Section I â€“ Executive Summary and Corporate Profile 1.
Indicate the contractual entity to be held responsible for the performance of all aspects of this contract. Provide name of firm(s), address(es), contact person(s), email address(es) and telephone number(s). Provide number of employees on staff. University Health, Inc., 1350 Walton Way, Augusta, GA 30901 Contact Persons: James R. Davis, firstname.lastname@example.org, 706.774.8061 and Edward L. Burr, email@example.com; 706.774.8063 The University Health Care System has 2,489 full time and 235 part-time employees.
Provide a brief overview of the key elements of your proposal and history of your company. Highlight any features or areas that differentiate your services and products from competitors. University Health Care System proposes to build and operate a one hundred bed full service general acute care hospital on the University campus in Evans. The approximately 252,000 square foot hospital will include six operating rooms and a twenty-three room emergency department. The proximity of the new hospital to the extensive outpatient services and numerous physician offices on and adjacent to the Evans campus will make the hospital very convenient for patients and their health care providers. The size and location of the hospital are a perfect fit with the existing medical providers and will be conducive to their growth and promote new investment. Certificate of need (CON) approval is required for construction of the hospital. The applicable Department of Community Health regulations require at least a twenty percent contribution from the Columbia County Commission to the capital cost as a condition for granting the CON. University will partner with the Commission to meet that requirement. As a nonprofit hospital, the Columbia County hospital would be eligible for exemption from ad valorem real estate taxes. In view of the Columbia County contribution to the construction cost, University will not seek exemption from real estate taxes for the new hospital. The University Health Care System is the only locally governed health system with facilities in Augusta and Columbia County. Like Universityâ€™s other two hospitals, University Hospital and University Hospital McDuffie, the governing board for the Columbia County hospital will be comprised of local citizens. The Columbia County Commission will be given the option of nominating a significant portion of the Columbia County hospital board. The University Health Care System, through the Columbia County hospital board, will operate the hospital. University will indemnify and hold harmless Columbia County from
any losses incurred by the hospital. In recognition of the capital cost contribution, no support for the costs of indigent care will be expected or sought from Columbia County. As a locally governed nonprofit health care system, University has a mission that is laser focused upon serving and reinvesting in this community. Profits for shareholders are not a consideration. The mission of University Health Care System is to provide health care services which help the citizens of our communities achieve and maintain optimal health. University Health Care System is anchored by the 581-bed University Hospital, and serves Augusta-Richmond County and the surrounding region. University Hospital is governed by the Board of Trustees of University Health Services, which serves voluntarily to help ensure that our patients have quality medical services. Founded in 1818 as City Hospital, the hospital was first located on the 100 block of Greene Street. University has since moved through four facilities to its present location, which opened in 1970. Over the years, the campus has expanded to include the Heart & Vascular Institute and office buildings that house numerous private practice physicians and various treatment centers. University has a long history as a leader in delivering cardiovascular, cancer and women's services. We developed the area's first outpatient cardiac catheterization procedure and performed the region's first angioplasty. We opened the area's first Breast Health Center and put the area's first Mobile Mammography Unit on the road, giving more women in our community access to breast cancer screening. Our W.G. Watson, M.D., Women's Center features 36 obstetrical suites and state-of-the-art surgical suites dedicated for obstetrical and gynecological patients. The center has a wellbaby nursery and a 40-bed Level III Special Care Nursery offering neonatal intensive care to our smallest and most critically ill infants. The Heart & Vascular Institute, a 188,000-square-foot cardiovascular center with 72 universal inpatient suites, is the largest, most comprehensive center of its kind in the region and offers a full range of heart and vascular care, from diagnosis to rehabilitation. Recognizing the need to serve more of the community closer to home, University has established medical centers in South Richmond County and expanded services in Columbia County to include medical office buildings, a joint-venture diagnostic imaging center, a skilled nursing facility, a joint venture Day Surgery Center and Prompt Care facilities. Columbia County is also the home of Brandon Wilde, widely recognized as one of the finest "Life Care" retirement communities in the nation. University is accredited by The Joint Commission (TJC), which is an independent, not-forprofit organization, established more than 50 years ago. The Joint Commission is governed by a board that includes physicians, nurses and consumers. The Joint Commission sets the standards by which health care quality is measured in America and around the world.
In addition: University is the only hospital in Augusta to receive the Magnet Award for nursing excellence from the American Nurses Credentialing Center (ANCC). Magnet status is the ANCC's highest honor, and largely considered one of the highest designations that can be received for outstanding achievements in nursing. University has received full Cycle IV Accreditation with Percutaneous Coronary Intervention (PCI) from the Accreditation Review Committee of the Society of Cardiovascular Patient Care. The Chest Pain Center at University Hospital has demonstrated its commitment to quality patient care by meeting or exceeding a wide set of stringent criteria and completing on-site evaluations by a review team from the Society of Cardiovascular Patient Care. The American College of Surgeons Commission on Cancer has awarded University a three year accreditation with commendation in six areas in recognition of excellence in providing quality care to patients. University Health Care System has been honored to receive the Consumer Choice Award from the National Research Corporation (NRC) for best overall quality and image in the Augusta region every year since 1999. The Consumer Choice Award is based on an independent survey of consumers conducted by NRC to recognize the most preferred hospitals in about 190 metropolitan areas across the country. University Hospital's Breast Health Center has been accredited by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. University has the only nationally accredited breast health center in the region and is only the second one in the state to be honored with this recognition. University holds the Joint Commission’s Gold Seal of Approval™ for certification as a Primary Stroke Center. Vascular Lab is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories in five areas of testing, the only vascular lab so accredited in the CSRA. 2013 Chairman’s Honor Roll “Right Care Every Time” (highest level of achievement) for high reliability of quality assuring processes from the Georgia Hospital Association. The 2012 Best Doctors list includes 129 physicians on the University Hospital Medical Staff, more than all other area hospitals combined. During 2012, the Georgia Hospital Association awarded the Distinguished Service Award to Board Chairman Emeritus Lee Smith Jr. and honored W.G. Watson, M.D., as a "Hospital Hero." 3
Named the 2013 United Way of the CSRA "Top Hospital" in all three categories of giving for the fourth consecutive year. By continuously responding to the needs of the community, University Health Care System has grown into one of the largest, most comprehensive health care providers in Georgia. University provides compassionate and skilled care through inpatient care, two extended care nursing facilities, home health and prompt care facilities and rehabilitative care programs. University Health Care System has two hospitals, University Hospital in Augusta and University Hospital McDuffie. Satellite medical campuses in Martinez, Evans and South Augusta deliver quality health care close to peopleâ€™s homes. A satellite center is under construction in Grovetown. University Home Health provides physician-directed, in-home care, including skilled nursing, occupational therapy, physical and speech therapy, social work and home health aide services in 14 counties in and around the Central Savannah River Area. At Kentwood Extended Care Facility, the staff strives to make residents feel at home and part of an extended family during their stay. This facility operated by University Extended Care offers 20 personal care beds and 80 nursing home beds. University continues its commitment to the outpatient needs of Columbia County, and University's Evans campus has grown in 20 years to not only Medical Office Buildings, but a Surgery Center, Sleep Center, Speech and Hearing Center, Prompt Care, Occupational Medicine services, a Cardiac Imaging Center and more than 20 private practice physician groups. Also featured on the University Health Care System Evans Campus are the following: o
Westwood facility, with its 149 beds, offers residents a comfortable environment designed to enhance their self-image and preserve their dignity. Westwood's separate Alzheimer's Unit is the only facility in this area that provides this level of care for people with Alzheimer's disease. o
Brandon Wilde, University's 250-unit retirement community in Evans, Georgia, offers independent living, personal care and nursing accommodations. Residents are assured of care for life, as they may move from one level of care to another as their conditions warrant. Brandon Wilde has become one of the most respected retirement communities in the nation, having been selected five times by New Choices Magazine as one of the top 20 retirement communities in the country. Its Windsor House twenty-five suite Alzheimerâ€™s assisted living community opened during 2013.
