Wilson County doctors backing Summit surgery center

A Nashville hospital's proposal to build an $11 million outpatient surgery center in Lebanon includes some local ownership and is projected to treat more than 3,000 patients during its second year in operation, according to state records.
Summit Medical Center's application to the Tennessee Health Services and Development Agency (THSDA) for a certificate of need – according to a copy obtained by The Lebanon Democrat – revealed plans for the facility have been endorsed by a number of local physicians and potential investors.
However, University Medical Center administrator's said for the first time publicly they will actively oppose the Summit application.
Under the proposal, an HCA subsidiary known as Surgicare of Wilson County LLC would sell "up to 49 percent" of interest in the project to local surgeons "who have expressed interest in joining the medical staff and participating as equity partners."
Surgicare of Wilson County would retain 51-percent ownership and manage the surgery center in consultation with the "physician partners," the application read.
Local physicians who have expressed their support for the project as well as an interest in its ownership include at least three representatives from Tennessee Orthopedics, a physicians' group which last year announced plans for a new MRI facility off Franklin Road near the Hartmann Drive Interchange.
"Our current practice is in the process of building a new office near the location of where the proposed Wilson County Outpatient Surgery Center would be," Tennessee Orthopedics' Dr. Douglas Freels wrote in a Nov. 16, 2004 letter to THSDA officials. "And it would be extremely efficient for me to be able to go back and forth from surgery and up to clinic near the same location without having to drive across town."
Convenient for patients as well as physicians, the facility's proposed location off the Hartmann Drive Interchange was identified as a benefit by most physicians who endorsed the project.
Noting nearly one-third of Summit Medical Center's employees reside in Wilson County, Summit CEO Jeff Whitehorn said he was pleased to have such support.
"We are very pleased with the favorable response we have received from patients, local businesses and community leaders," Whitehorn told The Lebanon Democrat Tuesday. "This new center will offer better access to quality care while providing the best technology available. This gives the people of Wilson County a choice for their health care that is close to home."
The certificate of need application lists Wilson County as the facility's "primary service area" but notes that, due to the surgery center's proximity to Interstate 40, its secondary service area would include Macon, Smith, DeKalb and Trousdale counties.
One recurring theme in Wilson County physicians' letters accompanying the Summit application was at times pointed criticism of the Health Management Associates, Inc.-owned University Medical Center in West Lebanon.
"The current hospital in Wilson County known as University Medical Center is very antiquated in its location … the location of the hospital makes it not an ideal location for the expected future growth of Wilson County," Freels wrote. "It is very cumbersome and the flow of traffic makes it difficult to get to and from the hospital as a patient and as a physician. The proposed Wilson County Outpatient Surgery Center would be located in a much more ideal location with easy and quick access to the interstate system."
Other physicians, including Tennessee Orthopedics' Dr. Stephen Neely and Dr. John Tate, noted a second medical facility in the area would help control health care costs.
"The University Medical Center where I have practiced the last 12 to 15 years has become recognized, I think statewide, and often is quoted as the second most expensive hospital in the state next to only Vanderbilt which has its reasons as a teaching facility," Neely wrote in a letter dated Nov. 19, 2004. "I think that we can give more efficient, more cost effective, and certainly more pleasing and friendly care in a brand new facility with state of the art amenities."
UMC officials responded late Tuesday by saying the hospital would oppose Summit's application, with UMC CEO Mark Crawford saying the proposed Summit facility would essentially "cherry pick" customers from the hospital.
"These are what we call limited service providers," Crawford said. "Historically they have cherry picked customers from us. ...These Monday through Friday , 9 to 5 operations are attractive to staff. But, it makes us provide ER (emergency room) coverage while they take the paying customers."
Crawford also pointed to investment HMA is making in the local hospital, saying the company had spent $7.2 million to date on the facility and announced a five year, $20 million capitol improvement campaign. He also said the hospital was active in doctor recruitment, saying in 2004 UMC recruited seven physicians to Wilson County and two already this year.
Crawford said the hospital was "not afraid of competition" but insisted the timing of the move by Summit and UMC's fight against the certificate of need application both have more to do with reduced and changing reimbursements from TennCare that will impact UMC.
"Right now, with the changing reimbursements to TennCare, they (Summit) are basically trying to kick us while we are down," Crawford said. "I don't want anyone to think we are hiding behind this C.O.N. because we are afraid of competition. It is not about competition, it is about the timing of this thing."
"We'll compete with anyone, but give us a level playing field," Crawford added.
Dr. Robert Woods, moderator of the UMC Board of Trust noted progress is being made at UMC under HMA but "things just don't happen overnight."
Woods also referred to the physicians' criticism of UMC as "kind of immature."
Woods noted HMA has invested more than $4 million in the UMC facility since taking ownership.
"I understand what these guys want," Woods said. "They're offered a nice deal to become part owners in this thing. So, they have to flex their muscle, but they're doing it by downgrading everyone else to uplift themselves."
Physicians who have issued their support for the project provided estimates of the cases and procedures for which they would utilize the proposed facility. According to those figures, the outpatient surgery center would handle 2,353 cases and 3,200 procedures during its second year in operation.
Staff Writer Brian Harville can be reached at 444-3952 ext. 16 or by e-mail at brian.harville@lebanondemocrat.com.