For coming out today, thank you all for being a part of this. We want to take just a moment today to talk about [xx] I think you've seen [xx] from the house and the senate that are part of the budget discussion and others, as we move forward that we have strong believe that we have an in equated seal in law, by its very definition eliminates competition within our healthcare as we continue to deal with healthcare cost in the state that is rising faster than any other parts of our budget take you away from other things we do, we're looking for areas where we can reduce those cost, and see no better than how we allow competition to come into the system and control some of those expenses for us. So we're going to hear this morning specifically on how that's impacting rural healthcare and some of the challenges under the current system, thanks for coming in, and that being said representative Adler has a few comments, and then we move to our speaker. Thank you Senator Hise, I want to thank everybody for coming this morning and being willing to on a contentious discussion and I say we have to admit right upfront that this is going to be contentious, simply because we are in a period of healthcare that is what has happened in a number of our industries over the years and the disrupted change moving forward with progress, we have seen in the past few years so many man baggling advances in medicine in terms of the procedures and how they are performed where they can be performed the equipment that can be used as many have read this in the journal area health organisations now entities that are basically having.com chores, where they have people who can go to their office, come to your home, and wait a minute we're going back to the good old days in house chores and basically we 're and its an issue where I think CON sheets in infact that things are changing in how we deliver healthcare and we're going to work together the people want to make the change people that don't want to change and be able to pick the best of both and create an effective and accessible affordable health care system for all our citizens and as I said, it's contentious, there will be accusations from both sides of yes it is or no, it isn't but I think if we lay all the information on the table and we analyse it as we should that we can come to a conclusion that will be beneficial for the citizens of North Carolina and now I it presents mayor O'neil from Bel Haven. Thank you very much. I have a little story to tell and what I want to tell is of people trying to protect themselves and protect the healthcare and other people who aren't worried about the people trying to prevent that [xx] came to Bel Haven and took over our hospital. Had about a $1 million more assets than liabilities. They din't buy it, they took it over. September 2014, I got a call the local TV station saying that they needed a comment on the hospital closing. [xx] announced they are closing and then talked to the mayor of the town in any way, because they didn't want to try to work out ways to try and keep it open. [xx] wouldn't talk to me, I had the call a rally with about 300 people before [xx] people would talk with me, and then when I talked to them, they told me that they told our community they were going to close our hospital when they took it over, and thats a lie, I have Dr [xx] here, 50 opposition that can tell you that. He's the man that made the motion to go with [xx] So, our hospital was stolen away from us, Raleigh had no empathy for us, we had a public form, [xx] come down for a public form talk to the community, they told the community ambulances will be able to go to the new facilities they wanted to build, which is not to more than a primary care dot resolved they told folks that they would have blood like on the battlefields in Afghanistan quote on quote Mr. Herman they see so they came in and just did a shun job on our town because of their goals that they have business wise we ended up in federal mediation due to complain file while they end up with CP[sp?] we came up with an agreement with Viden[sp?] soon after the mediator left Viden[sp?] delayed documents the accounts received cash on hand patience records systems that they aren't assets to the hospital for they took all that stuff when they took our hospital over making dollars that agree to bring to us a lot first to help run the hospital they want some stipulation on it so once again they undermine us not worired about the peiople and about $200, 000 in good faith working towards the transfer invited intended to undermine