A physician-hospital partnership is essential to an integrated delivery system of health care, so University and physician leaders formed University Health Link in 1994. This PhysicianHospital Organization (PHO) is jointly owned by University Health Care System and University Physicians Associates, P.C., an independent practice association owned by its physician stakeholders. University Health Link maintains managed care contracts with area health plans that provide access to a comprehensive system of services for thousands of local employees and dependents. University Health Care System and University Hospital are governed by volunteer boards, whose trustees are comprised of physicians and respected business leaders within our community. They give unselfishly of their time and talents to help University exceed its commitment to the community it serves. The board members are reinforced by the small army of volunteers known as the Volunteer Board of University Health and supported by a host of donors to University Health Care Foundation. Since February of 1949 when the Volunteer Board was founded, volunteers have contributed more than a million hours of their time for the benefit of patient and family care. The current cadre of volunteers (more than 372 strong, including nearly 100 junior volunteers) contributed nearly 38,000 hours of their time in 2013, and more than $200,000 in proceeds from Volunteer Board run businesses to benefit patient care. University also counts at least 65 members of the Volunteer Board as residents of Columbia County, including the incoming President of the Volunteer Board in 2015. In addition to the philanthropic efforts of our volunteers, University Health Care System has also benefitted from widespread support from the community thanks to the work of University Health Care Foundation’s Board of Trustees and Community Board, which counts more than a dozen Columbia County residents among its ranks. Since its founding in 1978, University Health Care Foundation has served as the philanthropic arm of University Health Care System, raising tens of millions of dollars to improve patient care, facilities, and technology and to assist patients at their most vulnerable times. Between 2005 and 2008, UHCF raised more than $8 million in support of University’s Heart & Vascular Institute (at the time, the largest single capital campaign achievement in the community), as well as most recently raising more than $2 million for Brandon Wilde’s Windsor House (for early to mid stages of Alzheimer’s and dementia) and Wellness Center expansion, located in Columbia County. Finally, University Health Care Foundation partnered with Columbia County in October of 2011 for the dedication of the Lady Antebellum Pavilion and Josh Kelley Stage at Evans Towne Center Park. Funds raised at this concert organized collaboratively by Columbia County, University Health Care Foundation and our Young Philanthropists benefitted the Dr. John W. Kelley Endowment at University Health Care Foundation. This endowment helps ensure students receive the best possible training at University Hospital’s Harry T. Harper, M.D., School of Cardiac and Vascular Technology and improves heart and vascular care throughout our entire community. More than 4,000 people attended this event and dedication, and it was particularly rewarding given the dedication Dr. Kelley showed to his patients during his 23 year tenure at University Hospital and his family’s continued ties to our community.
Excellence is more than a goal for University Health Care System. It's a requirement. Anything less is unacceptable. Our uncompromising standards rarely go unnoticed. Recently, the American Nurses Credentialing Center recognized University Hospital with its prestigious Magnet designation for nursing excellence. This national award is considered one of the highest honors in nursing and means that our patient care program is one of the best in the nation. University is the only local hospital to receive this distinction. University Hospital has been a medical pillar in the Augusta community for nearly 200 years. In that time, we've stayed on the forefront of technology. In doing so, we've set the standard for health care in the region. Attached are copies of University’s 2011 and 2012 community benefit reports. Section II – References 1.
List five (5) organizations (public, private, and/or government) that have used or currently use your facilities or that you currently do business with. Include entity name (if applicable), contact name, email address, and telephone number. Include a brief description of equipment and services provided. Novant Health Shared Services, Mark Billings, President (firstname.lastname@example.org), 704-384-6370 – The primary point of contact between University and Novant for shared services as described in the response to Item 18 of the Scope of Work. Hospital Authority of McDuffie County, William P. Doupe’, 2012 Chairman (email@example.com), 706.840.2893 – University worked with the Hospital Authority of McDuffie County to create a sustainable hospital in McDuffie County and navigate the regulatory process governing a change of ownership and the construction of a replacement hospital. McDuffie County Board of Commissioners, Charles G. Newton, Chairman (firstname.lastname@example.org), 706-214-1233 – The McDuffie County Board of Commissioners was actively involved in the process that culminated in University purchasing McDuffie Regional Medical Center and developing a replacement hospital. MCBS, LLC, Alan K. Griffin, President (email@example.com), 706.667.7400 – MCBS provides management and billing services to many physicians who provide services at University. Additionally, MCBS has been involved with the strategic and day to day operations of joint ventures between University and physicians. VHA Georgia, Richard T. Howerton, III, President (firstname.lastname@example.org), 770-850-7402 – VHA Georgia is a membership alliance of 21 Georgia not-for-profit shareholder and partner health care providers along with an additional 60 member and regional affiliates. VHA Georgia exists to serve its membership by consistently delivering expert guidance and solutions that drive exceptional performance, and improve members’ clinical and financial performance. 6
Section III – Cost Information 1.
If you are requesting any funding from Columbia County, the amount should be specified here to include a breakdown of proposed expenditures in which the County is expected to participate. Please see the response to Item 6 of the Scope of Work.
Section IV – Contract / Request for Proposal Acceptance 1.
Acknowledge that your company agrees to all terms and conditions as listed in the attached draft contract. Indicate any changes your company deems necessary so we may consult with our Attorney in advance of the award. If any company should disagree with the terms and conditions set forth in the attached contract, Columbia County reserves the right to consider their proposal non-responsive. As this is not the “final” contract it does NOT need to be signed at this time. Yes, University agrees to the terms and conditions of the draft contract.
Indicate if you agree with all terms and conditions listed within this RFP. Yes, University agrees to the terms and conditions listed with the RFP.
Section V – Additional Information 1.
Include a statement indicating that your firm will comply with requirements detailed in the Scope of Work. University will comply with the requirements detailed in the Scope of Work.
Provide any other innovative and original ideas above and beyond the scope of work that is requested. Please see Item 2 of Section I above and Scope of Work Items 6, 13, 15, 18 and 20.
Indicate if your company has registered with Bid Express.com. information is attached for your convenience.
University has registered with Bid Express. 4.
Indicate if you have registered with Columbia County’s Online Bid/RFP website. Columbia County distributes bid, RFP, and Addenda documents via our website. In order to automatically receive them in the future, please register your company on our system via the following link: http://www.columbiacountyga.gov/bid/. Click on “New Vendor Registration” and proceed through the steps. Hint: Select as many
commodity codes as possible to boost your chances of receiving relevant bids/RFPs that match the products or services your company offers. University has registered with Columbia County’s Online bid / RFP website. 5.
Georgia Security and Immigration Compliance Act – Complete Contractor Affidavit (required) and Sub-Contractor Affidavit (if applicable). Attached.
SCOPE OF WORK 1.
