Crisp Regional Appeals Lee Co. Medical Center CON Approval

Published 8:32 am Friday, December 15, 2017

Erica O’Neal, Managing Editor

CORDELE – On Wednesday, December 13 Crisp Regional Hospital submitted its appeal of the Certificate of Need (CON) for the proposed Lee County Medical Center (LCMC).

The appeal was a decision made by the Crisp Board of Trustees. Crisp Regional Hospital is a not-for-profit, community hospital, which was created by the Hospital Authority of Crisp County for the purpose of the benefit of people who live within Crisp County. Board of Trustee member and CEO of Crisp Regional Hospital, Steven Gautney wants people to understand that the decision of the appeal is in the best interest of the surrounding community.

“We’re not structured to make a profit. Our profits don’t go to investors anywhere. We are owned by the community, we’re not owned by anybody for profitable purposes, we are owned by the people of Crisp County for their benefit. Our board serves as volunteers. They’re volunteers for the community, they’re not paid for what they do,” Gautney said.

According to Gautney, almost 80% of the patients Crisp Regional Hospital cares for are covered by supplemental programs through the government, i.e. Medicare, or Medicaid. Medicare pays Crisp Regional at what the cost actually is, while Medicaid pays the hospital about 18-20% below what the cost of care is.

Another 10% of patients are uninsured and the last 10% of patients are covered by commercial insurance. That small group of commercially insured patients is important to Crisp Regional because often times they are paying more than the cost of care to make up the gap between what has been spent and what the hospital makes back.

“Our budget goal is to get to break even,” Gautney said.

Excess revenue from commercially insured patients is used to fund services the hospital provides such as the trauma center and dialysis.

“Those services aren’t necessarily profitable, but they’re here because our mission is that we’re going to provide care for people as close to home as possible,” Gautney said.

The CON application for the proposed for-profit Lee County Medical Center anticipates receiving 5% of its volume from Crisp County. That 5% volume will be commercially insured patients that are important to balance out losses incurred by existing Medicaid and uninsured patients.

“By the nature of it being a for-profit hospital, the nature of the services they’re going to offer, they’re going to specifically try to pull commercially insured patients with profitable services from the surrounding area. When we calculate it, we feel like it’ll be between $1.7 and $2. 7 million annual reductions in the money we have available to take care of people here. So over five years, you’re talking a $10 million negative impact,” Gautney said.

Since the CON was approved, there is a 30-day window for when the Crisp Regional Hospital can file opposition. That window closed on Friday, December 15, which explains why the hospital filed the appeal earlier this week. The appeal will go to an Administrator of Law judge within the next 60 days and a decision may be made by February 2018.