population center is essentially granted state-sanctioned monopoly power. If such laws had been around in the 1950s and 1960s, Augusta’s downtown medical district would not have grown into the robust industry it is today.

And if Georgia would have let the program die in the 1980s, Columbia County probably would have had its own hospital by now.

CONs are a complex issue, no doubt. Advocates say health-care services are not like other products, and they do not obey the same kind of market forces. We’ve heard those arguments and many more. But it inevitably comes back to this: There is scant evidence that state-sponsored programs actually reduced health-care costs or improved the delivery of service during their 40-year-run.

Consumers all want the same thing from the health-care industry: quality care, convenience and lower costs. A competitive free-market system, not government planning, is the best way to fulfill those needs.

A second major concern with the CON process is the bid by the Georgia Regents University-affiliated health system, the last of the three to submit a proposal. Its ties to a state institution arguably creates conflict-of-interest issues in a contest whose referee is a sister state agency. We are concerned that the health system, which grew out of the 1950s-era Medical College of Georgia-owned teaching hospital, holds an unfair advantage because of its state backing.

The health system is, on paper, a private corporation. But it has been intertwined intricately with the university since 2010, when it was brought back into the government fold under the authority of newly installed university President Ricardo Azziz. System revenues, though separately accounted for, flow into university operations, and many physicians in its employ are on the state payroll as professors and administrators.

Just last year, the Georgia Supreme Court ruled in Shekhawat v. Jones that Georgia Regents Health System physicians are granted state immunity in medical malpractice lawsuits because they act “within the scope of their state employment in rendering the medical care.”

Georgia Regents Health System seems more government than not.

Though state Department of Community Health officials disagree Georgia Regents has any unfair advantage, we fear an uneven playing field and a real potential for conflicts of interest in this already-flawed bidding process.

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Riverman1
93862
Points
Riverman1 01/26/14 - 06:39 am
4
2
Make Your Own Way To The Klondike

This editorial is informative and avoids some of the false information of past articles. It also points out, as I’ve been saying, the CON process has been eased in recent years (2008). Columbia County has a large, fast growing population that is only going to grow faster with the Cyber Command on the way. The hospital will be a tremendous economic engine. Using the knowledge I have of other hospitals’ profits and what’s public knowledge, I’ll predict this hospital will bring in profits of over $50 million a year with the Columbia County, health insurance paying, demographics.

I agree GRU should not have an advantage because it’s a state institution. None of the three should have have an edge. Plus, what’s to stop the profits from the hospital being sent back to GRU downtown to please Azziz? University also is a Richmond County hospital and they could shift the profits back to their downtown operation. Doctors is private and its profits go to the owners.

My advice to the committee is NOT to give either hospital 20% funding in the misguided belief that a loophole is needed to obtain a CON. Let the CON process play out without Columbia County money. In fact, ensure a good percentage of the profits will only go to the Columbia County hospital to enlarge and improve its services over the years. Do not allow the profits to end up funding University or GRU in Richmond County. With privately owned Doctors stipulate the same requirements. Get it in writing from all of them.

Don’t be misled as many are that the only way to obtain approval is by using a loophole and use tens of millions of county money. This hospital will be a Klondike gold mine. Let them do their own digging.

ralphinga
1878
Points
ralphinga 01/26/14 - 11:05 am
3
2
Town vs. Gown

The editor of the Augusta Chronical laments the " conflict of interest " that may result from one state agency judging a contest that includes the only state funded medical school. This editorial totally ignores the reality of the CON legislation. The CON requirements give extra credit to teaching hospitals. To say a state agency may be biased in favor of the only state medical school is no different than saying the Chronicle does not have a favorite in this "competition". The Chronicle has already published " exceptions to the state’s need requirement. The three that would apply are: if the new hospital is part of an existing trauma center; if it is part of an existing teaching hospital; or if the county pays 20 percent of the cost to build it. None of those exceptions have ever been used in Georgia.". Now which facility meets some of these exceptions? Seems that the Chronicle is already operating in the 'sour grapes' mode.

jbtpt
16
Points
jbtpt 01/26/14 - 11:55 am
2
2
Typical Bias

Not surprised the chronicle is resulting to fear mongering to try to skew the selection process by using selective reporting....and "free markets" in healthcare... really?? yeah...that works to line the pockets of corporate elitists...surely that's not what the chronicle is advocating at the expense of the poor and underserved in our communities.

Gardencity1
92
Points
Gardencity1 01/26/14 - 12:48 pm
1
2
Seriously?

Did anyone read the proposals made by University Hospital and GRU, both of which have been shared publicly online? I still don't know why Doctors Hospital hasn't shared their document. Perhaps there is some sort of secret sauce in their document. GRU's proposal doesn't ask for anything from the county and offers a much more comprehensive facility than University's proposal. It's a no brainer. I guess the Chronicle thinks we are all idiots as pointed out by Ralphinga's comments. The exception is for an existing teaching hospital or an existing trauma center. These clearly give the advantage to GRU, because the other hospitals don't meet these guidelines. Columbia county will have one chance to get a hospital under these exclusions and if I was a betting person I would put my money on GRU since they could meet each exception. It is also clear that GRU could file for a CON today, or after a partner is chosen by the county since they meet the exceptions and don't need $ from the county. The RFP is clearly for political purposes only and are not needed by GRU. Did anyone notice that the GRU proposal also indicates that they could take on a minority partner? If this results in a change to for profit status, which will generate additional revenue, then it would be political suicide to not recommend them in such a heavily Republican county.

