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New surgery center application draws fire, support
East Georgia Regional opposes orthopedic groups request to state agency to build facility
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East Georgia Regional Medical Center CEO Bob Bigley says his company is opposed to a surgery group's application to build a surgery center in Statesboro. - photo by Special
    Southeastern Orthopedic Center, a Savannah based orthopedic group with 21 physicians, has filed a Certificate Of Need (CON) to build a limited purpose ambulatory surgery center for outpatient surgeries next to their Statesboro office.
    What may seem like a mere administrative formality to those outside of the medical community, is in reality, a very big deal to some medical service providers in this area. While the administrators of East Georgia Regional Medical Center and a number of local physicians and business people stand in firm opposition to the physician group's request, more than 200 local citizens have written letters to the state in support of it.
    Impassioned arguments are being made for and against Southeastern Orthopedic's application. Some believe that limiting competition in certain areas of medical care is in the best interest of the local community while others think a lack of competition has resulted in the inflation of some health care costs in the area.
    The Georgia CON program, which is regulated by the state Department of Community Health, was begun in 1979 as a mechanism to attempt to ensure the availability and reduce the costs of healthcare by preventing the unnecessary duplication of services, or in layman's terms, limiting the number of providers of certain services in an area.
    By allowing certain types of facilities to be constructed only as the population of the community warranted it, lawmakers felt medical service providers would be more apt to invest in a rural area where competition would be limited. Medical services and facilities which fall under Georgia's CON regulations include  limited-service hospitals, ambulatory surgery centers, and imaging centers.

Opinions on CON
    Many in the health care industry feel that CON regulations are antiquated and not in the best interest of the communities they were intended to protect. Local bank president and chairman of the board of East Georgia Regional, Tommy David, disagrees.
    "The reason we were able to get a large company to come in here and purchase our hospital and then build a regional facility like we have today is because Georgia is a CON state," said David, who is president of First Southern Bank. "HMA was willing to invest a tremendous amount of money in their facilities here because they knew that there would not be duplication of what they had done. They continue to invest millions of dollars in new technology and facility upgrades."
    David said the CON laws have allowed everyone in this area to receive healthcare. "East Georgia Regional has to provide service to everyone in our community regardless of their ability to pay," he said.
    David said one of the main problems with allowing a CON facility to be built, like the one being applied for by Southeastern Orthopedic Center, is that they would not have to provide medical care to those people in our community that are uninsured and cannot pay for it.
    "If this facility were built, Southeastern Orthopedic would be able to pick and choose who they wanted to serve," David said. "Meanwhile, the hospital cannot do that, and the local orthopedic surgeons who are affiliated with the hospital have to come and provide services to those who show up at the hospital and can't pay."
    "Basically, Southeastern Orthopedic would be able to take the most desirable patients away from the hospital's facilities," he said. "It would have a long term effect on the viability of the hospital if a precedence is set for allowing groups to construct operating facilities with a CON designation."

Southeastern’s case for need
    Michael Kleinpeter, CEO of Southeastern Orthopedic Center, said his group would not be the first to construct an outpatient surgery center in Statesboro as other local groups have already done so. He also said his group has been mischaracterized as outsiders trying to come in from Savannah and "poach" business from East Georgia Regional, and that simply is not the case.
      "We certainly don't consider ourselves to be outsiders coming to Statesboro," Kleinpeter said. "Our physicians were asked by the hospital authority in Statesboro to place a satellite office there 15 years ago because there were no orthopedists practicing there at that time. We now have seven different physicians that come from Savannah and practice in our Statesboro office including Southeast Georgia's only pediatric orthopedic surgeon (Donald McCartney, MD).  In addition, we have signed a fulltime orthopedic surgeon (Don Aaron, MD) who will live and practice in Statesboro starting in September of 2007."
    Kleinpeter said his group has seen more than 6,500 patients in the Statesboro area over the past 15 years and the time was right to place an outpatient surgery center here.
    "We have to file for a certificate of need for our surgery center because we are technically a multi-specialty physician practice," Kleinpeter said.  "I just want people to understand that our intent is to provide our patients with the same services that other orthopedists in Statesboro provide, and that would include an outpatient surgery center."
    "As a long standing member of the Statesboro medical community, we feel like our request is a reasonable and legitimate one," Kleinpeter said.  "When we looked at doing a surgery center in Statesboro, we considered the impact it would have on those in Statesboro.  A Statesboro surgery center will create more jobs in Statesboro, will give our patients a more convenient option for surgery, versus coming to Savannah, and will help recruit and retain physicians to Statesboro."
    " We felt like it would be a great opportunity for East Georgia Regional because it will give the hospital another orthopedic surgeon to do surgery and be on call at the hospital," he said. ”It will also give the other orthopedic surgeons in Statesboro another physician to share on call duties, which should reduce the number of nights they are on call by 120 nights."

