The State of NC Healthcare

On Stanly Regional Medical Center and Scotland Memorial Hospital

Posted in Grassroots, NC Healthpress, Reform-in-progress by writemyline on 12 February 2009

John Lowder’s recent article In the Stanly News and Press (1 Feb. 2009) discusses Stanly Regional Medical Center’s (SRMC) management service agreement with Carolinas HealthCare System (CHS). It is a well-written statement with significant points of discussion that speaks directly to Stanly County citizens. It identifies the issues and circumstances leading to the SRMC Board of Directors’ decision to deepen the hospital’s relationship with CHS. Articles similar to Lowder’s Making change work for the community appeared about the same time in The Exchange and The Fayetteville Observer; however, these articles announce a management contract between CHS and Scotland Memorial Hospital in Laurinburg.

It is not surprising that CHS is the largest healthcare organization in the Carolinas. It is a very aggressive one in terms of acquisitions, mergers, leases, and management contracts. The Charlotte-based business has ties to 25 facilities from North Wilkesboro NC to Charleston SC; two additional hospitals in western NC are currently considering affiliate proposals. Russ Guerin, CHS executive vice president of business development and planning comments in the Charlotte Business Journal that Carolinas HealthCare management relationships, such as those with Stanly Regional and Scotland Memorial, can lead to mergers and leases.  

Integrating CHS’s large academic healthcare model into Stanly and Scotland’s smaller healthcare culture will be challenging. Technically speaking, the contract provides that the autonomy of the small hospitals remain; however, the management association with Carolinas HealthCare will be very visible in the public eye as well as the professional one. This could tax the confidence of some folks. Stanly and Scotland have histories that are entirely built on their local communities. Shifting their identity towards a corporate giant is unsettling; and, to some people, equates to a departure from certain long-held values of the community.

Indeed, management is a necessary component of any healthcare delivery system; but the public and professional perception of management weighs heavily on patients and their families. Perhaps the decision of Scotland and Stanly boards to deepen their relationships with Carolinas HealthCare System will prove financially fruitful and beneficial to the health of the community; but if and how much community citizens and local healthcare professionals will benefit financially is questionable, especially given the current chaotic state of the US economy. And the greater community, including physicians and healthcare professionals, could wait months, or perhaps even years, before the trickle-down effects of change deliver a substantial and beneficial outcome.

Smaller geographic areas, particularly rural ones and those with increased over-65 and disabled populations, are bound to the services closest to home. For some, there is no element of choice when it comes to health services; and when this is the case, public trust is absolutely critical. The role of organizational healthcare leadership in small boroughs and rural areas has a primary obligation to its service area population because there is no local competition providing other options.  Regardless of the business, service, or industry, public trust is critical for security and progress. And fostering and maintaining trust requires forthrightness, especially when it comes to healthcare issues.

In regards to SRMC, there are statements in need of clarification for the benefit of Stanly County citizens:

John Lowder writes: “Control over Stanly Regional will remain within the community. The Board of Directors will continue to govern the medical center and will retain ownership of all assets. The Board will make decisions in the best interests of the community and our same management team, led by Al Taylor, will run the medical center.”

Scott White, spokesperson for Carolinas HealthCare, says something different about the contract with SRMC in the Hickory Record: “We’ll hire the executive officers and manage the hospital on behalf of the board.”  (Hickory Record, 28 January 2009)

White’s and Lowder’s conflicting statements are very troublesome for the public. Merging the two statements suggests that CHS will hire the existing SRMC executive staff, including CEO Al Taylor. If that is, indeed, the case, then “control over Stanly Regional” will not actually remain in the community because its executive staff will not be appropriately vested by SRMC and its board of directors. Clarification and a more detailed disclosure of CHS’s management contract would be a positive step towards preserving public trust.

Another thing lacking is substantion of SRMC’s claim of a long-standing relationship with Carolinas HealthCare by physicians and healthcare professionals close to home. Public confidence is better built on relationships with the first line of care–primary care physicians, family doctors, specialists, and other healthcare providers, not management.  Moreover, how involved were Stanly physicians in the board’s decision? 

 Healthcare reform is an undeniable paradigm shift occurring at all levels of American society, from grassroots to corporate giants. It is a phenomenon that will ultimately redesign systems of healthcare delivery, finance, and management. It is a phenomenon in which organizations like Stanly Regional Medical Center and Scotland Memorial Hospital along with hundreds of other independent non-profit hospitals in the US will lead and represent the healthcare culture of small communities. On the other hand, Carolinas HealthCare System and other corporate giants will aggressively protect their own interests and profitability; small community-led healthcare will not be a top priority in reformation from their perspective.

 Indeed, change can be positive and work for small communities when citizens are directly involved in the process. Patients and families in Stanly and Scotland counties have that opportunity now by expecting their leaders to listen and respond with diligence and honesty.