By Jeff Keeling
Standing in the expansive produce section of the newest Food City store last week, I was struck by a hint of irony.
Not so long ago, the ground now occupied by this temple to the latest and greatest in the grocery trade had been an important battle front in a war between our area’s two hospital systems – systems now claiming they will be “better together.” In the early 2000s, a large sign declared to the many passersby that this prime acreage at the intersection of Sunset Drive and State of Franklin Road was the “Future Home of a Wellmont Hospital.”
Wellmont Health System and Mountain States Health Alliance (MSHA) spent heavily over several years after Wellmont purchased the property in early 2000. Tennessee’s health facilities regulatory board refereed the hostilities, initially granting Wellmont a Certificate of Need (CON) to build an acute care hospital by a 5-4 vote. MSHA successfully appealed, though the case dragged on through several years of additional filings and counter appeals.
While it wasn’t the only example of our regions’ two hospital systems’ “spare no expense” approach to competition – they had another good row over a Wellmont proposal to build a facility in Boones Creek a few years later – the battle epitomized both systems’ desires to have it both ways when it came to competition.
If you ask me, patients, their families and their friends were essentially pawns in this power game between the systems. Whichever system wanted to encroach on the other’s territory argued that consumers needed competition and choice. If they got it, their health care would become better and cheaper.
The defending system would cite its own evidence, that duplication of capital-intensive services created higher, not lower, costs for consumers. While that argument flew in the face of standard free market economics, it generally proved a winner with the regulators, so long as the system could show it had adequate services available to serve demand. MSHA made an art form of defending its turf through the CON process, with Wellmont by no means the only entity shot down in attempts to create competition.
In the hospital CON request, Wellmont argued that the 65-bed facility was needed based on reports showing emergency room waits, delays in scheduling surgical and diagnostic procedures and unavailability of hospital beds. In overturning the CON approval, a judge ruled Wellmont submitted erroneous data. Wellmont’s then-CEO said, “We will appeal and we will prevail.” He was wrong, but for the next decade-plus, the systems kept spending plenty of money competing with one another.
Now for the irony. As I lifted a bag of 99-cent-a-pound honey crisp apples into my basket, executives and planners at Wellmont and MSHA were hard at work preparing their case to state regulators that they will be “Better Together,” as the website touting the advantages of their proposed merger claims.
Whether or not that will be the case remains to be seen, but several things are obvious. Acute-care hospital admissions have been decreasing as health care payment models change. America can’t afford to keep spending close to 20 percent of its gross domestic product for health care when the rest of the rich world spends a far lower percentage.
And here in the unhealthy Tri-Cities, where two systems became huge and powerful partly thanks to the presence of a lot of sick people, we face a challenge that won’t be solved by building more health care facilities. The government and the insurance companies aren’t done tightening the screws on payment yet. The Tri-Cities’ “admissions per 1,000” are far higher than the national average, and if that continues, our hospital systems (or system) and our regional economy are going to face tremendous headwinds.
Yet inside and outside the one-time “Future home of a Wellmont hospital” are signs that people get that. Inside, Food City offers far more healthy options than it once did. The company also emphasizes better health among its employees, knowing the cost of the alternative, and it works closely with Wellmont on initiatives to improve Tri-Citians’ health.
Outside, a bike path passes by the new store’s site. All around the Tri-Cities, amenities are expanding that encourage people to get out and live healthier lifestyles. If we don’t get healthier around here, hospital merger or no, we face a tough road.
If MSHA and Wellmont merge, they’re going to have to significantly trim some services where overcapacity exists. Imagine how much more challenging such a painful set of choices would have been if Johnson City had an additional 65-bed hospital sitting at the corner of State of Franklin and Sunset.