Loading...
HomeMy WebLinkAbout2020-06-22 Special Meeting NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 585 ASSEMBLY The New Hanover County Board of Commissioners met for a Special Meeting on Monday, June 22, 2020, at 5:00 p.m. in the Assembly Room of the New Hanover County Courthouse, 24 North Third Street, Wilmington, North Carolina. Members present: Chair Julia Olson-Boseman; Vice-Chair Patricia Kusek; Commissioner Jonathan Barfield, Jr.; Commissioner Woody White; and Commissioner Rob Zapple. Staff present: County Manager Chris Coudriet; County Attorney Wanda M. Copley; and Clerk to the Board Kymberleigh G. Crowell. PUBLIC HEARING TO RECEIVE COMMENTS ON THE SIX RESPONSES TO THE NEW HANOVER REGIONAL MEDICAL CENTER (NHRMC) REQUEST FOR PROPOSALS (RFP) Chair Olson-Boseman opened the public hearing stating this public hearing is being recorded and streamed live on the County’s Facebook page, NHCTV.com, and on NHCTV’s cable stations: Spectrum channel 13 and Charter channel 5. Each person will be able to speak for three minutes, and speakers can see their time on the screens up front and the monitor at the podium. She asked for speakers to please be courteous and end comments at three minutes. Several speakers will be called up and will need to line up in order on the marked spaces behind the podium and are asked to speak specifically about the six proposals that were submitted for New Hanover Regional Medical Center by Atrium Health, Duke Health, HCA Healthcare, Healthspan/Bon Secours Mercy Health, Novant Health, and UNC Health. For those who could not attend in person, there was also the opportunity to submit written comments by 9:00 a.m. today through the County’s public comments email. As of 9:00 a.m. today, 17 written comments were received and those have been shared with the Board of Commissioners and will be incorporated into the official meeting record by the Clerk to the Board. This public hearing is being held by the Board of Commissioners, but members of the New Hanover Regional Medical Center (NHRMC) Board of Trustees as well as the Partnership Advisory Group (PAG) are here tonight and also watching live to help inform and guide their conversations and in- depth evaluation. Chair Olson-Boseman requested that the speakers step forward to provide their remarks. Hannah Gage, PAG member, expressed appreciation for being allowed the privilege to serve on the PAG. The group has worked hard and she has learned a lot along the way. She began this process as a complete skeptic, and she does not think that comes as a surprise to many because she was vocal about it. She was focused on what would be lost, not what might be gained. It was hard for her to imagine that the opportunities would outweigh what we might have to give up, but her goal was to set out to learn as much as she could, so that she could make ultimately an informed decision. There were two things that eventually helped her change her thinking. Both of them can be summarized with one word. That is opportunity. The first thing that shifted in her head was realizing that the new decentralized model of healthcare delivery provides incredible opportunities with the right partner that has the sophisticated systems, and the analytics to take advantage of all the data that comes from many different points of delivery. Now, if you have the ability to analyze that, you understand where you are deficient. You understand where you have problems within a population. She remembers early in the process John Gizdic telling her that if he really did his job well he would be keeping people out of the hospital and at the time, it didn't make any sense to her. As she learned more she began to understand that hospital care is so expensive that you have to invest on the front end to keep people out of the hospital, and on the backend to make sure they are not readmitted if they are in the hospital. The analytics nowadays are so precise that they give us information that allows us to slice and dice right down to zip codes. You can gather information from the urgent cares, ambulatory surgery centers, CVS, and other drugstores that NHRMC partners with, take all of the electronic records, and then begin to understand where the biggest problems in populations are. You can look at it and the zip codes can tell you where you need to deploy certain kinds of care, screenings, and diagnostics to change the healthcare gaps that exist. In short, it's just remarkable. She does not think any of us really understood the kinds of things we could do to improve the healthcare of the population that we serve here and in surrounding counties. The second thing that shifted her was the expansion of graduate medical education that enables NHRMC to grow our own doctors, nurses, and healthcare workers. All three of the final respondents have incredible programs that they put forth. The bottom line for her is that after nine months she has determined that the opportunities to make a change are much greater than the downside of staying the same. Pastor Rob Campbell, PAG member, stated he is the Senior Pastor at New Beginning Christian Church and is honored to be a part of the PAG. He has been a part of a lot of groups and he will say whoever put this one together did an awesome job. People came in and put in the work and there was a steep learning curve. He, many times, was quiet because he did not know what health equity was and cost over profit, and he slowly began to learn. He went into this skeptical and thought somebody was trying to put profit over people. He thought it was us against them, the haves against the have nots. He will say after months of sitting in meetings, he thinks this is the time that we find a partner, and we prepare to go forward with our community to greater health. His biggest concern was health equity. At times the PAG talked about cost, but cost doesn't matter if you've got money. The PAG also discussed health equity