WDN, Klemm, Evans et. al. get the cart before the horse on the hospital | Eastern North Carolina Now

    Publishers Note: This is a fine editorial from the Beaufort Observer Editorial Team that helps to explain a condition that has plagued Beaufort County for decades - the acceptance of the practice of very bad government. Complete with a cheering section and a support team of folks with limited imaginations, we trudge forth and rarely do we ever learn from our mistakes. Maybe now is the time to break this co-dependency of sophistry intertwined between those who govern poorly and those who enable them.

    So the Washington Daily News has jumped on the University Health System bandwagon. Or is it "jumped into bed with" UHS? The next day after the hired consultants presented a brief overview of the proposals that have been received, the WDN came out with an editorial calling for leasing the hospital to UHS "soon." The full proposals had not yet been released before the WDN decided what the best deal for the next 20 years or so would be.

    In jumping on the UHS bandwagon WDN joins County Commissioner Al Klemm, commissioner candidate Jerry Evans and the Committee of 100, as well as former UHS board member Buster Humphries in advocating for selling the hospital to UHS. A distinguished list, no doubt.

    The only problem with this august rendering of wisdom is that none of them had read the actual proposals, much less did they have the benefit of what the consultants have promised will be "intense negotiations" about the details of any affiliation agreement. Assuming some of those negotiations will produce changes in the ultimate proposals, no one has the benefit of solid information with which, at this point, to compare proposals. This is like car shopping by simply looking at the sticker on the window.

    And it is arrogance of the highest order to jump to a conclusion to sell out to UHS before hearing from the medical staff and employees of their views of the specific proposals. And the condescension toward the "owners" of the hospital (taxpayers of Beaufort County) is amazing to decide before the public hearings to see how the people view the proposals.

    And with regard to the owners/taxpayers, we actually believe the final decision should be put to a vote of the people, even if that vote is for a bond issue or a special hospital tax. Let the people decide!

    We would speculate that if any agreement is struck with any of the four proposers that it will not be identical to the first proposal. First bids are seldom the best deal. (We wonder if Messrs Klemm, Evans, Humphries, the Committee of 100 et. al. would agree to sell their house before knowing what the buyer would actually pay.)

    We find it amazing that such smart people would decide which is the best deal before the specifics are even known much less before the negotiations even begin!

    But when one of the chief criteria used to decide that UHS is best is that you can drive a shorter distance to express your displeasure with services that might be rendered in the future, it probably should not surprise us that little attention has been paid to issues such as capitalization, ownership of the property at the end of the lease, how quality will be assessed and guaranteed, who is going to make what decisions, such as cutting expenses, capital investments etc. etc. Oh, and by the way: What is the property to be conveyed worth? Do these people know how much equity the County has in the property? We suggest you ask the next one of these folk who tell you UHS is the best deal this question: "At the end of the lease UHS will get all the property for $1 or less. At the end of the lease with CHS, for example, the County would still own the property. What do you expect that to be worth then?" That's two very different deals. (And to the Commissioners: "If you 'give that value away' how much in legal fees will it cost to defend against the likely suit that follows?"

    And we have yet to find anyone who is assuming that a "non-profit" partner is automatically better than a "for-profit" operation that has put forth any hard data to back up that assumption. But the consultants did confirm, in an interview with us, what we had learned from Google...that there no readily available valid and reliable research to show that non-profits operate at a lower cost or provide better patient care than do for-profits. The consultants (experts) did confirm what we had come to suspect: Health care is not different from other enterprises...the quality of management and leadership make more of a difference than where profit goes. And never forget..."not for profits" must make a profit, if indeed they are going to stay in business.

    We would like for some of these "experts" to explain why a monopoly should be expected to provide services at a lower cost and higher quality than would be true if there is competition between BRHS and UHS. Eliminating what choice patients now have would seem to us to be a prime consideration in determining the future of the health delivery system in this market. And the same is true for employees. Competition is usually good for employees who can offer their services to more than one employer. Why would that not be true in this situation?

    Here's something to ponder. If UHS is the only provider choice we have, is health care going to be more like buying electric service or more like buying cell phone service?

    Some of these UHS proponents contend that UHS will use its powerful resources to provide better facilities and services in Beaufort County than an independent hospital could. How do we know this? We have reviewed the UHS proposal and see nothing to support that conclusion. Rather, we suspect they will do what they have done in some other places they have taken over...match resources with demand. And if they don't do exactly that they will not be any better off eventually than is BRHS. Think about it this way: "Is UHS likely to siphon off resources from Greenville to put in Washington if Beaufort is losing patients as it has been?"

    But the chief bafflement we get from these predictors of Nirvana from UHS is that they have no way of knowing whether BRHS and BCMC (the hospital) can survive independently. They will tell you they know, but they have no data to back that up.

    That BRHS has been losing money does not mean it could not be managed in such a way as to make money. Obviously, BRHS has been managed poorly. They have expanded by taking in several additional private practices in recent years, but they do not have solid data to show whether those practices have been making or losing money. They can't tell you today which practices are assets and which are liabilities to the bottom line. But here's the clincher: They can't tell you whether it is the hospital that is losing money or the practices, much less which practices. So nobody knows what the future might hold. All we DO know is that we DO NOT know why the operating income is in the red.

    We do know this. Their billing practices have left much to be desired. They have a lot of money tied up in accounts receivables that they have not been collecting. Any business we know would focus on such things first before they decided to give up; and any buyer would likely to do so likewise.

    We've said it before and we'll say it again. We don't know what the best decision is for the future of health care delivery in Beaufort County. We don't know because we know we don't have the data and information to know. We don't think anyone knows because of the reasons mention above. We are startled that the WDN and all these other really smart people would think otherwise.

    UHS may be the best choice as a provider. But it may not. Duplin County learned the hard way that they could not count on what UHS promised them. (Duplin turned its management of their hospital over to UHS and that did not "save" their hospital.) UHS ended up scooping Duplin up in a fire-sale. One Duplin official described it this way: "UHS came in here promising to get our hospital back on a sound financial footing. Instead they drove it into the ground. Now they will get all of our assets simply for operating the hospital for 25 years and we have no say in how they operate it." Click here for that story.

    But we don't think Duplin should be the determiner of whether Beaufort should affiliate with UHS. Rather, what Beaufort should do should be determined by the specific details of the best deal that can be negotiated with whomever is interested in running BRHS. Nothing more, but nothing less. And in all due respect to the WDN we would suggest that cannot be determined before negotiations are complete.

    We take great consolation that commissioners Booth and Deatherage promised at the forum that they would carefully weight each proposal and seek the best deal for the People of Beaufort County. If that is UHS, so be it. But if not, so be it too. We just hope they'll do the right thing. And the right thing we think is a system that provides the best health care we can afford in a fiscally sound environment that the People of Beaufort County can have the greatest possible choice and control thereof.