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« Enablers | Main | One stop shopping »

Feb 27, 2007


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Dr. Mary Johnson

Just like Cone Hospital taking on High Point Regional by building an ambulatory center in north High Point, huh Ed? That one is out in the open too - since the state awarded Cone the "certificate of need".

Sometimes the economic enemies are closer.

And sometimes it is not a matter of "if" but "when".

Ed Cone

Well, perhaps not "just like."

Competition between hospitals, however desirable or undesirable for a variety of reasons, seems unlikely to change overall healthcare employment in a given city by a significant degree, no matter which hospital gains advantage.

Competition between distant cities for trade-show jobs seems like much more of a zero-sum game, with the losing city feeling a definite blow to its economy.

Dr. Mary Johnson

I would expect that kind of answer from HRH Edward Cone. It's a small matter of changing masters to you.

Perhaps you might want to check with the High Point City Council before you make smooth-over statements about the expected economic effects of Cone's bold step into High Point's "territory" (if Cone really wants to serve the public, why doesn't it build something on the poor side of town?). The economic balance is a bit more delicate than those on Cone's "side" of this argument (which the state has predictably sided with) would like to admit.

As for the furniture market, it's not rocket science. Las Vegas holds most of the big cards in this game.

Ed Cone

I tried to provide a serious response to the interesting comparison you raised, Mary, and included in my response the possibility that this competition may be undersirable for some reasons. But as an apples-to-apples comparison to the economics of the furniture market, it has its limitations.

Doug Clark

Although I agree with Dr. Johnson on the hospital issue, I see completely different principles here. Las Vegas and High Point aren't neighbors; no one expects them to be neighborly.

Patrick Eakes

Central economic arguments aside, MJ missed the mark badly to imply the Cone Health system ignores the pooor.

They provide lots of free care at their hospitals, their foundation gives away millions, and HealthServ exists to take care of uninsured and underinsured people.

Dr. Mary Johnson

Ed, as I pointed out (seriously), your response was predictable. Might it have anything to do with family ties?

Patrick, you completely missed my point (and if you have any questions, please refer to the N&R's story on the matter - published yesterday). Yes, Moses Cone provides charity care . . . but HELLO, it's a "non-profit". That's part of the mission.

Moses Cone is in Greensboro. It virtually "owns" healthcare in most of Guilford County (some would argue it "owns" the Asheboro/Randolph County market too). By encroaching into High Point Regional's "market" . . . into an affluent area no less . . . Moses Cone will divert profits into its offers that might be better situated in High Point . . . boosting HPR's bottom line so it can better serve the poor in High Point. The High Point City Council is right to strenously object to this less-than-neighborly move into a territory High Point Regional serves . . . and has, in fact, served VERY WELL (compared to other hospitals in nearby towns - which shall in this instance remain nameless).

Patrick if you are naive enough to believe that Moses Cone is after anything but lots & lots of money with this move, you're smoking something.

The reason the state passes out "certificates of need" is to balance out these competitive urges and prevent duplication - or depletion of resources. But in this instance, the state sided with Cone. No big surprise. What Cone wants - Cone usually gets.

But this time it deserves closer scrutiny.

Years ago, while employed by RMA, I once questioned Cone officials when they planned to put primary care offices in Randleman/Randolph County (literally spitting in the face of my newly-recurited collegues and I - who were working so hard to build our own practices and reputations). In the spirit of "collegiality" and "cooperative realtionships" Randolph Hospital officials quickly moved to shut me up . . . I was a lowly employee and as such did not have the right to express an opinion.

It's horse-hockey to muzzle physicians, but there you go.

As for Vegas, if I were a furniture buyer in China or Europe and I got to choose between going to Las Vegas or High Point, I'd go to Vegas.

This is what High Point will be forced to deal with in the immediate future. Who knows, maybe buyers will be able to get cheaper rooming during the market - when the locals figure out that gouging "customers" is a bad thing.

Ed Cone

Mary, I made no comment about the specific situation involving these two hospitals, about which I know relatively little. I responded to the overstretched comparison between rival medical facilities in close proximity to each other, and rival markets in distant cities.

Pertaining to your comment to Patrick: non-profit hospitals are not necessarily obligated to serve the poor, although many do have that as their mission; doing so is an explicit part of Cone's mission, and has been since it was created in the early years of the last century.