and the ways that we can improve that equity. When he started on the PAG, he was impressed with the board and with the hospital. They've done a great job, but when he heard NHRMC had $350 million of cash he thought that was a lot until he found out that that wasn't the highest rating, and NHRMC needs $125 million more. He knows that NHRMC does a great job, but when he found out it was at 90% capacity and sometimes people were there waiting to be seen in the hallways, he thought, “Well we've got a great hospital, but it's only great if you can get in.” it is known that this area draws people in for retirement. He was impressed with the respondents that came NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 586 and two of the respondents have national awarded records for improving health equity, and that's what impressed him. If the decision is made to go forward with one of these respondents, he believes with all his heart that healthcare will be improved as well as the access and costs for all citizens. Again, he appreciates being asked and selected to be a part of the PAG. He has put in some great work and he hopes the Board will take the PAG’s recommendations. Dr. Timothy Chase stated he is a urogynecologist and gynecologist here in Wilmington. He has been in this community for 29 years, the first four years of which he was a resident at NHRMC, and then he joined Glen Meade Ob/Gyn, which started in 1927 downtown in the Murchison building and it is now known as the Glen Meade Center for Women's Health. Several years ago, his practice saw, much like the County sees now, changes in healthcare. With those changes, his practice felt it needed to look at the opportunity for partnership, in order to not only survive those changes but also to thrive. They looked diligently, much like the County is, for a partner, and the partner was Atrium Health. For the last seven years, Atrium Health has brought to the practice the resources, the quality initiatives, and things that the practice was not able to do as a small private group. He is pleased to report that not only did they survive, but they are able to thrive. The other thing the practice talked about with the partnership is local control. With the partnership with Atrium Health, the practice has seen the local control has continued, they are able to make decisions on a day to day basis, and make decisions in regard to expansion and staffing. He feels that would be a continued local control with a larger organization. He loves NHRMC. His five children were born at NHRMC and he intends to continue in this community, serving at the hospital for many years. In life we meet people that are good people. We meet people that we respect, that we look up to, that we can trust. There are other people we meet that we can't do that. He just wants to report to the Board that his personal experience with Atrium Health is that these are people that he respects, looks up to, and trusts. He thinks the best decision for our hospital, for the community, and for the patients is a partnership with Atrium Health, not just for the next 29 years, but for the generations to come. Dr. Sam Wheatley stated he has been a practicing gynecologist in Whiteville for the last 42 years. His father would tell him that if you do not like change, you will like irrelevance even less. NHRMC will never be irrelevant because it has embraced change and he applauds them for it. Secondly, he has been not only a practicing gynecologist, but he has been on the Board of Trustees at Columbus Regional Healthcare System for 20 years. In 2007, they did the same thing in that they realized they needed a partner to maintain the mission and they chose Atrium Health. That was a good choice and has been a better choice every year. Atrium Health has brought them quality, cared for the hospital, employees, medical staff, patients, and most importantly the community. As a physician, he learned something a long time ago, and that was that patients care about what we know. However, they really want to know how much we care. That's important in healthcare systems too. Atrium cares. The third thing he wants to say is that NHRMC partnered with Atrium shortly after his hospital did and the most notable thing Atrium has done for the NHRMC organization is the physician network. It not only belongs to NHRMC; it belongs to the region. It belongs to the seven counties, because of Atrium and because of NHRMC, cardiologists from here are in his hospital, seeing patients every day with a continuum of care, and a system of triage and transport that allows for somebody with a life threatening illness to get to NHRMC’s cath lab and operating rooms in 30 minutes. It's saving lives. Lastly, you have to make a choice. Everybody wants a part of NHRMC because it is excellent. Atrium wants to be a part of NHRMC, as they have been in making NHRMC better. Dr. Hormoze Goudarzi, stated he is a general surgeon and joined AHEC and NHRMC 1981, and has been in practice since that time. He witnessed the deterioration of medical surgical services when Columbia ACA purchased Cape Fear Memorial Hospital and was forced to sell to NHRMC because of the hefty fine for Medicare and Medicaid fraud. He has witnessed the amazing growth of the hospital and the leadership of the physicians and board members, particularly Jack Barto and John Gizdic. NHRMC is a level two trauma center, providing diverse services in medicine, pediatric surgery, and has no competition in a vast catchment area from the South Carolina border to the Research Triangle area and Greenville. Indeed, NHRMC performs almost as many surgeries as that of UNC Memorial Hospital at Chapel Hill. He has witnessed three attempts to sell the hospital, and each time it came up better and financially stronger. It has been a successful, mutual, and beneficial partnership with UNC-Chapel Hill, which supports the training residency program with Atrium Healthcare that