July 1st 2014 they closed our hospital all the objections of our community and the determination of our community to keep our hospital open they pulled the plug and then nothing they said they're going to do in the mediation agreement they even went to surrender their license like the CON anything they could do to try and call these problems from opening[sp?] our hospital, why they closed our critical access hospital the first Hillburg[sp?] hospital in the United States of America in a year thy made $109million as on non profit is right now and is proud of it. They had $700 million and reserves and closed a per what we say people access house bill that's 50 to 2000 people, now the mission is to improve the health of the medicaid population, by increasing the value of health care delivery within the medical home and coordinating care through a collaborative network of health care position [xx] Hospitals, to improve the health of medicaid population through hospitals, they call [xx] hospitals on a mission, the board doesn't care. Now why divided [xx] they did it because they said the hospital is loosing too much money. They don't tell you that they told the doctors not to put people in the hospital and so took it over, they don't tell you that they transferred cost in this hospital and nothing do in this hospital boils the numbers up. It was planned [xx] that they did. The last year the community ran this hospital lost about $ 1 million, it had 129 employees when it needed 55, it has 74 too many employees, that's a lot of pay roll that they didn't make. Just rise up in the hospital where the community head would have worked. We've had 3 business plans done to show how you can be successful, and now what we have is vident, trying to undermine everything we are doing, including the CON in my opinion. The facts of [xx] they wanted to close the hospital because they had the Washington which was 30 miles away. So they knew if they closed Bill Highway Hospital, all people had to go to Washington. So they used the same business strategy, that you would use if you weren't in Hardware source. So they killed the expense of a hospital, no one else had to go to the other hospital is signed. I want for all of you to try and understand that. That there was a hardware store closed we might have another 30 miles to drive for a hammer, we don't a hammer to buy got folks that are having heart attacks, we got elphos[sp?] sitting on the chairs for another half hour. We got people having strokes, and there's more damage done because there is last, our more time attitude when they get treatment. We have people trying to survive bleeding to death because there is no blood in the area anymore. It is just a horrible situation I want to show you something just before the hospital was closed this man right here just knows the methodist of ministry in town on the way to the hospital he lived about two minutes from hospital died. Doctor Boyer knows about this really well. This man died they had to put him in tab with water nice walking for half an hour, that man is preaching at the Mathews Church in Belheaven today. Without the hospital in Belheaven where would be he today? He'd be in heaven. Alright, you see those kids in that picture that's the real world, what we're talking about. This is Dr. Blaire's patients, what she gives, first person to die after a hospital close. Okay I'm not going to beat up you any more, I don't want to. Okay, this lady letter right here had a heart attack at Fairfield, her husband took her to Swan Quarter, they sat for an hour in a high school parking lot waiting for a helicopter because there was no hospital. It took an hou, r she would have been in Belheaven in 25 minutes. When that helicopter sat down after an hour waiting in a hospital parking lot, she died as the helicopter landed, Dr. Blaire was on the phone with her husband the whole time. Three, five minutes into the hour she was talking to you paramedics. Would she have made it in Belhaven at the hands of an E. R physician with all the drugs. All the possibilities that they have to treat her of course she probably would have. She just missed the birth of her granddaughter this past Friday, let's talk about geographics a little bit. I just drove today from Belhaven, North Carolina. It's 130 miles. I came through Washington, I came through Greenville, I came through Wilson. Can you imagine if there were no hospitals in that distance? That wouldn't be right, would it? From Belhaven to [xx] there is no hospital. It's 130 miles. The exact same distance I just drove today. And the CON people, are acting like we we don't need a hospital.
