Gwinnett Medical Center in Lawrenceville, Ga., received certificate of need approval for an open heart program in Oct. 2009, following a nearly four-year process. While the hospital gained strong community support for its efforts, the initial CON approval was appealed by two competing hospitals. The two hospitals eventually withdrew their appeals and Gwinnett will now move forward with developing a $33 million open heart program. Phil Wolfe, CEO of the hospital, discusses the hospital's journey to receive final approval for its open heart program and shares tactics that helped the hospital win over the state and its competitors.
Q: How did the effort to bring open heart to Gwinnett begin?
Phil Wolfe: The hospital had tried to bring open heart to Duluth several times over the last 20 years. The most recent efforts started about four years ago, right after I came to the hospital. It seemed odd that a county as large as Gwinnett, with nearly 800,000 people, did not have an open heart program. We believed the county really did need these services, and we began talking about it more seriously from summer 2006 to summer 2007. By late 2007, there was a movement in the community to drum up support. More than 1,000 residents gave us letters of support, including local elected officials and local businesses.
We submitted the CON application to the state in Jan. 2008 and got initial approval in June 2008; however, the approval was appealed by Piedmont Hospital and Emory University Hospital, both in Atlanta. A hearing officer sided with Piedmont and Emory but then, in June 2009, the state upheld its earlier decision. The two hospitals opposed the decision again but eventually dropped their appeals in Sept. 2009, and we received final approval in Oct. 2009.
Q: What role did Gwinnett play in getting the opposing hospitals to drop their appeals?
PW: Before we submitted our initial CON application, I visited with both CEOs. At that time, they weren't sure if their hospitals would oppose the program, but once they did, we focused on making our best case with the state. We knew there was a need for the service, so we answered each objection and concern that Piedmont and Emory had. The state considered our responses and concluded there was a need for this service at GMC, so we were disappointed when the hearing officer overturned the state's ruling.
The state later reaffirmed its original decision, which the hospitals appealed again. At that point, we began asking staff and community members to reach out to anyone they knew at these hospitals and chat with them about dropping the appeal. We really tried to identify and use any community or political influence we could. In the end, both Piedmont and Emory did drop their appeals. I'm very thankful to Tim Stack and John Fox, the leaders of both organizations, for doing the right thing even though we agreed to disagree on some issues.
Q: Why was bringing open heart services to Duluth so important to your hospital?
PW: The closest open heart services for our residents are some 30-35 miles away in Atlanta, but the mileage isn't the problem — it's the congestion. We are the second-worst metro area for traffic congestion in the United States. If a patient needs to get to an open heart program at 2 a.m., they're probably going to be okay. But if it's rush hour, it's probably going to take an hour to an hour-and-a-half to get to one of the other hospitals, assuming there are no accidents. Time is critical for heart patients.
Q: Now that Gwinnett has received CON approval, what are the next steps for developing your open heart program?
PW: Right now we are working to plan a $33 million, 40,000-square-foot physical expansion, which we don't expect to be complete at least for the next year or year-and-a-half. We may be able to offer open heart services earlier than that by using existing space until the new construction is completed. Of the $33 million, we will raise $8 million in donations to offset some of the costs. We've currently raised $6.1 million, which we are very proud of considering we are in the midst of one of the worst recessions that our country has ever experienced. We're confident we'll reach our goal, but it will probably take a lot more smaller gifts to get us there than it would have in the past. We've been very pleased with the community's support around our efforts.
Q: Will you need to recruit physicians to staff the open heart program?
PW: We have cardiologists and interventional cardiologists, who can place stents, on staff, but we do not have cardiac surgeons. We are working with Peachtree Cardiovascular and Thoracic Surgeons in Atlanta to provide coverage for us. They also provide coverage for St. Joseph's Hospital (also in Atlanta).
Q: What has been the most important lesson you've learned through all of this?
