In Favor of the New Hospital in Greensboro

The Rhino Times published an article about the Atrium/ Wake Forest Baptist proposal for a new 36-bed hospital on Horse Pen Creek Rd. in Greensboro. Within the article, an e-mail address was included to send comments to state regulators regarding this proposal. Comments must be received by March 31. The e-mail address is as follows:

DHSR.CON.Comments@dhhs.nc.gov

I submitted my comments earlier today. They are as follows:

I am a practicing physician who resides in the city of Greensboro and who practices in the city of Reidsville. Cone Health owns and operates Cone Hospital and Wesley Long Hospital in Greensboro. It also owns and operates Annie Penn Hospital in Reidsville and Alamance Regional Medical Center in Burlington. It had also previously acquired via merger Women’s Hospital in Greensboro approximately 30 years ago.

I support the application by Atrium/ Wake Forest Baptist to establish a 36 bed hospital on Horse Pen Creek Rd. in the city of Greensboro. I base this support on the following considerations:

• The city of Greensboro has not had hospital competition for acute emergency services for a period of nearly thirty years. Throughout much of the city, the patient who has a true medical emergency for which care is time-sensitive would have to drive very long distances to access care at an alternative hospital. Greensboro is the largest city in North Carolina devoid of hospital competition.

• The Greensboro/High Point metropolitan area scored 4112 (or “High”) on the Herfindahl-Hirschman Index (HHI) that measures a geographic region’s degree of hospital concentration for the calendar year 2020 (https://healthcostinstitute.org/hcci-originals/hmi-interactive#HMI-Concentration-Index).

• Cone Health has achieved a de facto monopoly for acute emergency services by sequentially acquiring the above named hospitals in contiguous jurisdictions. This consists of a large, roughly rectangular geographic area that includes much of Greensboro and northern Guilford County; southeastern Rockingham County; northwestern Alamance County and southwestern Caswell County. These form one contiguous region in the eastern Piedmont Triad that has no hospital competition for acute emergency services because of Cone Health’s monopoly status. This situation is aggravated by the fact that this region has a high degree of urban sprawl. This means that driving distances to access services tend to be much longer. Our metropolitan area has ranked among those having the highest degree of sprawl for those designated as medium-sized (https://smartgrowthamerica.org/wp-content/uploads/2016/08/measuring-sprawl-2014.pdf).

• It is a well-established economic principle that competition lowers costs and increases quality. We need much more hospital competition to further these objectives.

• The Atrium/ Wake Forest Baptist proposal will not increase the number of hospital beds in Guilford County. The proposal is to shift 36 beds from High Point Medical Center to the new campus on Horse Pen Creek Rd. Given the fact that there will be no net increase in the number of beds in the county, the Certificate of Need process ought to be, for practical purposes, regarded as moot and uncontroversial.

• The regional hospital monopoly that Cone Health possesses for the above described region affects patients. Specifically, it has been my experience that many patients elect to forego seeking care in the emergency department even when it is needed because of the prolonged waiting times and the amount of time it takes to be evaluated and treated.

• But Cone Health’s regional hospital monopoly also affects health care workers. Nurses and other ancillary health care personnel whose focus is hospital-based often perceive they have no other options for employment because the driving times and distances to alternative hospitals in such a sprawling metropolitan area are quite lengthy. Doctors employed by Cone Health or who admit patients to Cone Health hospitals face the same conundrum. When hospital systems are emboldened to behave in an autocratic manner toward physicians and other health care workers because there are no viable alternative environments in which they can work, this hurts health care workers—but it also ultimately harms patients.

• Atrium/ Wake Forest Baptist cannot be represented to be particularly exemplary. Nearly all of the major hospital systems tend to act in very similar ways in the marketplace; and the issue of hospital consolidation needs to be addressed from a regulatory standpoint. Hospital consolidation raises costs for the payers of insurance premiums and taxpayers. It also results in diminished competition with fewer choices for patients and health care workers.

In view of all of the foregoing considerations, I urge that the Certificate of Need for this proposal be granted. Thank you.