manages Cape Fear Heart, New Hanover Medical Group, and the Ob/Gyn group. An excellent ambulatory surgery has been created through partnership with physicians and grants have been received from Duke Endowment in the past. NHRMC is in a relatively strong position because of the lack of competition and rapid growth in this area. Indeed, suitors with their attractive offers understand its potential and anticipate a great financial gain from our institution, which was created by support of the community and hard work of doctors, nurses, and thousands of people working in the hospital. In a civil setting with complete right of management, there could be partnerships with multiple medical centers and achieve a win-win situation. So long as humanity exists, there will be a need for healthcare and hospitals. Therefore, NHRMC should expand services even creating a medical school in Wilmington. We have a large hospital, we have UNC-Wilmington, we have the population, and we have enough clinical material. This in turn will boost our academic research and economic strength by attracting research grants and state and federal funds. Finally, he asked that the hospital, which belongs to us all and protects our health and vitality, be preserved. It is easy to give up this responsibility for temporary financial gain and a predictable future. The Board is the one that makes the lifesaving decision today and will be judged by history. Traditionally in southeastern North Carolina, we do not sell our homes and leave town when the center of a hurricane is developing in the horizon. Dr. Roc McCarthy stated he is a urologist at NHRMC and is currently the Chairman of Robotics at NHRMC. He does not write anything down, what he says is truly from his heart, and all his patients know that. He got a call about 12 years ago from John Gizdic who, at the time, was head of physician development. Mr Gizdic understood NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 587 he was a robotic surgeon wanting to come back to the area and before he signed with a local hospital, Mr. Gizdic asked he hear NHRMC out. NHRMC wanted to start its own physician network and at that moment it did not have a single doctor as a part of this network. However, it was known that there was a need to increase the level of care here locally and NHRMC had a lot of patients who required expert care going to tertiary care centers, and it could make a change slow and steady. Mr. Gizdic then said NHRMC does not have the infrastructure, but what he did have was a past relationship with Carolina's Healthcare System, which now is known as Atrium Health and that he wanted to discuss this with Dr. McCarthy and come up with a game plan. The plan was to build it from the ground up. He worked with Mr. Gizdic to come up with a game plan, and when he came here he was literally by himself. He came with open arms saying he was not here to take anybody over, he was here to just do what's right for patients. Atrium laid out a plan of how to develop a sustainable physician network. He is currently in the largest urology practice here 12 years later and through that time, multiple specialties have been added to the network, not trying to take over other groups, but trying to add to the level of care here as the community continues to grow. Everything that he has asked, he has pushed them for the advocacy for his patients and he will never stop with that. He started his career here and wants to finish his career here. It has been a tremendous experience working at NHRMC. Day in and day out, the love that he has for his patients is what draws him to work. The one thing he has always been allowed to do is take care of the patients the way they need to be taken care of, regardless of insurance. He does not look at that, but rather into determining what they need based upon the care that they need. He has never gotten questions along the way, whether or not a patient had insurance, whether or not a surgery would be done locally. He truly feels with a partnership with Atrium, which has shown that they have had the ability to take care of inner city areas, as well as rural areas, that they can support our area the way it needs to be supported from the top down. Not today, not tomorrow, but for the rest of his career and beyond. Neal Shulman, resident of Nash Drive, provided an overview of his 10 years of experience with Atrium. In November, he was admitted to the hospital under direct admit. His primary physician called the hospital and gave them a list of physicians from a neurosurgeon all the way down to a podiatrist. There wasn't one specialty not mentioned. After two days in the hospital, he asked the nurse and the doctor why he was not getting his medications as he was missing at least three. The doctors only came in, said good morning and asked if he wanted to hear a joke. That was how much medical care they gave him. After a week, he told the doctors he was retaining fluid and did not want to go into congestive heart failure as that is where he was heading. He either needed his pills and needed them that day or his wife would bring his so he could medicate himself. They argued more and the decision was made to weigh him and the result was that he had gained nine pounds, which is over a gallon of fluid. Again, instead of bothering to read his medical records or call the cardiologist or the primary care doctor, the hospital doctor decided how much of the diuretic he should take. He was overmedicated and he has kidney issues. Two surgeons walked in one morning, didn't tell him they were surgeons, just walked in in scrubs and said they were there to look at his foot. When they did, they told him to be prepared to lose his foot and walked out the door. When he asked which specific group they were from and if it was his vascular surgeons’ group, they did not answer. The next morning when he tried to order breakfast, he was told he was going to surgery