Describe in detail your strategic vision for a hospital in Columbia County. University’s strategic vision for Columbia County is to build, in partnership with physicians, employees, volunteers, patients, and other Columbia County leaders and health care providers, a continuum of care which includes physical facilities, illness prevention, and health promotion with the ultimate objective of achieving unparalleled rankings for indicators of community health. As detailed in other parts of this response, University has been steadily working to implement that vision since the early 1980s. The proposed hospital is part of the natural progression of the implementation of University’s strategic vision for Columbia County. The size and nature of the hospital will evolve as the health needs of Columbia County change over time. Guided by University’s commitment to serve others as we would wish to be served, the new hospital’s initial objective will be to make primary hospital services more accessible to Columbia County residents and health care providers based in Columbia County. True accessibility is dependent, however, on more than physical location. The cost of services is a very real barrier to access. University is committed to being both the highest quality and lowest cost provider in the area. A very significant component of University’s vision for Columbia County is applying University’s system resources to dramatically reduce the operating cost of the Columbia County hospital. University has decades of experience successfully providing locally controlled nonprofit health care. University will be able to influence those costs in a number of ways. Some cost reduction opportunities are most heavily dependent upon the size of an organization. Other cost reduction opportunities require geographic proximity as well. A stand alone one hundred bed hospital is simply not able to negotiate optimal supply and service contracts or have much influence during payor negotiations. The University Health Care System with its hospitals in Augusta and Thomson, skilled nursing facilities, home health agencies, and hospice among other services and its University Health Link affiliates will provide the Columbia County hospital with immediate scale. University’s shared services agreement with regional giant Novant Health (see the response to item 18 for 8
additional information about Novant) will provide the Columbia County hospital access to very favorable supply pricing and service contract rates. The physical proximity of the Columbia County hospital to the other facilities and resources of the University Health Care System facilitates the most efficient use of specialized talent and capabilities. The University Health Care System has demonstrated repeatedly the advantages arising from sharing human resources across business organizations. University’s proposed hospital brings connectivity and integration into a larger, area wide system of care. The new hospital will utilize University’s electronic medical records technology, which is the state of the art, top of the line system for connecting hospitals, physicians, and patients to achieve the best care and best outcomes. As part of the University Health Care System, the Columbia County hospital will have local access to resources at a fraction of the cost required to replicate those resources and without any loss of local nonprofit control. As its presence in Columbia County has grown and evolved since the 1986 acquisition of the Evans campus property, the new hospital will undergo continuous development. University is committed, as the orthopedic surgery program at University Hospital McDuffie demonstrates, to facilitating the provision of complex hospital services in the community in which patients live and work. As the only locally controlled organization, University has the ability to and will ensure that Columbia County’s government and citizens will always be deeply involved in the planning and operation of this key new resource. University will collaborate with Columbia County agencies and the Columbia County Chamber of Commerce to leverage the potential of the hospital for growth and development throughout Columbia County. 2.
Do you currently have a hospital plan for Columbia County? Yes. University Health, Inc. has a plan for a one hundred bed, including eighteen critical care beds, hospital. The plans call for six operating rooms and two catheterization lab/interventional radiology suites. The emergency department design includes twenty-three examination/treatment rooms and an eight bed clinical decision unit.
Do you currently own or have an option on real estate for property in Columbia County to build a hospital? University Health Care System has a long-standing commitment to Columbia County. In 1986, University invested in a 68-acre parcel in Evans, anticipating the county’s growing population and growing need for health care services. Since then, University has taken a pragmatic approach to service development and expansion to meet the needs of the community as it has grown and changed during the 27 years since acquiring the Columbia County site. As the population of Columbia County has increased from 66,031 persons in 1990 to 123,991 persons in 2012, University’s Evans Campus has grown in response to include a broad variety of services that meet the community’s growing and changing needs. These services include: five medical office buildings which house over twenty private physician practices, a cardiac imaging suite, an ambulatory surgery center, a diagnostic 9
imaging center, a sleep center which is a department of University Hospital, and Brandon Wilde, a nationally recognized life care community on an adjacent 104 acre site. The plan for the hospital places it on the University Campus fronting North Belair Road. To the immediate south of the site is Columbia County’s own EMS headquarters. Also located on the campus are: a freestanding ambulatory surgical center, a University Health Care System owned and operated 149 bed skilled nursing facility, a diagnostic imaging facility with both CT and MRI, five medical office buildings with 160,000 square feet of space, and Columbia County’s only parking deck. Occupants of the office buildings include several primary care practices, a satellite University Hospital laboratory, the imaging center, and several medical specialists’ offices. Within a quarter-mile of the campus are the offices of numerous other physicians, including an outpatient endoscopy center and, less than one-half mile from the proposed location is an ENT ambulatory surgery center. University’s proposed site is in the midst of the most predominant medical presence in all of Columbia County. The site is zoned for its proposed use and there are no encumbrances that could interfere with the use of the site. University Hospital already provides some outpatient hospital services in buildings located on the Evans campus. Those services include a sleep study center, a cardiac imaging suite, a speech and hearing therapy office, and clinical laboratory services. The ambulatory surgery center is a joint venture between the University Health Care System and approximately twenty surgeons. The diagnostic imaging facility is also a joint venture between the University Health Care System and radiologists. Another important aspect of the proposed site is access. Besides the site’s frontage on North Belair Road (a main traffic artery for Evans and Columbia County), Riverwatch Parkway, a multi-lane, limited access highway from downtown Augusta, is scheduled for extension in the next couple of years to intersect with Washington Road in Evans. The intersection point will be at Towne Center Drive which borders the Evans Campus on the proposed project’s north side. To the south and west, Hereford Farm Road is scheduled for widening to its intersection with I-20. The advantages of this site for local patient access, health care provider accessibility, and coordination with other health care facilities, are enormous. 4.
What size hospital would you propose for Columbia County (this should include total square footage, number of floors, number of beds, etc.)? The building will be approximately 252,000 gross square feet. The emergency department with twenty-three examination/treatment rooms and an eight bed clinical decision unit will be located on the first floor along with various support functions. The six operating rooms, two catheterization/interventional radiology rooms, imaging services, and other clinical services will be located on the second floor. One hundred patient rooms (each a private room with one bed), including one eighteen-bed critical care unit, will occupy a bed tower of three floors.
Describe your estimated financial investment to complete this project. The University Health Care System anticipates investing between $104 and $112 million in the construction and initial equipping of the new hospital. Additionally, the University Health Care System would, on the basis of the synergies arising from its McDuffie County hospital, a hospital in Evans, and University Hospital in Augusta, locate a data center on the Evans campus. The data center investment would be between $10 and $12 million.
Do you have funds readily available to complete this project? Would you expect county participation in financing? If so, how? The University Health Care System has available funds for the construction of the proposed one hundred bed hospital on its Evans campus. The development of short-stay general hospital beds is subject to approval of a certificate of need by the Georgia Department of Community Health. The rules of the Department of Community Health provide only one option for acquiring a certificate of need to construct a hospital in Evans, Martinez, or Grovetown. The applicable regulatory provision allows an exception to the bed need standard that that would otherwise prohibit the construction of a hospital in those locations. The regulatory exception requires that “more than twenty percent of the capital cost of any new facility is financed by the county governing authority.” While University has available funding to pay the full cost of construction of the proposed one hundred bed hospital ($130 to $140 million) and is willing to make that investment, the Department of Community Health rules require an investment by the Columbia County Commission of twenty percent of the capital cost. University would advance the hospital construction funding in order to ensure that Columbia County’s payment does not exceed twenty percent plus one dollar of the actual capital cost of the new hospital. Consequently, the first payment from Columbia County would not be required until the hospital was substantially completed. University would enter into a definitive agreement with Columbia County governing the obligations of University and rights of Columbia County with respect to the Columbia County capital contribution. Upon execution of the definitive agreement, a Georgia nonprofit corporation organized and operated so as to quality for recognition of exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code will be created. The Columbia County Commission shall have the right to nominate thirty-five percent of the members of the new hospital board of directors, but in no event less than one director. Each nominee shall be subject to the approval of University Health, Inc. University will provide to Columbia County periodic reports no less frequently than quarterly regarding: (i) the status of the preparation, filing, authorizations, and certifications required for construction of the hospital; (ii) the status of the execution and delivery of all architectural, engineering, construction and equipment contracts; and (iii) the status of the construction and equipping of the hospital.
