The digital hospital is the center of the storm
With Trinity Medical Center's intent to move to the partially finished digital hospital on Highway 280 and I-459 comes another battle for a certificate of need (CON). Both Brookwood and St. Vincent's filed opposition, which means they get to state their cases before an administrative law judge (ALJ).
The previous ALJ hearing, when only Brookwood opposed the move to Irondale, lasted 14 days. Once the hearing adjourns, it may take several months for the judge to render a recommendation. Then another wait for the CON review board, followed by more waiting for their decision.
The governor-appointed CON board does not have to follow the judge's recommendation, however. The point of the ALJ hearings lies more in allowing opponents to submit evidence and present their viewpoint, all of which reaches the CON board, no matter the judge's decision.
Brookwood contends that Trinity's move to Highway 280 violates CON criteria to not detrimentally impact existing healthcare providers or duplicate services. "Trinity Medical Center admissions are declining each year," says James E. Williams, an attorney with Melton, Espy & Williams in Montgomery and Brookwood's representative. "The only way they can be successful is to move into someone else's service area and take their patients. And that's not why you replace a hospital."
Trinity CEO Bill Heburn acknowledges that admissions have dropped over the last five years. "We used to average 400 patients a day. Now we average about 235 to 240," he says, agreeing that Trinity needs to move to where more patients are. "But you shouldn't even be thinking about that," he adds. "You should think of what makes the most economic sense for the community. And this move does."
Trinity projects needing $280 million to complete the digital hospital versus $319 million to build a new facility in Irondale. But Heburn says that to build a new facility equal to the size and quality of the digital hospital today would run about $700 million, so Trinity is actually offering the area a far better hospital at less cost than if they had to build from scratch.
"Everybody would like to have a brand new facility. If you get one, there's going to be an attraction," Williams says.
"I can't help that," Heburn replies. "But you've got to provide patients with the care or else it's a one-time visit, and that doesn't keep the doors open."
Which is why Williams argues that a new facility may not solve Trinity's trend of dropping admissions. "It's not the condition of their facility," he says. "It's because of mismanagement and not investing in their facility, not providing services and the things their staff needs. They've had multiple medical staff members leave. So there are a lot of factors to declining admissions other than their facility."
"Our need (for a new facility) has been proved," Heburn says, citing the CON board having already granted a certificate of need for the Irondale location. "We proved that we couldn't continue to serve by putting money back into the existing infrastructure."
For example, Heburn says Trinity's current space between floors to house piping and wiring measures less than 3 inches. "We can't fully sprinkle Trinity, because there's no space unless you bring the ceiling down."
Heburn estimates that Trinity's reach at the digital hospital will be south from I-459 down 280, a high-growth area with an insured population. Right now, 40 percent of Trinity's patients come from outside the Birmingham metro area. Heburn expects to retain them.
The 60% of Trinity patients who are from Birmingham include patients throughout Mountain Brook and the zip code of the digital hospital. Heburn expects to hold on to about 60% of this group, with the remainder going to other hospitals, like Brookwood and St. Vincent's. No one offers estimates of patient numbers that will migrate from Brookwood or St. Vincent's to the new facility.
"We didn't even feel like their proposal moving to Irondale was good healthcare planning and in conformance with the rules," Williams says. "But certainly the move to the digital hospital would be much more detrimental. It's in our backyard."
"And who is paying for all this?" Williams asks, listing the $55 million Birmingham taxpayers will put forth to entice Trinity to move to 280, plus the lawsuits by Irondale now in play. "How much cost and burden is this move to the healthcare system?"
"We're saving millions and getting 30 percent more hospital at less costs at this site," Heburn says, referencing the utility and repair costs that will be saved by the quality construction and design of the digital hospital.
"But every time people put delays in this, costs escalate," Heburn says. With a two-year delay and estimated 3.5 percent inflation for materials and labor, the $280 million quickly grows another $20 million.
The hearing for the Irondale location found in favor of Trinity's move. "We already proved that we need to move," Heburn says, "so this time we just need to prove that this location makes more sense. And we have two-thirds more population to serve around this site than around Irondale."
Which is why Williams asserts he has no concerns. "Brookwood is going to be able to prove that the potential for detrimental impact is so devastating, they will not allow a hospital that doesn't really need to be replaced to move," he says.
If Trinity again wins a CON, Brookwood will "probably" continue the battle to the circuit court, like they did with the Irondale CON. "But those are the kind of decisions you make at whatever place they occur," Williams says.
Heburn sees Trinity getting the certificate of need but facing more appeals, in which case, they plan to "fight through the appeals and keep pushing to get in here," he says, as he points to the empty digital hospital that hovers over the coveted 280 corridor.