“Logic seems to dictate that it’s a pretty reasonable thing to do,” Dr. Richard Saluzzo said Wednesday during an interview at Wellmont headquarters.
“It’s not going to be costly. It’s going to be safe. It’s practical. It’s a natural extension of our services, and it’s economically extremely feasible — that would be my summary of it.”
Saluzzo said Tennessee’s Health Services and Development Agency should have adequate justification to approve Wellmont’s Boones Creek proposal based on its standard criteria. Wellmont’s plan, which includes an 11-bed satellite of the Holston Valley Medical Center emergency department, four additional trauma bays and a diagnostic center, will be considered by the HSDA March 26 in Nashville.
Mountain States Health Alliance, which operates Johnson City Medical Center and North Side Hospital in Washington County, opposes the plan. Both systems are not-for-profits, in which the CEOs report to community-based boards of directors.
In broad terms, the HSDA is asked to look at need, economic feasibility and “contribution to the orderly development of adequate and effective health care facilities.” Saluzzo laid out the reasons he believes Wellmont’s project meets those standards, and also put in some plugs for giving local consumers more choice even in an industry where free market practices don’t always rule the day (hence the CON process).
In terms of need, Saluzzo said, HVMC’s ED has been drawing thousands of patients annually from northern Washington County (Boones Creek and Gray).
“There’s a lot of these patients that we’re taking care of already ... and it just makes sense to put an ED closer to them,” Saluzzo said.
While Wellmont’s CON application, filed in November, lists the long-term cost of the project at $41 million, Saluzzo said the system will lease the facility making the “present value” $15 million. He said that fact, combined with the reasonable cost of operating the site and the charges consumers will be able to expect, makes the project eminently feasible economically both for Wellmont and for patients.
“I believe it would be a much lower cost than a normal emergency department given the whole cost structure of the project,” Saluzzo said, adding that the facility will allow folks who visit for non-trauma situations to get care fast and relatively cheap.
“Actually I think this will be very competitive with the lowest-priced care, and in the range of patients that need emergency services, it will be a much more convenient operation and probably cheaper, too.”
On top of that, Saluzzo said, the “Wellmont Emergency Care and Diagnostic Center” will be safe, even for patients who show up with life-threatening emergencies. Fully staffed with board-certified emergency physicians, certified critical care nurses and all the equipment standard to hospital-based EDs, the facility would be more than adequate for a patient who may be having a heart attack or stroke, Saluzzo said.
“Even in very good EDs, there’s a lot of delays in care, and at this place if you’ve got a patient that had a heart attack and needed to go to the cath lab (for cardiac catheterization), we’ll start thrombolytics (clot-busting drugs) on them and get them to a cath lab probably within 60 minutes, which is probably better than most hospitals do that have cath labs on site. The transport process will be very slick.”
He said studies show patient outcomes at free-standing EDs “are as good if not better than regular EDs, so we think it could be completely safe.”
Wellmont’s proposal will represent “orderly development,” Saluzzo said, because the system has penetrated into the Washington County market with clinics in Piney Flats, Gray and Jonesborough — moves that didn’t require certificates of need.
“We do think it’s an orderly development ... given our expansion into Washington County, which again is driven by demand and patients that are coming to us already.”
Aside from the certificate of need factors, Saluzzo said, public response since the project was announced in November demonstrates Washington Countians want more choice in their health care. He said various public polls have shown a strong majority supporting Wellmont being allowed to proceed with its project, which could open as early as summer 2009 if approved.
According to Saluzzo, this support stems from higher quality service in Wellmont emergency services and that, he said, is tipping the balance of ED visits in Wellmont’s favor — not MSHA efforts to direct patients to alternatives to emergency care.
“Just being realistic, you’ve got 10,000 patients leaving Washington County to go to EDs elsewhere,” Saluzzo said.
“A lot of the people who come in the emergency department, we don’t know until after we work them up whether they’re really sick, and that’s where I think some of the fallacy is on this idea that Washington County has this strategy to take patients out of the emergency department and their numbers have shrunk because of that strategy.
“I think what’s happened is, the service has been bad, the people don’t go there, and our service has been great and people come.”
Wellmont has focused intensely on improving its emergency services the past few years, Saluzzo said, even to the point of getting staff into the parking lot to help family members get a patient into the building.
“The ED’s a process-rich environment. If you can fix process ... you can get patient safety outcomes, cost-effective outcomes, service outcomes.
“When I came they were putting a piece of paper through a glass, signing in, going to the waiting room, being called up by the triage nurse, going back to the waiting room, being called up for registration, back to the waiting room and being called in to the ED.”
Those process improvements, Saluzzo said, have sent HVMC ED visits on their upward trajectory as people choose the service.
“America’s health care system is based on choice,” he said. “I know it’s not one of the three criteria, but it’s a reality. Choice and service — that’s what Americans gravitate toward.
“We see that people want what we have to offer and they’d like some access to that. That doesn’t seem like a completely incredible concept. And so I don’t think we need to be hiding behind bureaucratic regulations completely in deciding what people really should have for health care, and I think the agency will understand that too when we make our case.”