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Health: DHEC board affirms rehab beds at Waccamaw Hospital

By Charles Swenson
Coastal Observer

The board of the state Department of Health and Environmental Control voted last week to uphold a staff decision to let Waccamaw Community Hospital add 17 beds for rehabilitation patients. That doesn’t mean the beds, which the hospital applied for three years ago, will be added anytime soon. Members of the DHEC board say they expect their decision will be appealed in the courts.

Following its decision on the 17 rehab beds, the board approved a new state health plan that shows 39 more rehab beds are needed in Georgetown and Horry counties. “The whole dynamic of everything we talked about changed when we adopted the health plan,” said board member Lee Hewitt of Murrells Inlet, who represents the 7th Congressional District.

Tidelands Health – formerly Georgetown Hospital System – and Grand Strand Medical Center both applied for the 17 rehab beds. Grand Strand’s request was denied. A panel of DHEC board members last month voted to let the full board review the staff decisions after giving the hospitals extra time to negotiate a settlement.

Cost was a key factor in the staff decision, said Sam Philips, former head of the certificate of need program. Waccamaw Community Hospital will convert 15 existing beds from acute care to acute rehab for about $500,000. Grand Strand proposes a new facility at nearly $12 million. “The cost couldn’t be farther apart,” Philips told the DHEC board. Although the reimbursement to the hospitals for services are fixed “we believe costs get shifted,” he added. Waccamaw already has 43 rehab beds. About 40 percent of the patients in its rehab facility come through referrals from Grand Strand, Philips said.

Officials from Grand Strand, which is owned by Hospital Corporation of America, said that’s part of the problem: 83 percent of the region’s population is in Horry County, but all the rehab beds are in Georgetown County. “What the staff did was not the best for the patient,” said Will Thomas, attorney for Grand Strand.

He told the board the “hyperfocus” on cost was misplaced. Grand Strand wants to enter the rehab sector so its costs should be compared with expanding an existing program.

Grand Strand also argued that rehab beds are needed for its Level II Trauma Center. Adam Rudd, chief operating officer for Grand Strand, said the gap in service was noted in a review by the American College of Surgeons. He told the DHEC board there are 25 patients in the trauma center awaiting rehab beds.

“If you have 25 patients who are waiting for rehab, give us a call,” said Dr. Jeff Wilkins, medical director for the rehab unit at Waccamaw. He pointed out that the unit is for patients who need at least three hours of multidisciplinary therapy and who are so ill that the services need to be provided in a hospital.

He’s been at the rehab unit since it opened in 2002 and said it offers “world class care” with specialities in stroke and amputee rehab. Shifting new beds to Grand Strand would reduce the flow of patients, lead to cutbacks in staff and reduce the level of expertise at Waccamaw, Wilkins said. The referrals that now come from Grand Strand will stop and “for every bed that is placed at Grand Strand there will be an empty bed at Waccamaw,” he said.

Dan Sullivan, a health care planner for Grand Strand, argued that the need for 39 more rehab beds in the new state health plan shows Waccamaw won’t be short of patients if some rehab beds go to Grand Strand. “If you look at the planning area, the beds are not evenly distributed,” he said.

He also told the DHEC board that the number of patients in Waccamaw and Georgetown Memorial Hospital have declined over the last three years while Grand Strand has grown.

Bruce Bailey, CEO of Tidelands Health, acknowledged the decline at his two hospitals, but said that Tidelands planned to shift beds to its rehab facility. “We’ll take credit for good planning,” he said.

Waccamaw Community Hospital was located in Murrells Inlet to serve patients in both counties, Bailey told the DHEC board. The hospital system has spent $20 million to develop its rehab center as a regional facility just as Grand Strand has focused on trauma care and cardiac care. It’s now one of the largest rehab facilities in the state, he said. If the board’s decision is reversed, “we will immediately lose 40 percent of our business,” Bailey said. “Volume does matter to quality.”

Until now, Waccamaw has collaborated with Grand Strand, Conway and Loris hospitals as its rehab facility grew, Bailey said. Board member Clarence Betts questioned the timing of Grand Strand’s entry into rehabilitation, saying they didn’t seem interested until Waccamaw applied. Thomas, the attorney for Grand Strand, said the applications were on “parallel tracks,” but conceded that Waccamaw applied first.

Hewitt said the argument Grand Strand made about access was persuasive. Traffic in the summer makes it hard to get from the Myrtle Beach area to Murrells Inlet in less than an hour, he said. Board member Mark Lutz said he was also sympathetic. When family members are in the hospital, “we want to be able to get to them.”

Betts asked staff if the board could approve both hospitals’ applications since it was about to approve the new health plan and its call for 39 additional beds. Philips said that might be possible, but would be unfair to any health care providers who might want to apply for those new rehab beds. Grand Strand can apply for those new beds in 45 days, Betts noted.

The vote to approve Waccamaw’s application was unanimous. “All of this is probably going to end up in the Administrative Law Court,” Hewitt said afterward. “All the hospitals take these things as far as they can.”

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