Although the new hospital will be operated by a nonprofit corporation exempt from federal income tax, in view of Columbia County’s contribution to the capital cost of building the hospital, the new corporation will not apply for an exemption from real estate ad valorem taxes for the new hospital. University would indemnify and hold harmless Columbia County from any liability arising from the operation of the hospital. The definitive agreement will provide the Columbia County Commission a right of first refusal in the event of any third party offer to acquire the new hospital. The structure of the definitive agreement will ensure that Columbia County receives as a result of any such transfer an amount equal to the greater of twenty percent of the net proceeds of the transaction or the capital cost contribution from Columbia County to the construction of the hospital. Georgia Regents Health System (GRHS) apparently will contend that the Department of Community Health rules permit it to build a hospital anywhere it chooses in the state. On its face such an assertion is absurd. The GRHS interpretation is neither consistent with the plain language of the rule nor with the Georgia State Health Component Plan for Short-Stay General Hospitals which explains the intent of those rules. Those rules make it easy for a teaching hospital or trauma center to add beds to its existing “facility.” Further, why is GRHS suddenly now claiming the teaching hospital and trauma center rules, effective since January 2005, allow GRHS to build an entirely new facility anywhere in the state? If GRHS indeed has that extraordinary ability, GRHS could build a hospital in Columbia County at any time regardless of how many other hospitals were located in Columbia County. On the other hand, Columbia County has only one opportunity to use the sole community provider exception. 7.
How many personnel would your facility employ at full build out? Would employment be phased? Explain. University anticipates that the new hospital’s workforce will consist of individuals employed by the then new hospital and individuals who work for contractors engaged by the new hospital, as well as independent contractors, such as emergency medicine physicians, anesthesiologists, and other hospital based physicians. University anticipates a workforce, excluding physicians, of approximately 250 to 300 within a relatively short time after the completion of construction. The design of the facility, with essentially eight independent nursing units or modules, will facilitate the phasing of staffing to correspond with the growth of patient volume.
How long do you anticipate it will take to build your proposed facility? Will the project be phased? Explain. The Georgia Department of Community Health Certificate of Need Rules require no less than a one hundred bed hospital for Columbia County. University is not opposed to exploring a phased approach to satisfy the one hundred bed requirement, but is currently contemplating opening the hospital as a one hundred bed facility. We anticipate that construction will take approximately 24 months. 12
Does your solution offer a Trauma Center designation? What level is being proposed? A Level Three Trauma Center designation will be sought for the new hospital.
Define your ability to be considered a critical access hospital as defined by state rules. Critical access status is, among other criteria, dependent upon the distance to other hospitals. No location within Columbia County meets the distance criteria for critical access hospital designation.
Define your ability and intentions to be or become a teaching hospital as defined by state rules. If so, submit a detailed description of the teaching activities proposed and the number of potential learners in each program (physician, nursing allied health, etc.) University Hospital is an affiliated training facility with Georgia Regents University School of Medicine. Pursuant to the affiliation agreement between University Hospital and Georgia Regents University for providing Graduate Medical Education, general surgery, obstetrics, and internal medicine residents train at University Hospital. During 2013, 28 Georgia Regents University residents trained at University. University Hospital also has an affiliation agreement with Dwight David Eisenhower Army Medical Center under which physicians in residencies at Eisenhower receive some of their training at University Hospital. Truven Health Analytics classifies University Hospital as a teaching hospital. Truven Health Analytics delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry. Hospitals, government agencies, employers, health plans, clinicians, pharmaceutical, and medical device companies have relied on Truven for more than 30 years. Advantage Suite, Micromedex, ActionOI, MarketScan, and 100 Top Hospitals are registered trademarks or trademarks of Truven Health Analytics. Nevertheless, University Hospital is not listed by the Georgia Board for Physician Workforce as a teaching hospital. As a hospital with existing graduate medical education program, University Hospital is not eligible for new program development funding under Board Rule 195-13. The new hospital could qualify under Rule 195-13. In addition to the residency affiliations, University Hospital works with several area schools to provide clinical training opportunities for a number of health professional programs. University Hospital has educational partnerships with many schools of nursing including: Georgia Regents University, the University of South Carolina â€“ Aiken, Aiken Technical College and Georgia Southern. In addition, University has educational partnerships with area schools for allied health programs, including: Aiken Technical College (surgical technician and phlebotomy programs), Augusta Technical College (LPN, medical assistant, respiratory therapy, emergency medical technician, unit clerk, EKG technician, phlebotomy and hematology technician programs) and Savannah River College for a nursing assistant program.
The Stephen W. Brown School of Radiography and the Harry T. Harper, Jr., MD School of Cardiac and Vascular Technology are University Hospital based training programs. The Brown school has produced radiology technologists for over thirty years. The Harper CVT program has produced cardiology technicians since 1992. Currently 14 students are enrolled in the Brown school and over fifty students are enrolled in the Harper CVT school. University also is the host site for the Augusta Area Dietetic Internship Program. That program attracts students from all over the United States who complete an academic year of clinical experience required to become a registered dietician. The most recent class has twelve students. With its long and distinguished tradition as a health care training institution (the name “University”, memorializes the fact that University Hospital was for many years the primary teaching hospital for the Medical College of Georgia), the extension of educational programs to the new hospital would be completely consistent with University’s history and current activities. 12.
How will indigent care be addressed in this facility? What is your current commitment to indigent care? How much has your entity spent on indigent care in the past 36 months? What do you expect Columbia County’s obligation to be to indigent care annually? University does not envision any indigent care support payments from Columbia County. The University Health Care System currently receives no indigent care support payments from any local government. University would apply the same indigent care policies currently in place at University Hospital. Those policies ensure that no individual is denied a medically essential service based upon lack of ability to pay for services. No one seeking emergency services will be turned away because of an inability to pay for services. All patients presenting to the emergency department will be treated according to their individual needs, consistent with University’s current policies. Individuals using the new hospital with income levels up to 200% of the Federal Poverty Guidelines will only be liable for a modest copayment (for example $25 for an emergency department visit, $25 for an inpatient hospitalization and $5 or less for other services) if they cooperate with a very reasonable application process. Most services which Georgia Medicaid would cover for a Medicaid beneficiary are covered under this policy. Additionally, University would offer at the new hospital the same deep discount (currently 50%) from charges that it offers uninsured individuals regardless of their income level. University would also extend its catastrophic expense discount policy to the new hospital. That policy provides a 25% discount to any individual with an income up to 400% of the Federal Poverty Guidelines whose outstanding liability to the hospital (all open accounts) is at least $5,000. University Hospital permits installment payment without security, interest or service charge. That practice would be extended to the new hospital. Information regarding the availability of financial assistance will be posted in the emergency department and patient registration areas throughout the hospital, as well as on the University Health Care System website. 14
University Hospital participates in the Medicare, Medicaid and PeachCare programs and is a major sponsor to the Richmond County Medical Society's Project Access and several independent nonprofit clinics which provide primary care services and pharmaceuticals to the un- and underinsured of the area, including Columbia County. University has consistently provided significant levels of uncompensated care to patients with limited financial resources who lack the ability to pay their health care bills. In 2011, 59.34% of University's patient days were Medicare and 12.09% of days were Medicaid. Furthermore, during 2011, University Hospital provided $60,075,862 in uncompensated indigent and charity care accounting for 10.82% of University's adjusted gross revenue. Medicare accounted for 56.24% and Medicaid for 13.33% of University's 2012 patient days. Uncompensated indigent and charity care of $74,324,665 accounted for 11.25% of University's 2012 adjusted gross revenue. The University Health Care System expended $64,694,529 on indigent care over the 36 month period ending December 31, 2013 (the latest period for which complete information is available). That amount is University's cost, not the charges written off. 13.
