University Health Systems of Eastern Carolina responds to questions about 10 issues

Published 9:21 pm Friday, January 28, 2011

By Staff
During a public session Wednesday afternoon, the Beaufort County Board of Commissioners posed questions about 10 issues to four representatives of University Health Systems of Eastern Carolina — Dave C. McRae, chief executive officer; Roger R. Robertson, president East Carolina Health and HealthAccess; Nancy B. Aycock, general counsel; and Kathy G. Barger, chief growth and development officer. The responses were given by Barger. Answers that are direct quotes are so indicated. Additional information on the issues discussed has been obtained from the UHS response to the Beaufort Regional Health System’s request for proposal and from the UHS website, as indicated.
ISSUE 1: In the event that UHS chooses to build a new facility, the county and UHS should describe the arrangement in today’s contracts that predict the necessary steps for UHS to (a) demolish the current facility and (b) begin construction of a new facility.
ANSWER: UHS intends for a hospital to remain in Beaufort County in the future. Under North Carolina law, the Certificate of Need for the hospital would require that UHS “operate the hospital in Beaufort County.” That issue could also be covered in the lease agreement between UHS and Beaufort County. The $10 million purchase agreement in effect at the end of the 30-year lease also could be subject to a hospital remaining in Beaufort County.
ISSUE 2: While we have had some limited discussion regarding the Certificate of Need, is there a contractual method we might use to ensure the CON always remains in Beaufort County?
ANSWER: UHS would ensure that the CON always remains in Beaufort County by including that agreement as part of the lease-and-purchase agreement.
ISSUE 3: Please describe, in general, your efforts to provide indigent health care in other places and comment on any relationships you have with alternative health-care providers for the indigent.
Answer: “Indigent patient care is not denied based on the individual’s ability to pay.” UHS devoted 3.5 percent of its net revenues to charity care in 2010 and maintains a “very aggressive” indigent care policy. “We believe it would fit here.” That policy, which would be included in any lease agreement with Beaufort County, provides that those patients who do not have enough income to meet designated thresholds are not asked to pay for their care. 
Editor’s Note: The UHS website contains information about charity care. 
UHS offers charity care to our patients who are unable to pay due to financial hardships. We may require supporting documents, including tax returns, pay stubs, Social Security award letter and other financial information. Patients will qualify for 100 percent assistance based on the following key criteria:
• Income below 200 percent of the federal poverty guidelines based on family size;
• Limited assets and possess no real property other than immediate dwelling;
• Amounts owed to UHS;
• Type of service received (some elective procedures are not eligible, including cosmetic).
Issue 4: The county and UHS should have a written understanding regarding the present relationship between BRHS and the East Carolina Behavior Health local management entity.
Answer: Psychiatric care is “a critical part of our mission at UHS.” While UHS is not as familiar with the existing program with East Carolina Behavior Health as the county commissioners, UHS does not foresee any decrease in psychiatric services and “possibly increases in services over time.”
Issue 5: The county is interested in the perception of UHS as it relates to primary-care practices that are presently owned by BRHS. How does the current arrangement fit into the UHS business model long term? The county also has a specific interest in maintaining a primary-care practice in Aurora or in close proximity to Potash Corp.
Answer: UHS will “support the expansion of primary care in Beaufort County and all of the hospitals we serve.” The primary care practices currently owned by BRHS would become part of UHS Physicians. The Aurora community is in a “unique situation” as a result of geography and location of Potash Corp. UHS would continue that primary care and continue the current relationship with PotashCorp.
Editor’s note: The UHS proposal indicates that UHS Physicians owns and operates 42 practices with 188 doctors and physician extenders in locations across eastern North Carolina. Specialists include family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, physical medicine and rehabilitation, cardiology, urology and general surgery. UHS also employs hospitalists who provide care to hospital inpatients.
Issue 6: The county and UHS should reduce to writing the plan and schedule for investing in the highest priority capital projects prioritized by the county commissioners as follows: $3 million addition to the Marion Shepard Cancer Center, emergency department renovation and expansion, patient room renovations and electronic medical record overhaul.
Answer: UHS is supportive of a priority list that includes those items on the county’s priority list.
Editor’s note: The UHS proposal calls for UHS to make a minimum capital commitment of $21 million for the first five years of the lease, including conversion of the information system with electronic medical records, emergency department expansion and renovation, renovation of patient rooms and annual normal capital expenditures.
Issue 7: Could UHS explain to the county the relationship between UHS communities and the UHS foundation? The county is interested in pursuing foundation funding for a new allied-health building at Beaufort County Community College.
Answer: Many UHS hospitals have their own foundations or development councils that conduct fundraising in their own local communities. University Heath Systems also maintains its own foundation which donates annually to local hospital foundations for specific community projects. The “long-standing relationship” between UHS and BCCC “would continue and strengthen because we would be in the local community.”
Issue 8: BRHS has traditionally supplied the “medical control” responsibility for seven county-funded EMS first-responder nonprofits. BRHS has accomplished this task by utilizing rotating emergency department physicians. The long-term commitment of UHS to provide this “medical control” responsibility for EMS units will prevent the county from employing its own medical doctor for this same purpose. This is very important to the county government and our community’s first responder EMS organizations.
Answer: “We don’t anticipate changing that relationship.”
Issue 9: The UHS proposal envisions an advisory board. The county and UHS should reduce to writing the commitment that a single Beaufort County commissioner will always have a seat on the advisory board. The county commissioners hope to be left with the freedom of choosing how to appoint the individual county commissioner.
Answer: Hospitals under the UHS umbrella have advisory councils that report to the UHS governing board that have a variety of responsibilities pertaining to the operation of the local hospital typical to those duties a hospital board performs. The advisory councils are “advisory in nature” and “make recommendations to the governing body.” While they are ex-officio members of the governing body and do not have a vote, “they have a voice.” The local authority would nominate half of the members of the advisory council. Proposals unique to Beaufort County could be included in the lease agreement.
Editor’s note: The UHS proposal and website contains information about its governing board. The governing board of UHS sets the policies that govern the operation and direction of University Health Systems, Pitt County Memorial Hospital Inc. and its subsidiaries. Members of the governing board meet monthly and are responsible for the articulation of its mission and values, the protection of assets and the quality of services. They serve voluntarily and without pay. Members of the governing board are chosen for their management experience and their standing as community leaders. They are chosen by the University of North Carolina Board of Governors and Pitt County commissioners for a term of five years, not to exceed two consecutive terms. The UHS subsidiary that operates the system’s community hospitals, East Carolina Health Inc., forms a separate corporate organization to operate each of its wholly owned or joint-ventured community hospitals. A seven-member board governs ECH. The local directors council for the hospital in Beaufort County will make recommendations related to budget, quality issues, new programs and services and medical credentialing, among other responsibilities. The advisory council chairman and hospital chief of staff will be nonvoting, ex-officio members of the ECH Board of Directors.
Issue 10: Could UHS give us a description of the annual amount of capital it expects to invest in the facility aside from the capital investment it has committed to?
Answer: UHS typically budgets between 100 percent to 110 percent of its depreciation expense at its hospitals to building and equipment upkeep and replacement.