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Sep 29, 2014

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Billy Jones

Translated: You're having trouble coming up with ways to fill all those new rooms you just built and you're out to turn a few bucks by selling the old Women's Hospital property to developers.

Or B. That was the plan all along.

Which are both fine, it's MoCone's business but why try to act like it isn't?

Eric Townsend

Ed, how many square feet is the current Women's Hospital? That 50,000 number feels small to me if this announcement signals a complete replacement. Billy's translation does make me wonder if the recently opened Moses Cone expansion will be an incorporated feature of the new Women's Hospital.

Ed Cone

Hi Eric, good to hear from you. This building is not just a replacement, it should be an enhancement and a boost to women's health across the spectrum.

The existing WH building is indeed much larger than the planned 50K sf new construction, but as you know it is a recommissioned building that was intended for other uses, not purpose-built -- in fact, rehabbing it as needed would have cost a ton, which is one reason behind this move.

Note also that the 50K is just the new square footage -- additional space from MoCo will be used, including OR, but recommissioned space will come from the west wing and not the new tower (the North Tower was planned and initiated long before this project was conceived). Also note that the new facility won't need to move duplicated space such as storage, food services, maintenance etc.

There are no plans as of yet for the current WH building, which will of course continue in its current role for the next several years. My bet would be against it being sold, but that's just a guess well ahead of any eventual decision.

There is a national trend of declining hospital utilization, as Cone has discussed in this context. I fear this trend will hit some markets hard, but we are fortunate here to have the financial strength to make a substantial capital investment in facilities -- including new square footage -- instead of just consolidating buildings.

Billy Jones

Much of the recent addition and even much of the older rooms of the existing Moses Cone Hospital are currently empty. All one needs do is walk down the halls to confirm.

Dr. Mary Johnson

Ahhhhhhh . . . the infamous leadership retreat. Executives learning to support one another - while they STOMP their underlings.

Referring to the story on WFMY2, since executives are talking about spending $100 million dollars on a building project at a time when they are supposedly hemorrhaging money - and "providers" are charged with doing more with less, I'm not clear on something:

How does one have "over-capacity" and "declining volumes" at the same time?

OBTW, Billy's observations are correct. I did the walk not too long ago.

Ed Cone

Declining volume and overcapacity are cause and effect. People are spending less time in hospitals, so less capacity is needed.

Many hospitals (including CH) are encouraging this trend, but at the same time it creates a challenge for them.

CH volumes are not at a problem level, and the system has a strong balance sheet, healthy operations, and management that started addressing some of the big issues earlier than many other places.

Our leadership retreats are not the touchy-feely trust-fall kind. If you like long meetings, you'd like these.

Eric Townsend

Thank you for the response, Ed. I don't pretend that my feelings about the move are anything other than emotional. WH was nothing short of a spectacular experience for my wife and me when we brought our children into this world. Its (albeit distant) relocation from Green Valley Road pulls at the heartstrings. At the same time, I certainly recognize this is business, and there are significant benefits to Cone Health's bottom line. I'll say this much; no one LIKES going to a hospital. What makes the current Women's Hospital a wonderful resource for the region is that most patients go there for relatively happy reasons. That makes it stand out. I'm curious how the "expectant" market will respond in five years when Women's Hospital is essentially a wing to a traditional medical complex where you see just as many folks departing as they are arriving.

Ed Cone

Eric, that consideration was discussed a lot by the people who studied this issue in depth and by the board -- many of us, including me, share that personal loyalty and good feeling based on our own experiences.

I think the new facility will allow for the preservation and advancement of the culture that grew in the old building, and that the physical environment on the MoCo campus (eg dedicated entrance to building, dedicated nearby parking) will mollify a lot of the concerns about a new location.

Dr. Mary Johnson

Yet, most hospitals I've walked through (and staffed) in recent years have an abundance of "capacity". As Billy points out, empty halls, empty rooms - especially on Pediatrics.

And still, the million-dollar executives build new buildings (as legacies to themselves) while medically under-staffing the floors and nurseries that remain open.

I'm on a Locums assignment at a community hospital managed by your "parent" company Ed. It will end this week because I've been black-listed for long-term employment. You see, sixteen years ago, one night in the middle of the night, I defied the threats of three-of-those-kinds-of-folks who put on the long meetings and rescued a Cone-owned doctor who was botching a desperately-sick newborn's care. In the interest of learning from his errors and ensuring good care for the babies who came after, I reported him to hospital peer review the next day. I fought back when hospital executives came after me - instead of properly disciplining him. The rest is history.

You and your band of progressive online do-gooders didn't care. Now you sit on Cone's board. Still want to say you can't do anything about it?

Here's the thing: Doctors like me never get invited to the long meetings with the bigshots until something goes horribly wrong - until we can't clean up the mess. Then suddenly, the people who've spent months ignoring you (because doing the work of two people propped up their balance sheet) suddenly want the benefit of your wisdom, insight and expertise.

It is as I've always said, someone has to here's before anyone listens.

The baby didn't die in Asheboro.

Stay proud.

Ed Cone

CH does not have a parent company.

We do have a deal with CHS to provide us scale and expertise in some key areas, but we remain a locally-run, locally-based organization.

Which I think is a really good thing for our region.

Dr. Mary Johnson

Managing partner, parent company, cooperative relationship, corporate mother-ship . . . whatever. Have heard them all.

