This article also appears on NorthwestGeorgiaNews.com and in the Catoosa News Walker County Messenger opinion pages.

By the end of this week, either CHI Memorial-Georgia will receive approval for a certificate of need (CON) for the new hospital on Battlefield Parkway or Parkridge East Hospital, which filed a 106 page letter in opposition, will be successful in their attempt to control who can and cannot compete against them.   CON Laws explained VIDEO

So, what happens if the CON is approved?

It depends.

In an ideal situation, Parkridge would accept the decision and resolve to compete for patients and market share by providing excellent service at a great value. However, Parkridge is owned by the biggest hospital chain in the country, HCA Healthcare. A quick look at their history in past CON challenges does not inspire hope for a smooth conclusion.

In 2014, an HCA owned hospital and two other hospitals in Augusta, GA filed competing CON applications seeking to build a new hospital in neighboring Columbia County. One of the other hospitals was granted the CON. The HCA owned hospital appealed the decision in court. Seven years later, the 150,000+ residents of Columbia County are still without a hospital. The new hospital was on hold until the appeal was resolved last year.

If the CON for CHI Memorial-Georgia is approved, a judicial appeal could be pursued by Parkridge. That, however, would be riskier than they realize.

NW Georgia residents are tired of waiting for a new hospital. They are excited for the new beginning offered by CHI Memorial. They are ready to put Tri-County/Hutcheson(old names still used by many) in the dustbin of local history for good. 

Parkridge does not need to go down the litigious path. The good reputation Parkridge currently enjoys in Northwest Georgia would certainly suffer in the event of a lengthy judicial appeal. Further, in such a scenario, it is likely that the people of North Georgia would organize not only Georgia residents but others in the region to boycott Parkridge. But what would that look like?

A grassroots campaign could easily make use of existing ratings, rankings, and data to influence public opinion. Here are a few examples.

Below is a screenshot from the independent Lown Institute's hospital rating index. Parkridge cherry picked some of the data from this index as part of their CON opposition statement. According to the full index, Parkridge Hospital has the worst ranking of hospital systems in the Chattanooga area, and it ranks among the bottom half of all hospitals in Tennessee and the nation.

The Centers for Medicare & Medicaid Services(CMS) offers a wealth of data that could be used for a grassroots campaign. CMS has multiple measures to hold providers accountable for patient outcomes and service quality. One tracks readmission or re-hospitalization of discharged patients within 30 days. If hospitals do not meet standards, they are penalized. In every year since 2015, Parkridge has been punished with increasing penalties for their readmission rates. During the same period, Memorial had only a single one.  

Another measure tracks Hospital-Acquired Conditions. In the image below a “Yes” means a hospital was penalized and had payments reduced because of high rates of complications.

Ratings and rankings are not the only arrow in the public’s quiver which Parkridge should hope to avoid. A 2019 Trump executive order and a new CMS regulation could make a far greater impact on rousing people to the cause. Under the rule, hospitals must implement new price transparency rules. All hospital websites must list the standard charges for every item and for every service. The chart below shows more detailed requirements of the rule and Parkridge compliance status with each as of 12/21/21. Hospital Price Transparency Video

As with every other HCA hospital, Parkridge has failed to comply with regulatory requirements. The standard charge file available on their website enables some comparisons with other providers. But the file is woefully inadequate. To find out more, I contacted a new healthcare tech startup, Turquoise.Health.

Turquoise has taken on the challenging task of compiling price data and making it usable and useful for patients, insurers, employers, and providers. Their aim is to engage with well-intentioned providers and payers that want to work together to create price transparency for patients and employers. The image below uses price data from Turquoise.Health.

The image below uses data from each provider’s standard charge file.

The good people of Northwest Georgia may consider another strategy in addition to a citizen-led boycott campaign against Parkridge. This would involve all government entities(Schools, Cities, Counties etc.) in the area working together to exclude Parkridge Health System from employee health plans. As an alternative to full exclusion, employers could restructure their plans to create provider tiers and thus encourage their employees to use providers other than Parkridge Health System. Private businesses in Northwest Georgia could be lobbied and encouraged to join such an effort by adopting the same strategies.

Despite the seemingly unusual nature of such actions, citizens have few options when rent-seeking corporations are well-represented by very able lawyers and the courts remain overly deferential to the legislature's unconstitutional and ill-conceived whims that ignore and trample on economic freedom and liberty, as with Georgia's certificate of need system.