PW: I think that through this process you "re-learn" things, and what I've re-learned is the power of a concretive effort by an entire community should never be underestimated. We had the entire community in agreement and marching together toward bringing the service here, and that was very powerful. That's the reason we were able to get this approved. It seems obvious that community is a strong factor in the success of a hospital, but through this I've re-learned just how powerful it is.
Learn more about Gwinnett Medical Center.
Q: How did the effort to bring open heart to Gwinnett begin?Phil Wolfe: The hospital had tried to bring open heart to Duluth several times over the last 20 years. The most recent efforts started about four years ago, right after I came to the hospital. It seemed odd that a county as large as Gwinnett, with nearly 800,000 people, did not have an open heart program. We believed the county really did need these services, and we began talking about it more seriously from summer 2006 to summer 2007. By late 2007, there was a movement in the community to drum up support. More than 1,000 residents gave us letters of support, including local elected officials and local businesses.
We submitted the CON application to the state in Jan. 2008 and got initial approval in June 2008; however, the approval was appealed by Piedmont Hospital and Emory University Hospital, both in Atlanta. A hearing officer sided with Piedmont and Emory but then, in June 2009, the state upheld its earlier decision. The two hospitals opposed the decision again but eventually dropped their appeals in Sept. 2009, and we received final approval in Oct. 2009.
Q: What role did Gwinnett play in getting the opposing hospitals to drop their appeals?
PW: Before we submitted our initial CON application, I visited with both CEOs. At that time, they weren't sure if their hospitals would oppose the program, but once they did, we focused on making our best case with the state. We knew there was a need for the service, so we answered each objection and concern that Piedmont and Emory had. The state considered our responses and concluded there was a need for this service at GMC, so we were disappointed when the hearing officer overturned the state's ruling.
The state later reaffirmed its original decision, which the hospitals appealed again. At that point, we began asking staff and community members to reach out to anyone they knew at these hospitals and chat with them about dropping the appeal. We really tried to identify and use any community or political influence we could. In the end, both Piedmont and Emory did drop their appeals. I'm very thankful to Tim Stack and John Fox, the leaders of both organizations, for doing the right thing even though we agreed to disagree on some issues.
Q: Why was bringing open heart services to Duluth so important to your hospital?
PW: The closest open heart services for our residents are some 30-35 miles away in Atlanta, but the mileage isn't the problem — it's the congestion. We are the second-worst metro area for traffic congestion in the United States. If a patient needs to get to an open heart program at 2 a.m., they're probably going to be okay. But if it's rush hour, it's probably going to take an hour to an hour-and-a-half to get to one of the other hospitals, assuming there are no accidents. Time is critical for heart patients.
Q: Now that Gwinnett has received CON approval, what are the next steps for developing your open heart program?
PW: Right now we are working to plan a $33 million, 40,000-square-foot physical expansion, which we don't expect to be complete at least for the next year or year-and-a-half. We may be able to offer open heart services earlier than that by using existing space until the new construction is completed. Of the $33 million, we will raise $8 million in donations to offset some of the costs. We've currently raised $6.1 million, which we are very proud of considering we are in the midst of one of the worst recessions that our country has ever experienced. We're confident we'll reach our goal, but it will probably take a lot more smaller gifts to get us there than it would have in the past. We've been very pleased with the community's support around our efforts.
Q: Will you need to recruit physicians to staff the open heart program?
PW: We have cardiologists and interventional cardiologists, who can place stents, on staff, but we do not have cardiac surgeons. We are working with Peachtree Cardiovascular and Thoracic Surgeons in Atlanta to provide coverage for us. They also provide coverage for St. Joseph's Hospital (also in Atlanta).
Q: What has been the most important lesson you've learned through all of this?
PW: I think that through this process you "re-learn" things, and what I've re-learned is the power of a concretive effort by an entire community should never be underestimated. We had the entire community in agreement and marching together toward bringing the service here, and that was very powerful. That's the reason we were able to get this approved. It seems obvious that community is a strong factor in the success of a hospital, but through this I've re-learned just how powerful it is.
Learn more about Gwinnett Medical Center.