Someone in Charlotte is pulling your strings. Ooh-rah!

Nice dodge of the rest of my comment - par for this course. Cone is a locally-run, locally-based organization that's not above crushing a home-grown Pediatrician who stood up to you in order to save the life of a baby girl. Randolph's cooperation was a "really good thing" for your local image.

Have fun at the long meetings . . .

Ed Cone

There is a big difference between the agreement Cone signed with CHS and the types of relationship mentioned above.

Assuming otherwise is not an uncommon mistake, but it's a mistake nonetheless. Nobody in Charlotte or anywhere else is pulling the strings in GSO.

Cone Health is locally owned, governed, and managed.

Dr. Mary Johnson

Ed, I DO NOT CARE who owns or operates Cone Health (I pretty much stopped caring the night I had to rescue a FP that Cone/Randolph had marketed to unsuspecting parents as having neonatal skills/training he most assuredly did not possess). But I've made no "mistake".

Cone Health needed the (much bigger) CHS for something - the strings are most certainly there - you're just parsing words and saving face - cuz you sit on Cone's board. You're a big shot now. And this blog has become a giant ad.

I'm here at Word Up (for the first time in months) to call you on HOW your hospital (and many other hospitals in this state) are managed. And, as has been the case since my debut in the blogosphere in 2005, you are deliberately, methodically ignoring the evidence in front of you - as well as the experience and expertise I might bring to your table - IF I were EVER asked to sit there.

Which I haven't been - because it was easier, back in the day, to call me "crazy".

In the past two years . . . since getting fired for a second time . . . by a "mother-ship" executive (at the evil hospital-killing Vidant) . . . someone I had met ONE TIME, IN PASSING, in a hallway . . . this because I dared challenge the brutal/inequitable/inhumane terms of my indentured servitude as an inpatient Pediatrician taking 24/7 ALL THE TIME for four years in the middle-of-rural-nowhere (if I had been a resident it would have been illegal) . . . I have seen every manner of base and amoral behavior on the part of medical managers trying to save a buck. They talk about "teamwork", but they can't come upstairs to talk to the clinical pawns on their chessboards. Pediatricians all over everywhere (including locally) have walked away from inpatient care - because they're sick and tired of being treated and paid like lesser beings - because the old business models that hospitals used to batter them over the heads no longer work.

We're "a dime a dozen" . . . just there to dry off the baby (as long as the OB's give us a "live" one). Why a nurse practitioner could do our job . . . except when he/she can't.

IT IS NOT GOOD FOR OUR REGION OR ANY OTHER.

And I've filled the gaps - in the middle of nowhere - in the middle of the night - when all of the high-dollar executives were at home asleep in bed - after my colleagues in private practice had thrown up their hands and walked back to their offices and not come back (I do not blame them). I've done it for the love of the work. And I'm VERY, VERY good at it - even YOU and your gang of oh-so-progressive goons could not take that away - as much as you did manage to destroy almost everything else.

YOU got everything you wanted - politically and socially - and my world went to HELL. Since we're talking about a Women's Hospital, newborns are not even counted on the census at most community hospitals (when someone doesn't count on the census, HOW, pray-tell, do you expect to even break even?). In many places (in this area included), managers want them booted out of the hospital in 24 hours . . . one LOCAL exec (a surgeon no less) would not even LOOK at AAP protocols for newborn management. Even Medicaid allows two days for a newborn admission - but if you kick 'em out in one, you get paid the same amount of money - and save on staffing. Neat trick, huh?

If they're not breast-feeding well, or turning yellow, or going to withdraw, or a critical heart waiting to happen - well, WHO CARES (except the Pediatrician whose name is all over the chart)?

In our post-Obamacare world, for the first time in twenty years, I've been forced to triage critically-ill babies in the community setting - because transport services at what I used to call "the Mecca" have been cut - and there is no back-up any more. Child protective services in North Carolina is just in the TOILET - the inmates run the asylum. There's so much more - but why bother - since you're more concerned with making sure everyone knows Cone is locally owned and operated?

And hey, let's spend 100 million dollars on a new building - when the old one is full of empty rooms. Everything's just SWELL.

Doctors and nurses cannot talk about ANY these things openly in any detail because (1) HIPAA and confidentiality (which executives hide behind) prohibits it, and (2) they know they'll get canned or black-listed (as I have most certainly been) if they raise too much of a fuss.

I certainly can testify to the fact that medical whistle-blowers only get shot - we're "disruptive" . . . the conversations we try to have "unproductive".

When you really want to talk about healthcare - particularly Pediatric healthcare - as it really is behind the veil in communities all over North Carolina, you let me know.

But this is a waste of my time.

Ed Cone

I would be pleased to stop discussing the ownership question, but your repeated statements on that topic are just inaccurate. Cone contracts with CHS for services rendered (eg purchasing) but remains locally owned, managed, and governed. No strings pulled in CLT or anywhere else.

You raise an interesting point about the length of stay for newborns. Obviously it dropped a lot over recent generations. Two days was standard by the time my kids came along. Not sure how much further there is to go on that front --two days felt OK to us -- but the longterm trend is one example of capacity needs not being what they once were.

In any case, I think replacing the worn-out old WH building with a new one -- including an updated NICU -- will be a welcome change for families and healthcare pros in this region.

Dr. Mary Johnson

Like I said, a waste of my time.

Keep counting those beans.

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