KasparHauser
368
Points
KasparHauser 01/26/14 - 01:25 pm
0
0
Same Old Line
Unpublished

See that the AC buys into the party line that the community's health should be governed only by the free market, where free market actually means a market set up to benefit, and controlled by, people like the AC editorial staff.

Good thing there are also adults in the room who realize that the country is best served by a population of health taxpayers instead of a 'throw them out the back of the sleigh' predatory society. Wonder which is the true Christian ideal, too, assuming a reasonable interpretation of Jesus' message and not a tortured, pound-to-fit/paint-to-match exercise in GOP rhetoric, which is what seems to be the only belief system allowed insde The Bubble, anymore?

I remember Bill Buckley sneering about The Hive Mind of the 1970s Lillian Hellman wing of the Democratic Pary; that's the GOP, nowadays, except I'm sure the GOP inmates find bees too Hug a Tree to acknowledge they exist.

And, what about that paragon of GOP rhetoric and ethics, D'Souza?!!

Same old....

Riverman1
93862
Points
Riverman1 01/26/14 - 02:49 pm
2
0
@GardenCity

GardenCity makes some good points about the advantages of GRU. I don’t think the Chronicle was slamming GRU as much as they were lamenting about the whole CON process. It is a tool for behind the scenes, bureaucratic dealing. Those of us in the CSRA know how that works out with the Board of Regents.

I hear vague references to a loophole being necessary, but when I try to pin it down, close as I’ve gotten is someone has been told by a few that they’ve had experience with the CON process. Not disputing their word, but it certainly wasn’t for a hospital CON around these parts. Columbia County had a previous ruling on a free standing emergency room, something that hasn’t been approved anywhere in the state.

Let’s sum up again about the two loopholes if the committee believes that’s the only way although there is absolutely no evidence that’s the case. The county contributing 20% is so absurd I won’t even bother with it.

1. A teaching hospital. GRU certainly is one. University trains residents and possibly could use that.
2. A trauma center. GRU is one and Doctors will be soon.

Thus it appears all three can use one of the loopholes. The main concern for the county is to ensure most of the profits are reinvested in improving the hospital in Columbia County. As they bring in tens of millions in profit, that’s something they shouldn’t mind doing.

Esctab
1238
Points
Esctab 01/26/14 - 03:19 pm
0
0
Gardencity1, Doesn’t your

Gardencity1,
Doesn’t your statement that - “The RFP is clearly for political purposes only and are not needed by GRU” - confirm rather than refute the conflict of interest concern expressed by the Editorial Staff?

Additionally, since there has been no public announcement of Azziz leaving, the GRU proposal can only be viewed under the assumption that a GRU hospital in Columbia County would be under his thumb too. Since Azziz considers all GRU-related resources to be there for his plundering, good luck with ensuring that things will go according to “the plan.”

Gardencity1
92
Points
Gardencity1 01/26/14 - 04:03 pm
0
0
Esctab

The point I was making about the RFP is that GRU appears to meet all of the exceptions, therefore would be in the best position to get the CON versus the other two proposals. I believe it is political from a commission point of view. The proposal is clearly a better proposal but they may be concerned because of the Azziz baggage to have picked them outright. You are correct that all things report to Azziz, but my understanding is they have a different CEO of the hospital and a different board of directors, so I would imagine that he has less control of the hospital piece compared to MCG/GRU. Most boards will do what is best for the organization and won't approve any crazy actions. It seems like most of the volatile things Azziz has done have been around the university. I will be surprised if anyone gets the CON in the end because it may impact other counties in the state and it's easier to keep the status quo. The decision is made by politicians and not the residents.

Esctab
1238
Points
Esctab 01/26/14 - 05:16 pm
1
0
Gardencity1, Here are two

Gardencity1,

Here are two current GRU titles:
(1)Ricardo Azziz, President of GRU and CEO of Georgia Regents Health Systems;
(2)Steven Scott, Vice President and CEO of Georgia Regents Medical Center

Who knows what any of the current titles listed above mean to Gov. Deal and the Board of Regents. However, the current employees of GRU know all too well the amount of dysfunctional control Azziz has over both the university/academic side of things and the health care provider side of things; he has proven himself volatile to all.

Riverman1
93862
Points
Riverman1 01/26/14 - 06:56 pm
2
0
Azziz Is In Charge All Right

Oh, I have no doubt that Azziz has firm control over MCG and the hospital. He's still seeing some patients there, I believe. He came here to head MCG. Listen to people who work there talking about his control. But his control only makes it more important to have in writing that profits will be mainly reinvested in Columbia County...if GRU is chosen.

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