Dr. Mary Johnson

There's not much stretch, Ed. Rival markets are rival markets . . . be they only thirty or many hundreds of miles away.

You routinely throw something out there, then take no position. That's what frustrates some of the rest of us so.

But when you do comment, why it's a real whopper: ???"Non-profit hospitals are not necessarily obligated to serve the poor."???

I'm fairly positive that's not the way the majority of the general public sees it. It's certainly not the way I (as a physician) see it.

You sound like you work for Blue Cross Blue Shield of NC . . . or the very-well-paid boys at Randolph Hospital.

And honestly, I'm baffled. I cannot believe that came out of a liberal Democrat's keyboard.

Who are you and what have you done with Ed?

Ed Cone

If I knew enough about the HP/Cone issue to take a postion, I'd take a position. But I don't know much about it, and I'm comfortable saying so instead of leaping to a conclusion. And I didn't throw it out there, I linked to a post about the furniture market, you introduced the hospital situation.

As for the comparison, the Las Vegas furniture market threatens to eliminate a huge number of jobs and economic activity from High Point. Rival hospitals don't seem likely to reduce the number of sick people, or the number of healthcare professionals required to treat them, or the associated economic activity in a given locale. The differences in the two scenarios are pronounced.

As for the requirements of non-profit hospitals, that's not a statement of ideology, just a statement of fact: non-profit status does not necessarily require indigent care. NYT: "Before 1969, the I.R.S. required hospitals to provide charity care to qualify for tax-exempt status. Since then, the agency has not specifically required such care, as long as hospitals provide benefits to the community in other ways — for example, by offering health fairs, screening for cancer and cholesterol, providing emergency care, training doctors and conducting medical research."

Patrick Eakes

MJ, I'm sorry I missed your point.

When you wrote "if Cone really wants to serve the public, why doesn't it build something on the poor side of town?", I thought you meant if Cone really wants to serve the public, it should build something on the poor side of town.

It has. Multiple times.

And I agree Cone is moving into HP to make money. It's one of the ways it funds its indigent services. However, my previous comment did not address Cone's motivations on the current deal, we will have to find another measure of my naiveté.

Dr. Mary Johnson

Well, hospital situations are my thing.

"Before 1969, the I.R.S. required hospitals to provide charity care to qualify for tax-exempt status. Since then, the agency has not specifically required such care, as long as hospitals provide benefits to the community in other ways — for example, by offering health fairs, screening for cancer and cholesterol, providing emergency care, training doctors and conducting medical research."

And my-oh-my how some of our hospitals have taken advantage of that!

It's interesting how you know so much about what is specifically required of "non-profits", Ed, yet you don't know enough to have an opinion about Cone Hospital's motives in this instance.

As for the IRS, it would be nice if the agency would do more to educate the public about what is actually required of "non-profits" . . . because the general public seems to be operating under some big misconceptions. I know I did for a long time. No more.

I'm quite sure there's room for more services on the poor side of Greensboro, Patrick. A good portion of people who use the ER services that Cone is proposing are poor. So my question stands, why is Cone building something in High Point?

And again Ed. I brought up the comparison to make the point that markets are markets. Competition can get ugly. Unless, of course, under the guise of the public good, the state paves the way for a name brand.

Besides, I thought you and JR were ignoring me.


...back to furniture...of course it will have an impact on High Point's furniture market...duh... The good news it that it might help the remaining furniture makers if there are more buyers in Vegas.

This is simply another example of free enterprise at work.

I'm not sure I even understand why this is a newsworthy topic. Maybe North Carolina can turn High Point into the next Vegas.

Ed Cone

Mary, I politely responded to your direct question at my blog. I have no interest in confrontation with you, and no policy about either ignoring or engaging you.

My knowledge of the rules for non-profit hospitals came from a 30-second trip to Google, which I made in response to your (contrafactual, as it turns out) statement about such rules.


"Maybe North Carolina can turn High Point into the next Vegas."

If we really want to be competitive, let's bring a Las Vegas style gaming environment to North Carolina. (Cherokee doesn't count.)

High Point could then be the new Atlantic City if the True Believers somehow get lucky about their "rising sea levels" talking point.

Las Vegas' beach ambiance leaves a lot to be desired.

Percy Walker

I'm with Bubba. High Point should be renamed Wynn High Point and high end gaming allowed. No cheap slots or less than $100 bets at the blackjack tables.

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