How will your proposed facility create an inclusive environment to eliminate/reduce any detrimental impact to existing facilities in the surrounding area? University’s Evans campus is already at the hub of the medical facilities located in Columbia County. Located on the campus are: a freestanding ambulatory surgical center, a University Health Care System owned and operated 149 bed skilled nursing facility, a diagnostic imaging facility with both CT and MRI, and five medical office buildings with 160,000 square feet of space. Occupants of the office buildings include several primary care practices, a satellite University Hospital laboratory, the imaging center, and several medical specialists’ offices. Within a quarter-mile of the campus are the offices of numerous other physicians, including an outpatient endoscopy center. Less than one-half mile from the proposed site is an ENT ambulatory surgery center. Immediately adjacent to the campus is University’s Brandon Wilde continuum of care retirement community which includes a skilled nursing unit and the recently completed Windsor House twenty-five suite Alzheimer assisted living residence. Approximately one mile from the campus is the Evans Surgery Center. Placing a hospital upon University’s Evans campus will be beneficial to all of those facilities and organizations. The surgery centers and endoscopy center will benefit from their greater proximity to a full service emergency department and hospital. The transportation and coordination challenges arising when a skilled nursing facility patient needs an emergency department visit or hospitalization will be significantly mitigated. It will be much more feasible for a physician to be involved in the care of a patient hospitalized within walking distance from the physician’s office than at best half an hour away. Columbia County is home to a large and growing population. The 2012 population of Columbia County is 123,991 persons. The Department of Community Health projects that the total population of Columbia County will increase 14% between 2012 and 2017, increasing to 141,915 persons. This percent increase is greater than that projected for the state of Georgia (10%). As significant as this population increase is, the increase in the Columbia County population age 65 years and older is even more significant both in terms of numbers and in terms of emergency department utilization. The Columbia County 2012 15
population age 65 years and older was 13,377 persons and represented 11% of the total Columbia County population. By 2017, the number of persons aged 65 years and older is projected to increase 35% to 18,074 persons – more than double the growth rate forecast for the County’s total population – and will represent a larger portion of the Columbia county population 13%. This large and growing population of persons age 65 years and older are significant users of emergency and other hospital services. In fact, the Agency for Healthcare Research and Quality (AHRQ) found that rates of emergency department visits were 24 percent higher for Americans age 65 and older compared to those ages 18 to 44 (550 visits versus 444 visits per 1,000 adults in each age group). The proposed hospital will bring 24 hour emergency and hospital services to all residents of Columbia County regardless of financial status or resources. Making hospital and emergency services available locally will be a vast improvement in providing services that are more geographically accessible to the residents of Columbia County. University has a long and strong history of ensuring physician involvement in both its day to day activities and strategic planning. University is unique among area hospitals in that its organizational documents ensure that the medical staff selects a member of the governing board of directors, not just a member of an advisory board or committee. Since the University corporations were organized in 1984 there has always been at least one practicing independent community physician on the ultimate decision making board. Currently the chairman of University’s board is a physician, Randolph R. Smith, M.D. Twenty percent of the University Health, Inc. board members are physicians. This special relationship at the governance level between community members, hospital professionals, and physicians has helped University develop initiatives that are mutually beneficial to the community and physicians. That culture will be continued at the Columbia County hospital. University believes that competition promotes health, whether of an individual, an organization, or a system. Nevertheless, out of control competition for competition’s sake is likely to be detrimental. University has demonstrated an ability to manage the balance between competition and collaboration. University is an active participant in statewide hospital organizations such as the Georgia Hospital Association (Georgia Regents Medical Center and Doctors Hospital are also members), the Georgia Alliance of Community Hospitals (Georgia Regents Medical Center is also a member,) and VHA Georgia. University’s President, James Davis, is a board member of all three organizations. University is a clinical training site for several Georgia Regents University healthcare programs pursuant to long standing academic affiliation agreements. University and Georgia Regents Medical Center have jointly engaged in community health needs assessments in 2010 and 2013. Georgia Regents University and University have worked together to create and operationalize the Greater Augusta Healthcare Network. The Dean of the Georgia Regents University’s Medical College of Georgia is a board member of University Hospice, Inc., the area’s only nonprofit hospice. University provided Doctors Hospital the cardiac surgery transfer agreement required to permit Doctors Hospital to offer a therapeutic cardiac catheterization service. This history of collaborative relationships portends that the Columbia County hospital will become another valued clinical training site for Georgia Regents University and a participant in the joint University and Georgia Regents Medical 16
Center efforts to improve access to and enhance benefits from the health care providers in our area. The University Health Care System has demonstrated both a willingness and ability to work collaboratively with other health care providers. University and St. Joseph Hospital partnered to develop Brandon Wilde. When St. Joseph decided to change strategic directions, University became the sole owner. Long term acute care hospital operator, Select, used part of University Hospital’s seventh floor prior to building its free standing hospital in Augusta. Select continues to contract with University for essential clinical services. Walton Rehabilitation Hospital is another product of collaboration between University and St. Joseph Hospital. While only those two sponsors invested in and financed Walton, the Medical College of Georgia was asked to participate on the Walton board. For many years, the Presidents of University, St. Joseph Hospital, and MCG were all Walton board members. University’s extensive pediatric emergency department and University’s neonatal intensive care unit have developed a symbiotic relationship with the Children’s Hospital of Georgia that provides patients the best both programs have to offer. As referenced above, University has also partnered with physicians to create new health care facilities. Two of those entities, the Surgery Center of Columbia County and the Evans Imaging Center are located on University’s Evans campus. 14.