Do you realize the whine and curvy roads that are in North Carolina and the dear and the bear, I just hit a turkey the other day and all the animals that are crossing that road, and at night especially. Do you realize the last year a hospital was home it had over 5, 000 visits at the emergency room? Emergency room, had over 5, 000 visits. Does that sound like [xx] needed? Some people say, well some people had the sniffles. Well let's say 90% of the people had the sniffle. That's 500 people. then lest, they need an emergency room. Obviously there is a need. The county next to Side county, of all these counties in North Carolina. There is no doctor or hospital. it's sad. [xx] wrote a letter to me today pleading for help. I think everybody in this room. Everybody in this room knows, that what I just told you is true and that this community need a hospital. I todays its twice about it, the USDA is giving us $ 6 million loan to open a hospital backup, the made money we have exempted in our hands now, alright so why am I here today, after all what we've spoke of Drextos[sp?] player with stiffening people who will start be willing with me, look down his nose at me, and basically told me that we don't need a hospital, now you tell me how any reasonable human being objective would say something like that or imply that, the any senate allowed to ask this questions he already needed the answer to and send it to the old hospital address which he new nobody was there, trying to be funny which we don't appreciate. The thing is why he doesn't care about what's happening in our community and we expect all those to care vital and have diversity answer to do whatever with the hospital and fight with us, in Raleigh people should be trying to help the people, you know the people have see we are in but I don't even know about Belhaven is, that department is heavily influenced by hospital association, which in which viadent[sp?] is strongly with, so we have folks, a structure, a system that is working against us, if the COE would like protect people they will acknowledge the point evidence so our situation in Bel Haven and help us in all they can, but the thing is the CEO in is nothing more than away from a belth in Oklahoma's to protect the monopolis, the CEO in regulation do not serve people any more they serve the cooperation who prove perfect before people, ask Mr. Begift[sp?] family we need a hospital that's real, we'll appear in Raleigh today taking [xx] from work and my family to try and get some attention on this. We need some help. And if we don't have some help we're going have to keep [xx]. Won't stick twice. We'll be walking in Raleigh all here in a few weeks if something doesn't happen. And the hall way to Raleigh we're going to ask, who cares about people? Who cares about people anymore? Does anybody care about the people anymore? [xx] when I made a mistake being the last one speak after that, I feel, kind of like a baptist minister having to do the alter call, but good comments we here more and more of this as we go down the road dealing with CON. I shared how it affected my wife's family, with resting sir, and getting an oncologist to treat her, radiology oncologist and the problems we had with that, we got a problem outwears this [xx] as we know with psychiatric [xx], so it's something we need dearly, and they had a choice, they could either work on building the facility, or they could do the CON application which was about 10, 12 inches thick, so they just started they can [xx], so we don't have the we have story after story, problem after problem, I get letters from small municipalities in Wake county saying we can get hospital beds because of CON, we ground so much that they will not even talk to us about building a hospital here, I had my former legislative assistant was sent home with a fractured back because they didn't have their beds in North of all places, so it's just case after case, we have an acquaintance system, it's not going to get any better if we just kick the can down the road every time we turn around well maybe in five years we can do this, well folks it's time to do it now, we can't keep waiting, sure we're not saying we got how to
do it all over night, but by not doing anything the problem is not going to fix itself. So I think there's a true consensus within the senate that this is something we need to do and I think our friends in the house fill many, I'm filled the same way we just got to get a majority on board and so we ask you here today to help us get that, and I was so glad to see Dr. Boyette here today I think if we do a list of 50 most influential North Carolinian's, he'd be in the top 10 in my book, so thank you Dr. coming I think you give a phase and credibility to the problem, your passion, we hear you and we got to do something and we know that, we've got to have small hospitals. We have a problem, we know that health care is an ever changing [xx] know that better than I but we have unique problems in the mountains of western Carolina but thank God we don't have the problem you have. So, we are committed to help you and I want you to walk away with that today and we will. So, if anyone has any questions, we'll be happy to try and answer them. Yes sir. [xx] Because I understand that the original force enforced will leave medical facilities go unchecked and prices when they can't feel bad cause of the market dilutions. What about that argument, as it exists today. That is the main argument and we're here but I want to turn up the expert to give you good advice. I think it's important to look at what you are seeing in health care, I think you're seeing the gammas buy all the practices that exist particularly in rural areas and urban areas as well and due to our fee structures