to have an amputation, without his permission and acceptance. After he got out of the hospital, he started getting their bills and of course, two phone calls from the physicians group. When he stated he wanted a detailed bill, he was told they could not give him one. He told them he was disputing the bill as he was not going to pay $200 for a doctor to come in and tell him a joke. Since December, they still have not been able to do give him a detailed bill saying their billing system is different than NHRMC. This is our hospital. Anything Atrium can do, we can do for ourselves. If we need $100 million to build another facility, we can get it with no problem because of the bonds. He has owned those bonds before and they are in high demand. At one point, he bought some and then two weeks later wanted to buy another one and was told he could not get more without paying 10% over par. On a $10,000 bond that means he would have to pay $1,000. This group is supposed to be looking out and listening to what the will of the people is, not the will of the hospital. We need a new manager at the hospital, not sell the hospital. David Long, resident of Belville, stated he has worked at NHRMC for the past 19 years and currently has the privilege of serving as the Director of Spiritual Care. As the members of the PAG shared last week, NHRMC does not have the resources to keep pace with this region's population growth. As he reflected on the presentations made by Duke, Novant, and Atrium, he was reminded of the elements that each of these organizations would support and strengthen spiritual care at NHRMC. The strength of Duke University School of Divinity and the resources that they share with and across the Duke healthcare system, most definitely allow for discovery, development, and delivery of a healthier tomorrow. The focus on faith community nursing that Novant Health offers, whereby nurses use their knowledge of medicine and personal faith practices to help the community and improve the health of the community one person at a time, is magnificent. Finally, the greatness of the work with the Clinical Pastoral Education Program at Atrium Health and their steadfast focus on staffers’ resiliency, through their Code Lavender Program exceptionally reinforces hope, health, and healing for all. Each system has much to offer both to NHRMC and to spiritual care, and he strongly believes that a partnership is the correct path for the medical center. He prays that each Commissioner will help us move down that path and follow the recommendation set forth by the PAG. Alex Hall, resident of Market Street and representative of Save Our Hospital, Inc., stated he has practiced law here for 42 years and served in the NC House of Representatives for three terms. His father was on the Board of Commissioners for 20 years and was one of the proponents that had the vision to promote the bond issue that allowed the hospital to be built. There was a lot of backlash from it then and he was glad the County had the vision to establish NHRMC. He thinks a big mistake is being made by selling the hospital. The Board can call it a partnership if it wants, it is a sale of the hospital. He has listened to the people supporting it and has yet to hear anything that was compelling as to why we should partner the hospital. Atrium is the front runner as he understands it. Atrium was nothing more than the Charlotte-Mecklenburg Hospital Authority. One of the things that the Save Our Hospital NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 588 Board of Directors, on which he serves, wanted to look at was whether we could form a hospital authority here in this County and in the region around southeastern North Carolina. Are the people in Mecklenburg County that much smarter than we are, that we couldn't form a hospital authority? He does not know how much time was spent on that. In any event, what he understands about Atrium is they will get to pick the board members. He does not know if that's correct or not, but he understands that it's correct. The board members won't have any accountability to any elected official. A hospital authority that we form would be able to issue bonds just as Atrium does now. He is concerned that an outside entity such as Atrium will, once they've made the investment, suck the money out of here and take it to Mecklenburg County. Another issue that has been raised is the COVID-19 situation, the pandemic. That is more than enough reason for us to stop to make sure we know what we're doing, make sure of the strategic plan for the hospital, which by the way nobody knows what's in it because it's a secret. But in any event, there's more and more healthcare delivery through virtual practice of medicine than there has been in the past, and we ought to wait to see how this pandemic shakes out before we sell our hospital. He thinks this could be one of the worst mistakes that this County has ever made and he would ask the Board to reconsider it. Natalie English, President/CEO of Wilmington Chamber of Commerce, stated she has been in the community development and economic development businesses for over 27 years. She has seen and learned that healthcare can have a major impact on a community. The most direct impact healthcare has in most communities is through the number of jobs that it represents and the same is true here as NHRMC is our largest employer. When you add all the other healthcare jobs in our community it's easy to see the impact it has on our economy. As it pertains to economic development, access to quality healthcare is a critical component of economic growth. A community will see the retention of existing businesses as well as the creation and recruitment of new businesses when there's adequate infrastructure to support the growth. That infrastructure is transportation, education, and healthcare, among many others. Communities that cannot accommodate growth and population by investing