|
State process regulates hospital projects
By Rachel Pleasant
Staff Writer
Before a spade of dirt is turned or a brick is laid, South Carolina hospitals wanting to expand must go through a rigorous state review process in the hopes of receiving a certificate of need.
This detailed, behind-the-scenes process began in 1971 when the state enacted the program, now called the “State Certification of Need and Health Facility Licensure Act,” to regulate the development of health facilities and services.
The process, typically a four- to six-month undertaking, is designed to achieve a handful of goals: to control costs, prevent unnecessary duplication of health care facilities and services, establish health facilities and services to best serve public needs, and to provide for a high quality of service in the state’s facilities.
“If you’re going to build a brand new hospital, we want it to be needed, for there not to be any duplication of services and, without it, patients are going to have serious problems with cost, availability or accessibility of services,” said Joel Grice, director of the Bureau of Health Facilities and Services Development within the state Department of Health and Environmental Control, the agency charged with issuing certificates of need.
The certificate of need program begins with the 14-member State Health Planning Committee’s state health plan, which is written at least every two years and outlines the need for medical facilities and services in the state.
“Essentially, the certificate of need committee can’t approve a project that is not consistent with the plan,” said Les Shelton, a planner in DHEC’s division of planning and certificate of need.
The state health plan, Shelton said, is basically a projection of need for various services and facilities, including hospitals, nursing homes, ambulatory surgery, rehabilitation, psychiatric care and home health.
The State Health Planning Committee looks at a hospital’s current utilization, projected need and population estimates for seven years into the future. Based on that data, they come up with a plan for each facility, a plan that determines a facility’s ability to expand.
To illustrate how it works, Shelton used Trident Medical Center as an example.
“We looked at the 2003 population for its service area and the 2003 utilization,” Shelton said, adding that in developing the 2004-2005 plan, 2003 data was the most recent available.
“We look at patient days per population, and for a facility of Trident’s size, we used a 75 percent occupancy rate, but that can vary with the facility. Taking all that, we determined that they will need an additional 42 beds by 2010.”
However, as straightforward as it may sound, determining a facility’s need to expand is not always so black and white.
In cases such as the one in Mount Pleasant, where Roper St. Francis and East Cooper Regional Medical Center are both looking to build new facilities within eight miles of each other, the committee has to look at how each project will impact the other.
“East Cooper Regional Medical Center has 100 beds, and they want to add 40 more. Roper St. Francis wants to move 85 of its beds from downtown to East Cooper. Does this exceed the need of the community? Is any of this an unnecessary duplication? We don’t want to duplicate services,” Grice said.
Grice, who confers with a 10-member committee but is ultimately the one who signs off on a certificate of need, said an analysis of the proposed Mount Pleasant projects is still being conducted, and he couldn’t say whether he anticipates problems in the certificate of need process for either project.
Plus, Grice said, every situation is different, and it is difficult to predict how the process will play out for a project.
For instance, Grice was initially concerned that East Cooper Regional Medical Center wanted to replace its existing facility, which he considers to be a modern facility, with a new building estimated to cost $160 million.
“But we determined they do need to expand, and the way their building is designed, it would cost a lot of money to expand. In this case, it is really practical for them to look at replacement as an option. Those concerns have been resolved in my mind,” Grice said.
Both the Roper St. Francis and the East Cooper Regional Medical Center projects were published for notification in the Sept. 23 South Carolina State Register, which is required under the certificate of need plan. As part of the program, the opportunity for public comments must be given.
Grice anticipates a decision on both projects will be made by late February or March.
“We want to make the best decision, and we don’t know what that’s going to be yet,” Grice said.
Once a certificate is issued, a hospital has one year to sign a construction contract, but a certificate can be extended for two six-month periods, if needed.
The certificate of need program can cost an applicant a maximum of $15,000 in fees, which goes to the state’s general fund.
Rachel Pleasant is a staff writer for the Business Journal. E-mail her at rpleasant@charlestonbusiness.com.
|
E-Mail This Article
Printer-Friendly Version