If applicable, how will your solution have a positive impact on the cost, quality, and access to healthcare in Columbia County? University Hospital is the highest quality and lowest cost hospital in the area. University will bring to the new hospital on the Evans campus the charge structure, management resources, policies, procedures, and technologies that have enabled University Hospital’s achievements. During the summer of 2013, the Center for Medicare and Medicaid Services published data on hospital charges that confirmed University’s charges for comparable cases are far below those of other area hospitals. Two examples, both relatively high volume procedures, illustrate the magnitude of the differences: University DRG 247 Cardiovascular Drug Eluting Stent Average Charge DRG 470 Major Joint Replacement Average Charge
Georgia Regents Medical Center $65,653
The attractiveness of University’s by far lower charges will positively impact both cost and access. The Columbia County hospital will also carry University’s policies with respect to indigent care and self-pay discounts into the heart of Columbia County. It would be difficult 17
to find a hospital anywhere else where the average hospital cost to an uninsured patient for a total knee or total hip patient would be $15,515; let alone find that cost at a hospital whose quality for those procedures warranted a Five Star rating from Healthgrades. Medicare also provides information about spending per hospitalized patient on its Medicare Hospital Compare website. The data compares Medicare’s cost for the hospitalization, for services from all providers, for example, the patient’s physician, during the three days prior to the hospitalization, and for services by all providers, for example, a skilled nursing facility or rehab center, during thirty days following the hospitalization for equivalent patients. That total spending for patients hospitalized at University Hospital is lower than the national average. In contrast, the total spending for patients hospitalized at Georgia Regents Medical Center or Doctors Hospital is higher than the national average. Trinity has the highest total spending ratio per equivalent patient. Because Medicare pays hospitals in the same geographic area, such as a single county, virtually the same amount, differences in total spending on equivalent patients are likely attributable to higher quality and better coordination that reduce spending during the thirty days following discharge. That explanation for the lower Medicare spending on equivalent patients hospitalized at University Hospital is completely consistent with the results of Healthgrades’ analysis of Medicare data. Founded in 1998, Healthgrades is the leading online resource for physicians and hospitals. Today, more than 250 million visitors use the Healthgrades websites to find, evaluate, compare, select, connect and communicate with physicians and hospitals that best meet their treatment needs. To help consumers understand, compare and evaluate hospital performance, Healthgrades provides objective, comprehensive information about hospital quality in America’s hospitals. Unlike other hospital quality analyses, Healthgrades evaluates hospitals solely on clinical outcomes – risk-adjusted mortality and in-hospital complications. The Healthgrades analysis is based on approximately 40 million Medicare discharges for the most recent three-year time period available. The data measures 31 common procedures and conditions and adjusts each for the ages, gender and medical conditions of patients. Healthgrades awards a Five Star rating when actual performance was better than predicted and the difference was statistically significant. Healthgrades determined that patients treated at a hospital receiving a Five Star rating in a particular procedure or condition have a lower risk of dying during the hospital stay than if they were treated at a hospital receiving a One Star rating. Patients being treated at a Five Star hospital for a particular procedure or condition have a lower risk of experiencing complications during a hospital stay than if they were treated at a hospital receiving a One Star in that procedure or condition. The most recent Healthgrades report (the 2014 report released October 2013) awarded University Hospital fifteen Five Star ratings. Georgia Regents Medical Center received one Five Star rating. Doctors Hospital received none. Georgia Regents Medical Center received One Star ratings for coronary interventional procedures and hip replacement in contrast to University’s Five Star ratings for those procedures. Doctors Hospital received One Star ratings for coronary interventional procedures in contrast to University Hospital’s Five Star rating. Doctors Hospital received One Star ratings for the treatment of the conditions heart attack, sepsis, and pneumonia in contrast to the Five Star rating awarded University Hospital for the treatment of those conditions. 18
The Georgia Hospital Association, a nonprofit association of Georgia hospitals, serving over 170 hospitals, recognized University for excellence in implementing evidence-based standards of care by placing University on its Chairman’s Honor Roll. The Chairman’s Honor Roll is reserved for the highest achieving Georgia hospitals. The bi-line of the honor roll, “Right Care Every Time” is a concise summation of the processes evaluated and the results analyzed in determining honor roll status. The National Research Corporation (NRC) survey of consumers has determined University Hospital to be the Augusta area’s choice as the hospital with the best overall quality and image for fifteen consecutive years. The national survey of more than 250,000 households produces results that validate its methodology. The results in other markets are consistent with other measures of quality and customer service, for example, Cleveland Clinic in Cleveland, Emory in Atlanta, UAB in Birmingham, Medical University of South Carolina in Charleston, Northwestern in Chicago, and Mayo in Jacksonville. Data on the Medicare Compare website confirms the proposition that University Hospital is preferred by patients. Higher percentages of Medicare patients give University Hospital 9 or 10 ratings on overall quality of care than either the Georgia or national average. Georgia Regents Medical Center is below both the national and Georgia average while Doctors Hospital was at the Georgia average but below the national average. Similarly, the Medicare survey reflects University patients are far more likely to definitely recommend University Hospital than patients nationally are on average to recommend their hospital, than patients in Georgia are on average to recommend their hospital, or patients of GRMC and Doctors are to recommend those hospitals. University Hospital is not only accredited by the Joint Commission, but has received specialty certification for advanced heart failure (one of only four in Georgia), stroke, hip, knee, and shoulder replacement surgery from the Joint Commission. University is the only hospital in Georgia to have achieved Joint Commission certification for all three of hip, knee, and shoulder replacement surgery. The new hospital would be accredited by the Joint Commission. University has full Cycle IV Accreditation as a chest pain center with percutaneous coronary intervention (PCI) from the Society of Cardiovascular Patient Care. University Hospital was the second hospital in the nation to receive that advanced level of certification. University is designated a Magnet Hospital by the American Nurses Credentialing Center. Magnet Hospital designation is widely recognized as an indicator of both outstanding nursing practice and of an organization’s status as an excellent place to practice nursing. University Hospital is the only Magnet Hospital in Augusta and one of only five in the state of Georgia. The Blue Cross and Blue Shield Association has designated University Hospital as Blue Distinction+ Center for both hip and knee replacement surgery and spine surgery. A Blue Distinction Center designation is awarded based upon an analysis of outcomes and program data. Only hospitals with exceptional date are designated. No other Augusta area hospital is 19
a Blue Distinction Center. The Blue Distinction+ Center designation is reserved for those hospitals who also offer that extraordinary level of service at a great value. 15.
How can your facility leverage the Countyâ€™s Broadband infrastructure and capabilities for telemedicine, communication, etc.? Will telemedicine be offered? Connecting to the County Broadband, University will augment the extensive physical presence University has and actively continues to grow in Columbia County by enhancing the satisfaction Columbia County residents, businesses, schools and government experience in being able to interactively engage in managing their families, students and employeesâ€™ health through timely, reliable electronic access to their health information and healthcare providers in a highly reliable, responsive and cost effective way. University Health Care System has an extensive physical presence in Columbia County anchored by a campus in Evans. This campus serves a central location (electronic hub) connecting patient and healthcare providers located throughout Columbia, McDuffie, and other outlying counties. This electronic infrastructure at our Evans campus was designed and is well suited to interconnect with Columbia Countyâ€™s Broadband infrastructure, offering the ability to electronically interconnect health care service delivery to Columbia County residents, schools, businesses and government. Specific opportunities include enabling residents to electronically interact with Columbia County based specialist physicians who themselves are connected to the integrated electronic infrastructure. This will be particularly valuable for the homebound, elderly, and other individuals who have transportation challenges. In addition, the Broadband connection facilitates more advanced capabilities, such as Telemedicine,Telemonitoring, and TeleRadiology, and ongoing patient and community education. The ability to extend University Health Care System electronic medical records (EMR) system (used by all UH care providers) through the Columbia County Broadband would enable residents to actively participate in their ongoing care by providing real time, secure access to their personal electronic medical record containing their medical history, medications, and test results, and enabling email communication with their care providers. University Hospital and University Hospital McDuffie both currently use telemedicine to acquire expert interpretation of radiographic studies. Additionally, beginning early this year, University Hospital will commence a telemedicine arrangement with the neurology department of Georgia Regents University for the identification and treatment of strokes. Consistent with those initiatives, University is certain that telemedicine will be used at the new hospital.