in important infrastructure will not only limit the growth of existing businesses, but also the attraction of new companies and jobs. From the beginning of this discussion of a partnership possibility for our healthcare, the Wilmington Chamber of Commerce has encouraged the County Commissioners to support an effort to explore new ownership opportunities. It has not endorsed selling, rather it endorsed asking the question. The members of the PAG have done just that. They've dedicated countless hours over the last eight months learning about and understanding the plans for investing in healthcare that will accommodate our expected population growth toward the mission of leading our community to outstanding health. The members crafted a request for proposals to track those partnership opportunities, and the proposals that came confirmed that we have a valuable and desired healthcare system. The members of the PAG learned through their process that as good as NHRMC is, there are barriers that will keep it from being truly great in the future. The most notable they say is access to resources to keep pace with how quickly the region's population is growing. The PAG considered whether a change in governance structure or limited partnership would be the best way we could retain local ownership and secure the needed funding. Their determination is that a full partnership that preserves local control of important decisions is the best avenue. The Wilmington Chamber of Commerce continues to support the process of the PAG, and trusts their evaluation will identify an outcome that considers all the key priorities we have while maintaining a staff and culture that has contributed to the great success of our system. Gene Merritt, representative of Save Our Hospital, Inc., stated that we have a profitable and successful hospital that has never been a financial burden on the County. NHRMC is scheduled to make nearly $100 million this year and has reported $600 million in reserves. That may be different now, but a few months ago NHRMC claimed that its bonded debt is around $300 million, giving it a strong balance sheet. The operating margins are very good compared to other hospitals in the region. As UNC Health said, “…in short, NHRMC is in good shape and there is no reason to sell even considering the pandemic.” The hospital administration and their consultants have never made a viable case for selling. Their main premise is that trouble is coming down the road, and NHRMC will not be able to deal with that trouble. Unfortunately, they have not explained what that trouble might be, and they have not yet explained why some other healthcare systems are equipped to deal with those same perceived problems. Their strategy since day one of this process is to use fear of the unknown as a justification for selling. The other fear tactic used by the hospital administration and its consultants was to create a financial scenario that predicted a 68 cent county tax increase to cover future projected deficits. Those deficits were projected based on their strategic plan. That plan has been seen by a few, but it is felt that it is more of a wish list than a viable economic plan. It is not certain the plan deals with the likely changing landscape of the healthcare industry in the near future. Quit talking to the public about how the Board wants to partner the hospital. It is very clear the Board wants to sell it to the highest bidder. The offers of the three finalists are all effectively purchase offers. It is believed the hospital’s consultant encouraged bidders to make purchase, not partnering, offers. It is not the will of the people of New Hanover County to sell our hospital. The failure of current and past County Commissioners to apply effective checks and balances to ascertain that our hospital has been operated effectively is effectively a violation of the public trust established in 1967 when Community Hospital and New Hanover Memorial Hospital merged. The Board may now be getting ready to pay the price for its historic lack of involvement. Anne Patterson, resident of Brookshire Lane, stated she is a former NHRMC Administrator, a future New Hanover pensioner, and is a past and likely a future patient at the medical center. All these roles and particularly her previous administrative experiences at NHRMC over very many years, beginning in 1985, including leading the New Hanover County Medical Services transition to the medical center, were experiences that afford her both a unique and an informed opinion. She believes that the decision for NHRMC to partner with a larger healthcare system is inevitable and in part, she thinks it is necessary. NHRMC cannot continue to provide the needed level of healthcare services to the community, the right ones, in the right amount, to the right people, and for the right reasons if it remains independent and without financial support from all the counties that they serve. Second, she thinks that NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 589 the PAG members and the County Commissioners should consider the following as they make their decisions. First, choose a partner that offers the greatest good for the greatest number of people. Base this on the health of the community, with a focus on prevention rather than sick care. Healthcare equity, racial, socioeconomic, gender status, and insurance among all the constituents should be the top priority. Choose a partner that will do the least damage to the community. This is not always the same as the first bullet point, but they may overlap. Choose a partner that can be vetted over time to make sure their actions truly have the interests of the community at heart. Right now, we only have words. Put the financial windfall of a sale to the side so that the Board’s decision is not tainted by the money. Finally, with these thoughts in mind she strongly recommends not selling NHRMC immediately. A lease