FOCUS:  MUSC approves a turkey of an idea

MUSC’s Basic Science building.

By Lynn Bailey, special to CharlestonCurrentt  |  This week, I guess in honor of the turkey, the Medical University of South Carolina Board of Trustees approved a turkey of an idea:  the acquisition of four poorly-performing hospitals from Community Health Systems (CHS), a for-profit health company that is rapidly selling off its underperforming assets.

The hospitals to be acquired are:  Chester Hospital in Chester County, Springs Memorial Hospital in Lancaster County, Marion Hospital in Marion County and Carolinas Hospital in Florence.  Except for Carolinas Hospital in Florence, all of the hospitals are located in rural counties and are in serious danger of bankruptcy and closing.

Bailey

Additionally, CHS is unloading some more loser hospitals in the Upstate to Spartanburg Regional Health Center:  Mary Black Health System in Spartanburg and Mary Black Health System in Gaffney.  Spartanburg Regional Health Center is also a public health system controlled by Spartanburg County.

CHS must be thinking they’ve hit the “sucker” mother lode in South Carolina.  What are these S.C. health care systems thinking?  It looks like public-funded resources are bailing out for-profit private health systems, which was supposed to be the salvation of America’s health problems. A better deal would be to acquire these rural assets out of bankruptcy for pennies on the dollar.   Sounds to me like public corporate welfare based on extortion in the name of rural care, dressed up as rural health rescue!

MUSC unloaded its hospital years ago with the creation of the MUSC Hospital Authority.   Why does MUSC need more hospitals?  Poorly-performing hospital requiring significant investment in locations out of the neighborhood need expensive upgrades and are difficult or costly to serve. [If they were making CHS margin, they wouldn’t be for sale.] How exactly, then, does this acquisition of “loser” facilities serve the MUSC education mission of training future health professionals like doctors, researchers, administrators  and nurses?

It would be less expensive than to rescue rural health facilities for South Carolina to expand Medicaid.   We’d at least receive federal matching funds and provide coverage to more working low-income South Carolinians. We could rescue more rural facilities like in Edgefield. Williamsburg, Abbeville and Allendale counties, as well as The Regional Medical Center of Calhoun and Orangeburg counties.  It is too late for Fairfield Memorial, Marlboro Park, and hospitals in Bamberg and Barnwell counties.

The MUSC-acquired hospitals are still tied to their local governments.  CHS just leased the real estate.  CHS then assumed the operating license.  To transfer assets requires a two-year process and approval by county councils. The funds going from CHS for the original CHS acquisition have gone to community foundations to assist in providing care to low-income county residents.  Cost of care is Chester, Lancaster, Marion and Florence counties has not gone down.  If anything, it has increased. What happens to those resources?  This is complicated.

None of this requires public oversight.  It doesn’t require a Certificate of Need from DHEC.  It doesn’t require the oversight of the legislature or the executive branch.  It may require tacit approval of the governor or review by the Attorney General but mostly the AG or the governor really don’t care what happens in South Carolina health care.

MUSC and its affiliated Hospital Authority are undertaking some out-of-the-box projects like redeveloping abandoned retail space for outpatient focused care, moving off the Charleston peninsula and directing care closer to where patients live and work.  They want to construct a community hospital in Berkeley County to better serve patients from the Midlands and Upstate who need MUSC’s specialized care.  They are advancing telemedicine by connecting specialized services across the state to communities where patients lack transportation to get to Charleston for care.  Their students and residents do tours of duty delivering care in underserved communities.  There are many was to serve the underserved in Chester, Lancaster, Marion and Florence counties without purchasing physical assets.

I don’t’ see the benefits. I see costs and headaches.  My only explanation is MUSC needs to be seen as a “hospital system.” Regionally, there is PRISMA (Palmetto Health + Greenville Health System), Atrium (formerly known as Carolina Medical System which just merger with UNC Healthcare) in North Carolina, Novant also in N.C., MedStar in Atlanta or Mayo Clinic in Jacksonville, Fla.  This doesn’t include the expanding for-profit systems such as HCA in Asheville or in North Charleston, or Tenet Healthcare in Mount Pleasant and Rock Hill.  The access to capital for investor-owned companies are investors, but MUSC’s access to capital is often, directly or indirectly, taxpayers.  Before MUSC heads down a rabbit hole, I want to know more about the details.    The facilities to be acquired by MUSC are not a Black Friday bargain.

Health care economist Lynn Bailey lives in Columbia.

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