and Medicare and medicAid and others we have facility fees to all those costs as they continue to be consolidated, so what you're seeing is someone who could control the market by centralizing it sending out which artificially raises the cost across the board when an individual can go provide those services in rural areas for a cheaper cost but they can't make the payment structure work as well as someone who happens to be based in an urban area can buy that practice and work out without repayments. We did that with [xx] areas in there and so, what you see is, the riving cost of health care is not the number of facilities that are out there, but the charge that has been placed by the individual for services provided. And so I will see controls the number of facilities, it's actually forcing the growth, in the charge to reach the procedures. What do you see we might see this session? this one goes to you. I'd like to respond to the first comment that you made about this popping up all over the place. I really want to people to take a businessman's approach to this. I was in the hair styling business and within a period of 10 years, I opened 4 locations in the Rollkolley[sp?] area, but before I opened any one of those, I did a very intensive demographic study. Where are the people? Would they need their hair styling services? Where is the competition? You're not going to find people with $10 million or $50 million and they just want to blow it and go build a nice looking building, they're going to find out, if there is a need before they build, so this theory about opening up the flood gates, is erroneous and I think it's fallacious argument, even offer it as one of the reasons for saying no to CON repeal. Yes ma'am. So you're saying that people are going to see the need before they build but in Yadkin valley, so the corporations that owned the Yadkin valley hospital they weren't turning enough of the profit so basically they walked away, there might be a need there but they also have to make money. So how do you reconcile those two things. It's not how can it just magically happen if their is no [xx]. And this is were in terms of COE in that is not the issue the issue goes back to what Rough was talking about it's our fee structure, it's our service structure that we have built in that is not adequately put the reimbursement where it is necessary and for whom it's necessary, and I'll let [xx] take it from there. I think there is a lot of ways to stress what the payments are made providers know, that's why we enlist such a move to single base rate across the state Medicaid and not making sure that we're paying hospitals in urban areas $3000 for service while we pay in rural 800 for that service and kind of level that across the field, but quite frankly I think when you look at health
care providers across the state in a rare opportunity to go over financials and now that it's operating I'm not seeing those healthcare operators out there who're struggling margins on the profit when you look at the conglomerations that exist right now when you look at what we're seeing with LME, MCOs and the fund balance holding in mental health services right now while we have caps on were mental health can go when you look at the hospital systems that exists across this state those are not marginal operations, and they hold large cash balances, but fall finder[sp?] the non profit because that doesn't dissolve to shareholders in the operations their is significant payments within the system. The important thing for do it is not to create systems that can benefit sending individuals to certain facilities, or certain facilities that have partnerships across the board, and make sure that we are paying an adequate rate at a base level for same service all across the state and I think that moving in the Medicaid side moving for a member per month payments I think will get us there if not move to when you have to provide network adequacy will actually move to having rural areas being more competitive for being able to do a lot of so right now we've been doing an analysis about the hospitals in the state we're finding about a third of the hospitals are running in the red most of those are rural hospitals so again if you've got hospital running in the Red and rural parts of the state, how are you going to address this? I think the better analysis, and I say when I have seen this done, this are a few, look at where patients and their spindle are located. It's very easy to say that the west of Carolina in large hospitals is possible where rural is not when most of the faculty chaos merely shifted from the rural hospital to the other hospital there is another, but we are not offering to cure in the rural areas, but we are going to make sure that the majority of the spin that is occurring in the central laws hospital, that's why our system comes to get together and you have to look at the system property as a whole and now have the car about the individual hospitals, because they are the controlling factor of where services are provided. Picking up on that, there has been a lot of talk to the session about urban verses rural, is this legislation something that would benefit particularly rural areas like Belheven] and Malix? I think what we are trying to do initially with the tax, sales tax redistribution or reallocation, whatever you want to call it, is to get more money into the rural areas and I think the hospital and the medical situations a perfect example of what rural areas are facing. I'm going to say something else that senator Hise was kind of hitting around edges. We realize as a state we are going to owe it to our rural hospitals to probably give them a little more assistance than we do our major hospitals, in order to