arrangement with specific and defined success criteria would allow us all to evaluate this decision to make sure it's a good one. Once sold, the decision and local control can never be taken back. Pamela Waite, resident of Glasgow Drive, stated she is a market researcher to the healthcare industry. Her understanding of this process has come from both her professional experience and her education. She has a doctorate in psychology from Harvard and MBA from Northeastern University. It's also come from attending all but one of the meetings. She has listened to all of the presentations and observed the three top runners. She is very impressed by all three and their dedication to things she thinks are needed such as clinical trials, having access to those without having to necessarily go to Raleigh, and bolstering the specialties that are not here. This also applies to health equity and rural health, which she sees as not one of our strong suits recently, and the rich data that we all churn out every single day. But going forward she has some concerns and questions. First of all, she would hope that the Board would negotiate a clearer understanding of the difference between a sale and a partnership. In none of the executive summaries nor in the memorandums of understanding did it clearly make the difference of what are we giving up when talking about partnership, but talk is about effectively a sale. Also, she thinks all said there would be two places on their boards of trustees, but in none of them is anyone going to be given a seat on the executive board. She would hope that maybe the Board could negotiate something there. Two out of 17 or two out of 19 voices is not, to her, a meaningful share of voices, as promised by these three. Also, her concern is that the Board offers unfettered access to the folks who have gone with Wilmington Health or independent practitioners. That is nowhere in any of the proposals. She is also concerned about the 70% of the populace that said they're not for this sale. We haven't done a good job of explaining what this is if 70% of the population is against this partnership or sale. The Board is going to need someone who's really good at communications. She has worked for CBS in the past and can that there will be a need for a professional to come in to sell this to people. Dale Smith, resident of Bedminster Lane and representative of Save Our Hospital, Inc., stated that before coming to Wilmington and for about 10 years after he was in Wilmington, he worked for multibillion dollar corporations doing primarily mergers and acquisitions and due diligence work all over the world. One of the things he learned back then was that about 90% of acquisitions are not successful against the goals that they established. Part of the problem is the problem of transition. He does not think that's been given any serious consideration. Everybody says we're going to have all these systems and all these wonderful things, but that requires retraining 7,500 employees and getting them to get on board with the new philosophies and the new policies and new programs. That is a major effort that has to take place and it will be disruptive for some period of time. The PAG is fantastic and he knows many of those members. They've done a great job and work very hard. He has observed all of those meetings, one way or the other. He has read all of the documents and had the opportunity to meet with Atrium. He does not blame anybody for wanting all of these wonderful things. It's fantastic, but all of these wonderful things will cost money. It's not magical or it should not even be in dispute that virtually all mergers in healthcare result in increased costs. You cannot add a bunch of new services, new facilities, and spend a bunch of money for new facilities and equipment without it costing somebody something. There's nothing free. It is amazing to him that the Board has not considered this seriously because it would not consider raising the taxes to buy something like this. He has never seen the Board do that and that’s been a major consideration. Unfortunately, he sat through the last two hours of the PAG meeting and they all got on board with all of the wonderful things that this would bring. Not one time was the word cost mentioned, not once, so unfortunately he thinks the PAG has fallen a little short there, as good as they are. It's already been mentioned that this could have gone a lot smoother if a lot of work had been done up front. It really started wrong. He learned a long time ago when you're trying to make major change, you better get the people on board that you need to get on board to support the thing in advance. Whichever way the Board goes it is going to have to do a lot of work to try to get people on board with this thing Robert Nevin, resident of Gray Walsh Drive and representative of Save Our Hospital, Inc., stated he has a Master’s Degree in both Public Health and Business Administration from Columbia University. He is a licensed registered Health Information Technician and a Certified Revenue Cycle Representative as deemed by the Healthcare Financial Management Association. He is here to talk as a board member of Save Our Hospital. The fact that a poll of almost 700 voters, citizens, and constituents showed that 70% are against the sale of the hospital. It was publicized today in an ad in the StarNews. What was not printed in the StarNews, but as part of important details that are in the public domain and that which we are able to give the Board easily, is the fact that 73% of the respondents thought that medical costs would increase as a result of any sale or partnership. Save Our Hospital has looked at extensive studies done by the highly respected Quarterly Journal of Economics, which shows that on average across the board, medical expenses for the same procedures increase about six percent after typical merger and acquisition activity. Both Novant and