Petitions could hurt hospital
Petitions to keep North Georgia Medical Center open with an operating room and overnight patient privileges have been delivered to the Health Care Facility Regulation division of the Department of Community Health, but it may be too little too late.
In fact, the petitions – over one dozen in all – may cause the Ellijay hospital to cut services sooner instead of benefiting from a lease agreement that would allow Piedmont Mountainside Hospital of Jasper to run the emergency room, the North Georgia Medical director said.
“While I think everybody that has contested this has a good heart – they just want to keep the hospital (open) – in a downward way it’s a hindrance because nothing’s going to happen now for six to nine months (and) we can’t wait that long,” said Earl Whiteley, chief executive officer of the Ellijay hospital. “The situation with Piedmont may be the best approach that can be done. We need patients, or someone coughs up some dollars.”
Chuck Scragg, director of the local Joint Development Authority, said the process of stopping the transference of the certificate of need from North Georgia Medical Center to Piedmont Mountainside could be lengthy.
“Piedmont has 10 days from which to answer (the petitions), and they will send a written letter to each one of the entities or persons that filed a complaint,” he said. “Piedmont sends the answer back to Community Health, they send it back to the signatories, who then send it back to Community Health and then it goes back to Piedmont. We could bounce like this for up to 60 days.”
Scragg said several Gilmer County citizens filed complaints aside from the authority, totaling 14 petitions in all.
“(Community Health) could say, ‘Let’s get together and try to resolve this,’ ” he said. “(Or) they could just say the complaints have no merit and we’re going to approve (the certificate of need transference) ... They may want to move this up to a full-blown certificate of need hearing. So there’s where we’re at.”
The hope for a hearing is not to shut the hospital down, but to “find out the details of the deal.”
“Again, there’s nothing wrong with Piedmont or SunLink (Health Systems, the owner of North Georgia Medical and Gilmer Nursing Home),” Scragg said. “It’s just that we don’t know the ramifications of everything in this deal – and that’s what we want to know. That’s no aspersions on anybody or any other organizations, but we’re really in the dark here and just want more information.”
Needed: paying patients
However, Whiteley, who has been sounding the alarm about the failing financial health of the hospital for months, needs only one thing — paying patients. He said without an immediate influx of cash — which any hearings would stop Piedmont from providing — the Ellijay hospital will have to begin cutting services. Even the emergency room.
When asked about the hospital Monday, Whiteley said it was “halted.”
“I’m going to have a chat with some of the people involved (who petitioned),” he said. “It’s my understanding that this thing could be dragged out and protested by a lot of people for maybe six to nine months. We can’t live that way since we’re losing money. Something’s got to be done. We’ve got to cut services or whatever.”
Gilmer Nursing Home is not affected by the potential lease agreement between North Georgia Medical and Piedmont Mountainside. In fact, SunLink has plans to remodel and even expand the facility.
Whiteley was asked what he would like to see happen as a result of the certificate of need being challenged so strongly.
“Some of the people that contested it, I think they had the wrong comparison,” he said. “They feel like it’s business as usual, or we lose our hospital. That was perpetrated, or kind of assumed, out there. But in reality, what the issue really is, is Piedmont (coming in) – or closure.
“I’ve got to possibly cut services right now, but when you have fixed expenses and a lot of our agreements are 90-day-outs, and when you only have three or four patients in here it kills you. I’m looking at possibly cutting the emergency room and putting a clinic in there in the daytime and getting rid of the EMTALA law (Emergency Medical Treatment and Labor Act, which ensures access to medical care regardless of the ability to pay).”
How could Whiteley accomplish scuttling the indigent treatment law?
“A hospital does not have to have an emergency room to keep its license, to keep its (certificate of need), to keep the feds and the state happy,” he said. “What we’re trying to do is to cut expenses to still keep a hospital here in terms of its license, its (certificate of need) and protecting employees and other aspects.
“I want to be transparent as possible about all this.”
Piedmont Mountainside said in its “request for determination” document of the certificate of need transference, “(SunLink) intends to close (NGMC) and cease offering all short-stay hospital services, including emergency services, in that facility. Such a closure will leave a troubling gap in the provision of emergency healthcare services to ... Gilmer County.”
An online Jan. 24 article in Georgia Health News (georgiahealthnews.com) stated, “The plan in Ellijay could resemble the stand-alone (emergency room) idea pushed by Georgia Gov. Nathan Deal two years ago as a strategy to help financially struggling rural hospitals.
“One major drawback for freestanding emergency departments, as they were proposed in Georgia in 2014, is that they would not qualify for as much reimbursement as hospitals receive. Freestanding (emergency departments) would not be able to bill Medicare or Medicaid at hospital rates, but would have to bill those programs at a lower ‘provider’ rate, or as hospital outpatient clinics.”
Kaleb McMichen, spokesman for Georgia House Speaker David Ralston, cited federal government policies as an impediment to rural hospital success.
“Under President Obama’s administration, actions at the federal level have driven up the costs of healthcare including deductibles and premiums of commercial health insurance policies, as well as the state’s portion of Medicaid spending,” he said. “Unfortunately, many hospitals and doctors across Georgia, particularly those in rural areas, are struggling to cope with these changing financial realities.
“As recently as last week, Speaker Ralston has said time and again that maintaining access to high-quality healthcare for Georgia’s citizens is a priority. He remains engaged with stakeholders and is working with them to find the best of available solutions to preserve access to hospital care in Gilmer County.”
Georgia Health News reported that state hospitals have lost $400 million in federal indigent care since the Affordable Care Act was implemented. In 2014, North Georgia Medical provided more than 15 percent of its adjusted gross revenue toward caring for indigent patients.