Describe your current investment in the healthcare needs of residents in Columbia County. No organization has invested as much or for as long in the health care needs of Columbia County residents. The University Health Care System is founded on two interdependent ideas. Those ideas are that it is not possible to satisfy the health care needs of the region solely from 1350 Walton Way and that for a health care organization to remain viable it must be geographically dispersed throughout its service area.
University purchased its 68 acre Evans campus site in 1986. Over the ensuing twenty-seven years University has invested many millions of dollars developing that campus. Its five medical office buildings with 160,000 square feet of space have attracted many physicians to Columbia County. Those buildings also house hospital outpatient services such as laboratory, cardiac imaging, and speech and hearing therapy. University and Brown Radiology partnered to open a multi-million dollar diagnostic imaging center in one of the office buildings. It is not just coincidental that many other independent medical providers have opened offices and facilities adjacent to the University Evans campus. Also on the campus are University’s 149 bed Westwood skilled nursing facility and the Surgery Center of Columbia County (SCCC). Westwood is currently undergoing an over $1.5 million renovation. Among those who choose to treat their patients at SCCC are twenty surgeons, gastroenterologists, podiatrists and pain specialists who are investors. Offices on the Evans campus were the original site for the Center for Primary Care. University spent considerable time and resources helping to establish that now large group in Columbia County. As described further in the response to Item 119, the Evans campus offices have enabled University to recruit many more physicians to Columbia County, including Family Physicians of Evans, University Medical Associates, and University Medical Group. At about the same time that University acquired the Evans campus, it purchased a building at the intersection of Flowing Wells Road and Columbia Road in Martinez. In that building University opened Columbia County’s first urgent care center. University’s Prompt Care provided services seven days a week at that location for many years, before moving to its current location on the Evans campus. Today, the Flowing Wells Road building provides office space for Covenant Pediatrics, University’s Columbia County home health agency, University Hospice, and University Hospital outpatient diabetic services. Classroom and public space were part of University’s original design for the building. From the beginning, University has offered to Columbia County residents classes on a wide variety of health care subjects. University is currently developing a six acre site in Grovetown. A new 15,000 square foot facility will open June, 2014, housing a second Prompt Care, a satellite site with hyperbaric oxygen for University’s wound care program, and a new location for University’s Grovetown based employed family practice physicians. Those physicians will be moving from rental space on Wrightsboro Road. University will invest nearly $6 million in that land and facility. The Brandon Wilde continuum of care retirement community which includes a skilled nursing unit and the recently completed Windsor House twenty-five suite Alzheimer assisted living resident represents an investment of tens of millions since the early 1990s. Most of the three hundred twenty-five residents on the 104 acre campus are new to Columbia County. Brandon Wilde was the reason they brought to Columbia County their resources and experiences from successful careers all over the world. University’s investment in the health care of Columbia County residents goes far beyond providing health care providers and developing facilities. A significant proportion of 21
University’s employees live in Columbia County. University has a very deep interest in the health of those over 1,100 employees and their families. Recognizing the importance of community infrastructure and schools to good health, University has a long history of involvement with Columbia County schools and infrastructure development. University provided management services for Columbia County EMS for many years and was deeply involved in the Columbia County government’s employee wellness program. Since its inception, University employees have had the honor of serving on the Columbia County Chamber of Commerce Board. University is a frequent sponsor of Chamber events. In addition to community education programs in the Flowing Wells Road building, University frequently brings health fairs and often screening programs to Columbia County, including its award winning, life saving mobile mammography unit. Whether measured in sites, acreage, facilities, programs, dollars, people, or time, University’s investment in the health of Columbia County is unparalleled. As it should be, University’s new hospital will be a logical extension of a wide range of relationships with a long established friend. 17.
What medical specialties would be specifically addressed in this hospital (OB/GYN, Heart, Cancer, Neurology, Children’s medicine, Gerontology, Sports Medicine, Orthopedics, Occupational Health, etc.) The new hospital will be a full service hospital. It will offer the full spectrum of services generally found in a community hospital. Those services would include medical services such as cardiology, neurology, oncology, internal medicine, and gastroenterology. We also envision a broad range of surgical services including general surgery, orthopedic surgery and gynecologic surgery. More expectant mothers choose University than any other hospital. We are absolutely committed to continuing to earn that trust. Offering obstetrics at the Evans hospital would be very desirable. Unlike the other services in the previous paragraph, obstetrics is subject to a separate set of certificate of need rules. Consequently, Department of Community Health approval will be required before obstetrical services can be provided at the Columbia County hospital. As indicated in Response 13, University supports the Children’s Hospital of Georgia. While University Hospital has maintained a very busy pediatric emergency department, it has fostered relationships with the pediatric specialists of the Children’s Hospital of Georgia that have facilitated timely and seamless transfers of those few pediatric patients who would benefit from critical care or subspecialty services. University envisions following the same collaborative course to ensure local care at the Columbia County hospital for most children, but rapid access to the Children’s Hospital of Georgia for the small number who need intensive care or a pediatric subspecialist. University currently provides occupational health and medicine services on the Evans campus. The occupational health services provided include: minor injury treatment, preplacement physicals, post-offer physicals, annual physicals, medical surveillance physicals, DOT physicals, fitness-for-duty evaluations, drug and alcohol testing, laboratory work, vision testing, x-ray, electrocardiographs, and pulmonary function testing. The Columbia County hospital will support and coordinate with those services. 22
What advanced technology applications are included in your plan? The University Health Care System has adopted the EPIC electronic medical record. The EPIC electronic medical record provides an incredible array of provider to provider communication enhancements, new methods for patients and providers to interact, safety features and operational enhancements. University has invested approximately $50 million in this most highly rated information system. As recently as this past December, University had the opportunity to test how well its implementation (initial go-live December 2012) of EPIC has promoted patient safety. The Leapfrog Group annually conducts an extensive and in-depth assessment of hospital patient safety practices. Beginning in 2013, the survey contains a computerized order entry evaluation tool that involves an actual on-line third party test of a hospital’s electronic medical record system’s ability to improve care. As a result of the test of the EPIC system as applied at University Hospital, the Leapfrog Group assessed the computerized prescriber order entry (CPOE) as fully implemented at University Hospital. With the results of that CPOE evaluation, University Hospital anticipates an evaluation of an “A” hospital safety score when the Spring, 2014 safety scores are released. EPIC will provide a highly advanced information system backbone for the Columbia County hospital. University Hospital was the first area hospital to add advance radiation dose reduction to all of its CT scanners. One of the first things University did after acquiring McDuffie Regional Medical Center was to replace its CT scanner with a new one which incorporated advance radiation dose reduction capabilities. University will bring that same attention to patient safety and the most advanced technology to the Columbia County hospital. University has invested nearly $300 million in technology over the past decade. From Giraffe Omnibeds for premature babies to transcatheter aortic valve replacement (TAVR) for inoperable and high risk patients suffering from severe symptomatic aortic valve stenosis, University has an unparalleled record of applying technology to improve lives in our community. University’s TAVR program reflects a perfect melding of advanced technology and a comprehensive team of cardiologists, cardiac surgeons, vascular surgeons, anesthesiologists, and specially trained support staff to achieve medical miracles. Only five other hospitals in Georgia and South Carolina combined are able to provide TAVR to the 30 percent of aortic valve stenosis patients who are not candidates for open heart surgery. The greatest potential for improved outcomes at lower cost will be found in new more advanced and effective ways of using information and organizing health care providers. University is on the forefront of that effort. University will leverage its investment in EPIC to develop information that will enhance the ability of physicians and other providers to deliver the best care. University employed physicians are members of the Accountable Care Coalition of Greater Augusta and Statesboro (ACO). The ACO is a physician led organization, the vast majority of whose physicians are private practice primary care physicians. Several of those physicians’ offices are in Columbia County. The ACO has partnered with a subsidiary of United American, a publicly traded health insurance company and one of the largest Medicare Advantage plans to bring this much heralded Medicare 23
program to this area. Additionally, University Hospital and over 250 members of University Physicians Associates, an independent practice association, have engaged in a clinical integration initiative which facilitates contracting with insurers and other third parties on the basis of the quality of performance rather than the volume of work. University entered into a shared services agreement with Novant Health during 2013 in large part because of the commonality of our mission, vision, and values. One of Novantâ€™s core objectives is to provide world class technology when and where it is needed. Novantâ€™s twenty not for profit acute care hospitals provide University a unique opportunity to explore in depth applications of advanced technology to clinical and administrative problems. While the two to three million dollars per year in expected savings from access to the large scale Novant supply and services contracts is a very important part of the Shared Services Agreement, access to the expertise of a $3.5 billion operating revenue organization with over 1,100 employed physicians has great significance. Under the Strategic Services Agreement, University has a right to up to ten, approximately one hundred hours each, analyses per year. Novant has a four state footprint (Virginia, North Carolina, South Carolina, and Georgia) whose twenty hospitals have 238,000 combined discharges and 542,000 emergency department visits. 19.