Atrium are headquartered in Charlotte. Together, they have a monopoly position in that MSA of 96%. The Healthcare Institute found that the Charlotte MSA has some of the highest healthcare prices in the United States, as much as 18% above U.S. averages. Even major insurers like BlueCross have limited power to hold the line against monopolistic powerful providers. This is what mergers and acquisitions are all about in the healthcare community. It is not about patient care in his professional opinion. It is about power, money, and influence and that is what is going on here, among other things. If it is allowed to happen, what it means is that healthcare costs will NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 590 increase and will impact most individuals that work for small corporations, small outfits, mom and pops bars, restaurants, and the hospitality trade. That is the backbone of much of Wilmington and the local area. In 2018, Atrium settled an antitrust litigation suit. In 2019, Duke Health settled on antitrust collusion. Today, the American Hospital Association and health insurance groups are deep in battle suing the federal administration over its desire st to have effective January 21 transparency on hospital pricing. This is how much they loath the prospect and the aspect of consumer knowledge. Murray Sherman, resident of Motts Village Road, stated he and his wife retired here and never had a moment of regret. It's been a wonderful experience. His industrial experience was in many states in the country and he retired as Chief Technical Officer of a company, which while small, was a giant in the industry in which it was active. He was involved in a couple of acquisitions and followed in the papers, other mergers and acquisitions. While the group that's investigated all the possibilities has done a great job and worked very hard, this is an acquisition. There is a purchased and a purchaser. There is no doubt that once someone else takes over, it is not a partnership. There will be employment issues, there will be cost issues. He has watched it and participated in it. He thinks it's a mistake to accept an analysis that is academic and not real life. It is interesting that one of the pursuers has said people will have their jobs for one year. What does that mean? It means that people go away. He knows this because he has done it and he thinks it is a time to pause and get some more professionals involved in determining long term what should happen to our hospital. Dr. Frederich Meine, resident of Windlea Run, stated he is an interventional cardiologist with Cape Fear Heart Associates. He does not envy what the Board has to do for the next few months. He thinks taking care of a heart attack at 2:00 a.m. is a lot less stressful than what the Board will be doing for the upcoming months and everyone at the hospital appreciates the work being done. He is not going to spend time talking about whether or not the hospital should be sold. The Board has spectacular consultation from the PAG, which he thinks is doing a wonderful job as well as the hospital team. He would like to speak about what many, who are physicians here and care for our patients, think is the most important aspect to look at if and when the decision is made to sell. There's a lot of money involved here obviously, from all the groups, but at some point that money is going to go away and what they all think is most important is local control and maintaining as much control of this hospital in the County as possible. About nine years ago, Cape Fear Heart Associates determined that it needed to have a partner and it merged with the hospital. Its employer through that has been Atrium Health. He cannot presume for a second to tell the Board how any of the other five groups would work when it came to local control in partnership with the hospital. He can only state from personal experience, that Atrium has allowed his practice to have an extreme, if not complete, local control of the practice and our hospital since they've employed them. Every doctor at the hospital will tell you that anything he or she needs to take care of their patients can walk into John Gizdic’s office, at any time, and tell him what is needed and he will do anything he can to help take care of the patients of New Hanover and the surrounding counties. Atrium has never affected that relationship whatsoever, whether other ones would or not he has no idea, but he can state that the relationship with Atrium has allowed his practice to maintain a tremendous amount of local control. He would urge the Board to make sure it can take as much consideration as it can into how we maintain as much control of this hospital and in the County as possible. Recently, his daughter asked him who was his employer and who was his boss as he has nine ID badges as he is on staff with Novant as well as Columbus Regional, he also has an Atrium badge, a NHRMC badge, and a Head of Robotics badge. He actually had to think about it and said it was actually pretty simple. He has two bosses: one are the people in New Hanover County and one is John Gizdic, in that order, and he really believes that's true. He thinks it's a testament to the relationship with Atrium that they've allowed the people in New Hanover County to be his employer for the last 10 years. He hopes whatever goes on with the sale, he’ll continue to be able to work for the people in New Hanover County. Helen Flowers, resident of Providence Court and representing Save Our Hospital, Inc., stated she was one of the nurses that moved from James Walker Hospital to New Hanover Hospital and worked there for 30 years. In her heart of hearts, she does not want the hospital sold. What she wants is what's best for our hospital, whatever it might be. She has had people all over town asking why is she working so hard for Save Our Hospital when it's a done deal. She hopes it is not a done deal and if it is, she will