The proposed sale of Franklin County's hospital has opened up a Pandora's Box of complex issues -- but our local political leadership is showing signs of waking up, shaking off the coma that its been in for years and responding, albeit weakly, to some of the challenges.
As you know, the hospital's owner, Novant Health, announced that the hospital is for sale -- and that should surprise no one. It has been in a tailspin for months although, notably, not for the quality of care that patients have been receiving.
Patient care, from what we can tell, has been excellent -- and that's an important consideration because Franklin Countians deserve high quality medical care without having to leave the county.
When Novant officials put the facility on the market, they admitted what many of us have long suspected, the facility may benefit -- and hopefully thrive -- under new management. Novant, for a variety of reasons, has failed in Franklin County and it's time for a change.
Now, the question is how to effect that change and get the hospital back on the right track.
If you'll pardon a bad pun, it's time for a dose of reality.
Hospitals, indeed virtually all health care, are about making money. Period.
It's a business.
The concept of a non-profit in health care is a misleading statement.
Non-profits still amass money, in Novant's case, scads of it, they just don't pay taxes.
Because they are tax exempt, they reap huge rewards including exclusion from paying most taxes and the ability to use very low interest financing to build or expand buildings, etc.
Instead of "profit," these companies roll up huge amounts of money -- and often pay very lucrative salaries to senior management.
They also require a lot of services -- police and fire protection leap to mind -- that they don't pay for.
For that reason, they are supposed to offer a certain level of indigent care and most fulfill that obligation, although they crow about it more than they probably should.
So, now what?
Franklin County, which sold the hospital to Health Management Associates back in the 1980s, has a stake in the outcome. HMA sold out to Novant in 2009 but it's likely the original sales contract remains in effect, although many of the services it required of a hospital operator have been unilaterally discontinued over the decades.
The key asset that Novant has is a Certificate of Need (think license) to operate in Franklin County.
These CONs exist largely for one reason. They prevent companies from easily fleeing one area in search of a place where they think they can make more money.
HMA tried to leave central Franklin County -- where it was the center of medical care for the county and for large, under-served regions to the north and east -- to get closer to Wake County and Wake Forest where it knew more folks had better hospitalization insurance and would generate more profits for them.
The state said no, the CON stays in central Franklin County, where the medical need is greatest, especially since the southwestern area of the county is well served by Rex in Wake Forest, WakeMed just down the road and Duke's Maria Parham up U.S. 1 in Henderson.
Some say health care would benefit from competition.
Maybe. But the field is so controlled by government programs like Medicaid and Medicare, and driven by private insurance companies, it's barely possible to envision a competitive environment much less create one.
Franklin County -- with help from the town of Louisburg -- MUST be a major player in this situation.
We have to find a way to get the hospital back in the right hands, to create an environment where doctors want to practice and to use the hospital, and to make sure local residents don't have to travel long distances for routine medical care.
We are both blessed -- and somewhat disadvantaged -- by having phenomenal medical care available in nearby cities -- but we need care locally.
Some can't get to Raleigh, Durham or even Henderson easily -- and our hospital has a proven record of being able to offer high quality care locally when its leadership is fully engaged.
Our elected leaders must be team players for once, working to make sure medical care in Franklin County doesn't take a huge step back.