For Novant Health and Wake Forest University Baptist Medical Center, playing the certificate-of-need waiting game isn’t so bad.
Novant, Wake Forest come to CON agreement
The two not-for-profit systems agreed recently to settle their CON differences over their competing proposals to build a hospital west of their Winston-Salem, N.C., bases. The CON section of the North Carolina Health and Human Services Department also is a party to the deal.
It ends more than two years of wrangling between the two systems over which one would expand in what was a rapidly growing residential area before the national economy hit the skids last year.
“When we got talking about the process that we were in—with the appeals with the state—we knew that that would take a lengthy period of time, four or five years,” said Donny Lambeth, president and chief operating officer of 807-bed North Carolina Baptist Hospital, the Wake Forest system’s flagship facility in Winston-Salem. “It would be very expensive litigation. Neither side felt it was worth spending all that time, effort and cost to do that.”
Novant won the right to move 50 beds from facilities in Winston-Salem to a new hospital in Clemmons, N.C., but they cannot open those acute-care beds until May 31, 2017, according to the agreement. Like Winston-Salem, Clemmons is in Forsyth County, near its border with Davie County. Wake Forest won the right to build a 50-bed replacement for its 25-bed Davie County Hospital.
That hospital is located in Mocksville, N.C., but Wake Forest would build the replacement in Advance, east of Mocksville and closer to Winston-Salem. Its replacement hospital could not open before Aug. 1, 2017.
In the meantime, both systems are required to build and develop outpatient services on their respective sites, which are about four miles apart.
The Wake Forest system was going to have to delay work on the project anyway, Lambeth said. Beginning the CON process in 2007, the system expected it to take four or five years to get through the process and any appeals, Lambeth said. When the recession really started to bite in the fall of 2008, he said, “That changed the rules some. Even if we had had a clean CON in 2008, we would not have been able to start moving forward at that time.”
The agreement also opens up the possibility that Wake Forest will build a critical-access replacement hospital in Mocksville and open only the outpatient portion of its plans for Advance, Lambeth said. Davie County Hospital really needs to be modernized, he said. In Advance, the system is weighing whether to start with urgent care or a free-standing emergency department, with urgent care the more likely outcome, he said. Beyond that, outpatient surgery and laboratory and imaging services are needed there, he said.
Novant Health faced the same economy-related pressure, said Greg Beier, president of acute-care services. The system has stretched out the schedule for two other hospitals it is building by two years and one by three years, Beier said. The Clemmons project adds capacity only in emergency services, which are needed, Beier said, but having them delayed to 2017 isn’t a problem, he added, even if that is a little later than Novant envisioned originally.
The heat generated by the competitive friction between the two systems was out of character for the Winston-Salem area, both sides said. “This was one of the times that we did get very involved and very competitive,” Lambeth said. “I said to (Beier), ‘I am not so naive to think that we won’t get competitive again,’ but for the most part, we have been collaborative. That’s what I prefer.”
Novant has Charlotte and Winston-Salem as its two main hubs of operation. Beier noted that in Charlotte, the hospitals look to compete first, then to collaborate, but the opposite is true in Winston-Salem; in part, that’s because it’s a smaller area where there is more of a sense of community, he said.
“When this conflict came up, it was really unsettling to the lay members of our board, and they really wanted to understand why,” Beier said. “They understand the need to compete, but they have a strong bias toward working together.”
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