be very disappointed. Everything she has looked into says that when there have been either purchases or combined efforts, cost goes up and care goes down. She was at the hospital when Dr. Chase and Dr. Goudarzi were residents, and they know she is all about good patient care. She thinks that needs to be our primary concern. She still, bottom line, wants what's best for our hospital. Steve DeBiasi, resident of Blenheim Place, stated he has managed multiple physician owned medical practices in Wilmington and Charlotte for 25 years, with the past 17 being in Wilmington. He currently serves as the Chief Executive Officer for EmergeOrtho. EmergeOrtho is a group practice with 50 locations across North Carolina from Asheville to Wilmington, and currently works at approximately 25 different hospitals. It has relationships with most of the hospital systems across North Carolina and really appreciates the relationship that it has with NHRMC. It stands out as a progressive and future oriented hospital system. While it appears that several people in the community, perhaps the majority, would prefer that NHRMC remain independent, and that the County not take any action, he supports NHRMC partnering to deepen the resources that are available in the community, to the medical community, and to the patients of the region for us today and for future generations to follow. He also believes that the County should not carry the financial risk on an ongoing basis for operating a hospital system, especially as other municipalities have moved away from that over the past couple of decades. Running hospital systems and running medical practices is a very complex process and operation. It's not like it was 20 or 30 years ago. It is a very different high risk operation. Insurance companies have passed a lot of responsibility back to the providers to take on that financial risk, and he thinks that is an important component of having deeper pockets and more resources available to you. Overall he would agree with the shortlist and in becoming educated on this process, he would agree with the NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 34 SPECIAL MEETING, JUNE 22, 2020 PAGE 591 shortlist that was selected of Atrium, Novant, and Duke, not in any particular order. Each of the potential suitors certainly brings their advantages. He thinks Atrium would be the easiest transition and likely have the least disruption to the physician community due to the existing physician group that's in place. He thinks Novant would bring an opportunity to be able to have coordinated care between the Brunswick County and New Hanover County hospital systems as there would be an opportunity for closer collaboration from that standpoint. He thinks Duke brings significant academic and research opportunities that may not be accessible today. Each of them also bring potential disadvantages, but since he works with all the hospital systems he thinks it's best that he probably leaves that out of the comments. As the options are considered, he has heard a lot about expanded clinical offerings. He hates to say it, but really the 90% to 95% of the boring stuff is really where we need to focus on and not so much the really high end top level care that is needed for that one-tenth of 1% of the population. He would encourage people to focus on the bulk of care. Dr. Mark Foster stated he is an orthopedic surgeon with EmergeOrtho and has been a resident of New Hanover County for 31 years. He is not here to speak on behalf of EmergeOrtho or the medical staff of any particular hospital. He recognizes there are a lot of factors to consider. However, because he has been here for 31 years he probably has longer in this community as a potential patient than he has left as a practicing physician. As a physician in private practice, he would like to stress the importance any potential successors maintaining and supporting independent physician practices in the community. Over the last 10 to 12 years, his practice has had a collaborative relationship with NHRMC to lower costs, improve patient care, cost containment issues, code management agreements, and other initiatives. When he looks at the Charlotte market where both Atrium and Novant are dominant players, the independent physicians have appeared to have been squeezed out by Novant, particularly in orthopedics and spine surgery. The most recent public example is Novant’s removal of the Carolina Neurosurgery and Spine physicians group to bring in Novant employed physicians. In the Wilmington area that would be devastating to independent physicians, as well as to the patients who have chosen those independent physicians for their care. While academic partnerships may have an added benefit, that would not be his main reason for speaking today. He expressed appreciation for everyone taking this process very seriously. He is available to speak with anyone if they would like to contact him. Chair Olson-Boseman thanked everyone who made comments and those who submitted written comments. The Board appreciates the community's continued engagement in this and its passion about our healthcare system. The Board is listening and will continue to do so, while also relying on facts and data to help guide the next steps for the best interest of healthcare in our community for generations to come. A copy of the written comments submitted by 9:00 a.m. on June 22, 2020 are hereby incorporated as part of the minutes and are contained in Exhibit Book XLII, Page 13.1. ADJOURNMENT There being no further business, Chair Olson-Boseman closed the public hearing and adjourned the meeting at 6:04 p.m. Respectfully submitted, Kymberleigh G. Crowell Clerk to the Board Please note that the above minutes are not a verbatim record of the New Hanover County Board of Commissioners meeting. The entire proceedings are available for review and checkout at all New Hanover County Libraries and online at www.nhcgov.com.