How will you recruit, train, and retain doctors for your facility? Approximately every other year since the early 1990s, University has conducted an analysis to guide the recruitment of physicians to meet then current and projected hospital and community needs. That analysis has resulted in efforts that have brought many physicians to the Augusta area. Having successfully recruited physicians in both primary care specialties, such as family practice, internal medicine, and obstetrics, and subspecialties such as orthopedic surgeons, neurosurgeons, vascular surgeons, cardiac surgeons, neurologists, oncologists, infectious disease specialists and other subspecialists, University is confident that the recruitment programs it has used would be successful for the Columbia County hospital. As the business and regulatory aspects of private practice have become less predictable and more onerous, employment has become an increasingly popular option for physicians. University has significantly increased the number and breadth of its employed physicians over the last couple of years. Employment has proven a highly effective strategy in bringing new physicians to the area, as well as effective in retaining physicians in the area. University employs nearly one hundred physicians. One of the advantages that University has in its recruitment activities is clarity of focus. University recruits, whether by assisting existing practices add a physician, or through employment, physicians to provide patient care. The fruits of Universityâ€™s recruitment activities are very evident in Columbia County. Many of the primary care physician offices in Columbia County arose from University recruitment activities or include one or more physicians who received recruitment assistance from University. Family Physicians of Evans arose directly from a decision by University to place employed physicians in Columbia County. While those physicians eventually decided 24
to enter private practice, University has helped that group recruit additional physicians. The Center for Primary Care’s first office was on the Evans campus. Financial assistance and support services from University facilitated the growth and development of CPC in its initial years. Other Columbia County private primary care practices with University recruited physicians include University Medical Associates, Evans Medical Group, Georgia Internal Medicine, Covenant Pediatrics and Pediatric Partners. Additionally, University has employed primary care physicians in offices in Grovetown and on the Evans campus and at Prompt Care on North Belair Road. University Hospital is approved as a provider of continuing medical education (CME). Through regular programs, University Hospital provides physicians the latest information and helps physicians satisfy licensure CME requirements. Physicians earn approximately 3,500 hours of CME credit annually through the University programs. Additionally, the employment agreements require physicians to maintain and improve professional competence through participation in continuing education, medical seminars, conferences, and other educational and training programs. Each employment agreement provides an expenditure allowance solely for medical education activities. University encourages medical staff engagement in the Georgia Regents University residency programs. Stipends are paid to medical staff members who have formal roles in the residency program activities at University Hospital. That engagement has multiple benefits for the physicians, the residents, and University Hospital. Teaching sharpens one’s skills. Further, unlike many educational settings, residency training is conducive to the sharing of information in both directions. Finally, serving as a site for residency training has piqued the interest of many residents in entering practice at University Hospital. 20.
What unique opportunities would you bring to Columbia County if you are the successful proposer? University’s proposal is the only one which provides local control. As a nonprofit organization governed by a board comprised of volunteer local business people, local leaders, and physicians practicing in the community, decisions are made in the community by the people whose stake in the organization is the nature and quality of the health services provided. All operating surpluses are reinvested in the community. There are no obligations to investors or requirements to provide returns to shareholders. The leadership team at University is not only very stable, but it has deep roots in Columbia County. Three members of senior management have lived in Columbia County more than twenty-five years. Their children were educated in Columbia County schools and learned sportsmanship at Columbia County athletic facilities. Their families are members of Columbia County churches. Attached are biographic sketches of senior management. The management team at University is stable, but it is not standing still. During 2012, University worked with McKinsey and Company’s Objective Health to determine the impact of the Affordable Care Act and the necessary organizational responses. University Hospital is the only hospital McKinsey knew of which had reduced its total cost per equivalent inpatient admission every year since 2008. An analysis from Truven Health 25
unequivocally confirmed the effectiveness of University’s management. Truven Health Analytics delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry. Hospitals, government agencies, employers, health plans, clinicians, pharmaceutical, and medical device companies have relied on Truven for more than thirty years. Truven’s 2013 analysis, based on trending various measures of performance over the five year period 2007 through 2011, found that University’s rate of improvement over that five year period was in the top ten percent of all hospitals. Julie Shook, the product director for Truven’s Center for Healthcare Analytics, observed University Hospital has a good rate of improvement that shows University is able to get things implemented, which is indicative of an effective leadership team. University is the only RFP respondent which owns the property on which the proposed hospital will be built. That fact eliminates the risks, expenses, and time associated with site acquisition. Further, University’s Evans campus is already at the center of medical services in Columbia County. University’s proposed site complements the numerous physician and other health care provider offices that have positioned themselves on and near the Evans campus. The roadways bordering and intersecting at the Evans campus provide unparalleled access to and from the new hospital. The University Health Care System is able to offer by far the most comprehensive range of health care services. No other area hospital service provider also is a provider of home health, hospice (Trinity Hospice is neither owned nor controlled by Trinity Hospital), and skilled nursing facilities. This unrivaled scope of services facilitates coordination of care as a patient progresses from hospitalization to the patient’s optimal recovery. The capacity to provide a full continuum of services gives University the ability to provide care in the setting that is most advantageous to the patient. Most significantly, no other organization would bring to the new hospital a better record of high clinical quality, great patient satisfaction, and lower cost than University. Fifteen Healthgrades Five Star ratings compared to no other area hospital receiving more than one, is a clear indicator of excellent clinical quality. The response to Scope of Work item 14 and the Executive Summary list other validations of University’s high quality. Selection in the National Research Corporation survey as the consumer choice for fifteen consecutive years speaks volumes about the University culture of service to patients and their families. The Medicare data on hospital charges (Scope of Work Item 14) undeniably reflects that University’s charges are far lower than any other area hospital.