East Georgia’s side
    On behalf of his facility, Bob Bigley, CEO of East Georgia Regional Medical Center, has filed a formal opposition to the group's CON request. In his opposition, Bigley cites several reasons why the group should not be granted their request.
    "The purpose of the CON regulations are to limit duplication of services," Bigley said. "The hospital has surgical facilities and so does the practice of local orthopedists John Hodges and Ken Johnson. In addition, Southeastern Orthopedics does not have medical staff with privileges at this hospital. They propose to do so by placing a full time physician in this area that will live here, but that hasn't happened yet."
New doctor
    Kleinpeter said plans have been made to place a physician in Statesboro that will live and work in the community.
     "We don't have a physician that has privileges with East Georgia Regional at this time, but that will change when Dr. Don Aaron begins practicing full time in the Statesboro office," Kleinpeter said. "If we are issued a certificate of need and build the ambulatory surgical center, Dr. Aaron will practice at East Georgia Regional and spend all of his time in the Statesboro office."
    "That should address one of the concerns listed by East Georgia Regional in the opposition they filed," Kleinpeter said. "We will have a local physician that can attend to patients that we have operated on in Statesboro in the unlikely event they must be admitted to the hospital."
    Don Aaron is a Sylvania native, who said he is looking forward to returning to the area that both he and his wife are from.
       "Our desire to move back Statesboro stems from our wishes to be close to our family and to raise our boys in the same environment in which we were raised," Aaron said. "We have recently purchased a home between Statesboro and Brooklet and look forward to becoming a part of the Bulloch County Community. My family grew up going to every Georgia Southern home football game and I remain a passionate fan to this day. I have not been involved in the application process, but it is my sincere hope that all of this will work out."

Hospital’s impact
    David said he wants the local community to realize the positive impact that the hospital has had on Statesboro and Bulloch County, and that it is why it is so important to support it.
    "East Georgia Regional employs over 700 people, pays over $1 million in taxes a year, pays over $28 million a year in salaries and benefits to its employees, and provided over $23 million in uncompensated care last year alone," David said. "They have recruited dozens of specialists to open practices here and made $5 million in technological upgrades to the hospital last year."
    "At this point, I cannot support the creation of a facility that will take away the most desirable patients for orthopedic surgery and send that revenue back to Chatham County," David said. "They will be able to pick and choose who they operate on. Our hospital does not have that option."

Profitable services
     Bigley said it is the profitable services, like outpatient  surgery , that offset the unprofitable services like emergency rooms, trauma services, and intensive care units.
    "Our hospital must serve a sufficient number of commercially insured patients to help pay for services provided to Medicare and Medicaid patients and the uninsured," Bigley said. "The CON opponents are a small, vocal group of profit-driven investors and doctors who want to open limited-service hospitals, ambulatory surgery centers, and imaging centers that compete with full-service community hospitals for profitable patients. The difference is, they don't have to take anybody that walks in the door."
    Southeastern Orthopedic Center's application and opposition to it are currently under review by the Georgia Department of Community Health. A decision is expected in the next several weeks.