The "unremarkable record" of the Bon Secours Health System in providing charity care in Virginia rebuts one of the Roman Catholic system's justifications for wanting to relocate one of its urban hospitals to the suburbs.
So says the staff of the state health department's certificate-of-need division in a report recommending the rejection of Bon Secours' CON application for the relocation project.
"Because of (Bon Secours') unremarkable record in the provision of charity care, it is doubtful that the project will result in any substantial increase in financial access to healthcare services for the population (in this area)," the report said.
The Richmond division of the Marriottsville, Md.-based Roman Catholic system wants to shutter 158-bed Stuart Circle Hospital in Richmond and build a 130-bed replacement hospital in the burgeoning southwestern suburbs.
Under the plan, Bon Secours would build a $70.3 million, 130-bed replacement hospital near Midlothian, an affluent suburb in Chesterfield County, south of Richmond. The system hasn't decided what to do with the Stuart Circle facility if its CON is ultimately approved.
Bon Secours filed its application with the regional CON authority, the Central Virginia Health Planning Agency, on July 1.
The Capital Area Health Advisory Council, a consumer-employer panel that makes recommendations to the CVHPA, last month approved Bon Secours' relocation plan.
The CVHPA also gave the plan a green light but conditioned approval on Bon Secours' providing more charity care and developing a reuse plan for Stuart Circle instead of closing it. Bon Secours agreed to provide charity care totaling 3% of its gross revenues at the new hospital.
The CVHPA then sent the CON application to the state health department, which analyzes applications and makes recommendations to the health commissioner. The commissioner has the final say on CONs.
The health department report said:
* The proposed replacement hospital wouldn't improve geographic access to health services. Columbia Johnston-Willis Hospital, owned by Nashville-based Columbia/HCA Healthcare Corp., is only six miles from the planned site of Bon Secours' replacement facility.
* Bon Secours did not consider other uses for Stuart Circle, including consolidation with another Bon Secours facility.
* Opening a new hospital would increase the demand for already scarce medical staff and "possibly create staffing difficulties felt long into the future."
* There is no evidence that more hospital capacity will be needed in the future. In fact, occupancy levels at Columbia Johnston-Willis and Columbia Chippenham Hospital, which together have 748 beds in Chesterfield County, are well below the state standard of 85%, which would justify building a new hospital.
* Giving Columbia hospitals some competition south of the James River would not necessarily lower healthcare costs for patients. Insurers already have "considerable discretion" in negotiating payment rates with providers, and commuting patterns show that the river is not a significant barrier to finding care.
Bon Secours took the negative report in stride, saying it does not supersede previous recommendations by the CVHPA and its advisory council.
"We're disappointed that (the state health department staff) views this as a new hospital, when clearly it is a transfer of beds," said James Goss, a spokesman for Bon Secours' Richmond system. "We're confident that the decision of the Central Virginia Health Planning Agency will be the one that prevails."
Goss also said that after the Medical College of Virginia Hospitals, Bon Secours provides the most charity care in the Richmond market.
"We're very proud of our (charity care) record," Goss said.
Columbia is opposing Bon Secours' CON bid. At a public hearing on the matter in September, doctors and other Columbia hospital staff told CVHPA board members that adding a hospital in Chesterfield County would create a staffing shortage. Columbia has also met privately with area employers and local government officials to discuss its reasons for opposing the CON.
Columbia, which was disappointed with Bon Secours' initial victories, agrees with the health department's report.
"We thought its conclusions were clear: There is no need for a replacement. That's been our position all along," said Mark Foust, spokesman for Columbia's Richmond operations.
Foust said Columbia paid $77 million in taxes last year and provided $2.6 million in charity care in 1997. Bon Secours, by comparison, provided $4.8 million in charity care that year, according to CVHPA data.
"Our charity-care levels compare favorably to Bon Secours," Foust said. "We take our responsibility to the less-fortunate very seriously."
Columbia agreed with the report's assertion that Bon Secours would better serve the poor from its inner-city location.
"According to U.S. Census data, Chesterfield County has 15,000 living in poverty, while Richmond has 47,000," Foust said.
The state will hold an informal fact-finding conference later this month at which Bon Secours will respond to the state health department's report. The hearing officer presiding over the meeting will then make recommendations to interim Health Commissioner E. Anne Peterson, who will decide the project's fate.