look after our people. So we feel that obligation and it's similar to what we have to do with some of the schools into poor counties, their is just no way they can exist on their own especially with you folks in Charlotte taking all their tax dollars scheme, but we're going to have to help those areas and I think this is a prime example of how we're going to need to step in as a state and see if we can help. We may have to do that legislatively. We're not gone yet. We had that discussion a moment ago and that's something we'll be willing to look at. Did I get you? Any other questions? Make your predictions for this session or would mind something happen legislatively since you invented it. We said form bill yesterday and we hope you all take a hard look at it get it passed. It is being discussed Marilyn might be there to give you a better answer on the house side, we're ready to go on the senate side, that's all I can say, and. I cannot speak for the negotiations [xx] just a personal preference, I do agree in the terms of of the senate of so mixed plan of those the MCO's as well as the PLE's I feel like for sustainability as well as stability having both available gives as a good safety net in terms of the upper arrangement of the supper vision and organisation I am still to be convinced that we need either separate entities authority or department of division I'm opening to listening for what he reasons are if the reasons weren't that without any other the option to reach the needed reform may be it's something we need to look at, for me it's still discussion. I want to go back to one of the question that you raised about the rural
and the urban one of the things that I found in preparing documentation for map seal and repeal for the ambulatory surgery centers is that their is quite a bit of out slow from rural areas to the urban areas because as I mentioned earlier the services aren't available in the rural areas, and my thinking is that if we remove the restrictions of CON some of these services could migrate back to the rural areas to keep the residents in their local county and in their local communities. So I'm looking at it from quite a different way in terms of it opens up more opportunities for the rural areas for the people to get the services for the people that they need. Which is impossible now under the evaluation that we use for our state facilities evaluation as well as the CON restrictions. Yes ma'am. But when you look at the quality issues volume usually ends up equally in quality like last year I had surgery, I wanted someone who was doing this surgery everyday, not someone who did it 12 times a year. So that drives some of that outflow to urban areas where there is more volume being done, will there be enough volume being done moral areas to justify someone with those kinds of skills staying there. You know and I think the short answer is no. I don't think you're going to have a plastic surgeon in every hospital in the rural communities, but what we've got to do is the situation we had on the gentleman that ministered here was able to be cared for why, now we have to have a facility there, [xx] facility with the medical personnel there, that can keep one alive till we can transfer, but the answer is we're not going to be able to have independence especially in every rural hospital, so but we've got to adapt to the system. Rural hospitals have been dying for 20 years, the one I think of the most is in [xx] I went to Western, and I remember seeing J Harries was about five storeys at one time, now I think it's about half the size, and they still have problems feeling up beds. That's one of the large problems also as we dig deeper into it, you don't have many folks for hospital so I had that from a chance from any county. So somehow we got to look at, but we got to have a facility there hopefully they keep the patient alive long enough till we get him somewhere they can heal. What advice [xx] CON so, looking across the country at World Hospital closures, they have tended to be in space that have chosen not to expand Medicaid. So, if you were to do [xx] would that also means that you would be expanding Medicaid so that there won't be more customers? Well you know, we said, we got a vote today on medicaid. But, something we said, if we get our system fixed, our Medicaid system repaired, it could be something we could look at and so we are not saying that's a definite no, but, I think again, like I said earlier, we have rural hospitals going into way before we had affordable healthcare [xx]. So, I don't think that is really a justification I would state on that very quickly, that's what we are coming through. I actually think that expanding Medicaid is one of the most devastating things to rue at all. I represent hospital from West of North Carolina they are already serving patient mix, that are nearly 80% Medicare and Medicaid patients. What we are seeing nationwide is that those who are at it, are under the expansion about 50% are coming from private insurance. Those individuals of council private insurance policies that they are paying for, that their employers had, because they now have a free Medicaid When you take these hospital;s and now you are running them into the 90% Medicare and Medicaid population and you produce their private insurance mix that is out there, there is no opportunity for them to ever operate in a profitable manner. So we are guaranteeing and walking in hospital will remain non profit. We'll not be able to make profit and that we will continue to have more healthcare that is at the mercy of the urban areas and those controls we went through the expansion [xx]. Okay. We want to thank everyone for coming and keep watching us, let us know what you think, thank you.