At a special meeting Monday afternoon of the county commission, Ascension Sacred Heart sweetened the terms of its health care proposal to replace Weems Memorial Hospital as the county’s emergency room and clinic provider.


Before a large audience, many of them vocal advocates of Sacred Heart’s offer, Roger Hall, president of Ascension’s hospitals in Miramar Beach and Port. Joe, along with Patti Greenberg, the health care consultant who helped draw up Ascension’s proposal, outlined the revised terms of what the company is proposing for Franklin County. Also on hand was Robin Goodwin, vice president of nursing at Sacred Heart on the Gulf, but she did not address the commission.


Hall and Greenberg opened by reiterating the foundation of the proposal the nation’s largest non-profit hospital chain first outlined in October, stressing that as a "faith based ministry" they aim to provide "spiritually centered holistic care that sustains and improve the health of individuals and communities."


They underscored the $90 million investment they’ve made in the Destin-area hospital, and the $28 million they’ve put into the Gulf County facility, noting the millions they have been able to raise in donations on behalf of those facilities.


Citing high rankings for quality, and for low infection rates, as well as the largest physician network in Florida, "our intention is to make health care better in Franklin County," Hall said.


"We’re not outsiders, we’re here in the community currently," said Greenberg, referring to both Dr. Ryan Pharr’s primary care practice, as well as a nearby rehabilitation center, both in downtown Apalachicola.


Greenberg provided names and numbers for the updated proposal, beginning by noting that after the county covers construction-related costs, and leases the building to Ascension at a nominal rate, the company would quickly enhance the medical services it would offer.


St. George Island resident Dr. Heather Wells, who now practices in Wewahitchka, would establish a primary care practice in a new office pavilion contiguous to a freestanding emergency room. Greenberg stressed it would be up to the county to decide where that emergency department was located, provided it complied with Medicare rules that require it to be within 35 miles of the Port St. Joe hospital, meaning it could be no further east than roughly where Franklin County High School is located.


The revised proposal also indicates orthopedic surgeon Dr. Stephen Sokoloski, now practicing in northwest Ohio, would relocate to Franklin County and work part-time in the new pavilion. In addition, Miramar Beach cardiologist Dr. Brent Chapman, presently affiliated with the Port St. Joe hospital, would work part-time at the new pavilion, as would general surgeon Dr. Stacy Harbin, who also works in Gulf County.


The freestanding ER would replace the existing Weems facility - which currently offers an ER as well as 25 licensed hospital beds - and be expanded from the original proposal, from two to six observation beds, along with six procedure rooms, for a total of 12,000 square feet.


The Ascension ER would be staffed with the full-time equivalent of about four doctors and eight nurses, plus about four CT scan, x-ray and ultrasound technicians, for two dozen fulltime positions, not including the telemedicine physicians as well as air flight personnel operating out of the existing helipad.


"The hospital we had 30 years ago is not the hospital of today," Greenberg said. "The majority of people are not admitted to the hospital to stay overnight. Our proposal is expanding health care services, offering an additional access point, incorporating telemedicine, and aligning with a major tertiary health care provider.


"The first piece of the proposal is emergency services as the ‘front door’ of the hospital," she said. "To establish a free standing hospital emergency department (that) has to provide all the same services as the host hospital."


The proposal calls for continuing to operate the Weems East clinic in Carrabelle for 5.5 days a week, and to use Wells, the two existing nurse practitioners and nine support staff to handle both it and the Weems West clinic in Apalachicola. "We would anticipate they would stay in place," Greenberg said. "If demand warrants, we would initiate additional recruitment and/or hours in the future."


Later in the meeting, Commissioner William Massey pressed Hall on whether the CEO had initially said that cutbacks to just a couple days a week were planned at the Carrabelle clinic.


"You’re correct. I stand corrected," said Hall.


"I had it right," said Massey. "I listened to everything you said."


Another enhancement to Ascension’s proposal is to bring state-of-the-art mammography to the specialist pavilion adjacent to the ER, which would provide cardiology, orthopedics and general surgery once a week.


Because these specialists are employed by Ascension, they "could come sooner, rather than waiting until a new building is built," Greenberg said. "This can be done more rapidly that recruiting a new physician to the market."


Hopes to draw on St. James beds


Ascension also announced on Monday that it is in talks with St. James Rehab Center outside Carrabelle to enhance rehabilitation services, and that it would relocate its rehab services in Apalachicola from 76 Market Street to 4,000 square feet in the new pavilion.


With the decertification of Weems would come the loss of the swing bed program that now exists, but which has had limited success.


Greenberg said an 83 percent occupancy rate at St. James suggests there would be available beds to work with to provide the sort of short-term skilled nursing care typically provided in swing beds.


"Robin (Goodwin) has been meeting with them," she said. "We’ve talked with them how Ascension can enhance what they’re doing to meet short term skilled nursing needs. We’re going to work with St. James to help enhance their capability."


In their presentation, Ascension did err in indicating that Weems does not now offer round-the-clock emergency room care and procedures, which Weems CEO David Walker pointed out when he and Weems board chair Doug Creamer had a chance to question Hall and Greenberg.


Walker also noted that Weems now offers air flight service, which was not listed in Ascension’s proposal, and that some of the data from the 2018 Weems cost reports, cited by Hall, may need to be updated.


Hall said that based on the 2018 numbers, Weems has 93 employees, including 26 that work for the ambulance service. Of the 67 non-ambulance personnel, 58 work at the hospital and nine at the two clinics.


Hall said that under Ascension’s proposal there would be 23 fewer employees. "We assume EMS won’t change," he said, noting that there likely would be no changes in the clinics’ employee levels.


He said the jobs lost would be in dietary and plant operations, accounting and medical records. "There would be opportunity to move into another Ascension location," he said. "We will give every employee priority on hiring if they have the qualifications. It’s not our intention to displace anyone; we want to displace as little as possible."


Hall said Ascension would employ 43 full-time staffers across five departments, not including the specialists’ practices. "As volume increases, we would anticipate increasing those numbers," he said. "We want to create a sustainable model. We really think in five years we’ll have more employees than we have now."


The report estimated that in the first year of operations, Ascension would lose about $1.4 million, and in the second year, about $1 million. Hall said the company would invest about $3.6 million in capital for equipment, and with the county investing about $8 million for the new facility, licensing and operations could be completed in 10 months.


"We would start and establish it as soon as practical," Hall said. He noted that the county would be asked to spend a half-million annually to help cover uncompensated charity care, and that would still leave the county about $1.8 million annually from the one-cent health care sales tax to spend as it saw fit.


"We would provide all the funds for operational losses," Hall said. "The county will have no operational risk."


Commissioners promise to review proposal


While he did not give hard numbers, Hall said the acquisition of Weems’ Critical Access Hospital designation "would have some value to us.


"Critical access provides you 101 percent of Medicare and Medicaid allowable costs," he said. "The more volume you have, the move value you have."


Creamer pressed Hall on whether the county would be able to write off the cost of depreciation of the new building on its cost reports. "That $8 million would be a total expense," said Hall. "The cost report would go away."


Hall, who has announced plans to retire this summer, reassured commissioners Ascension is in it for the long haul. "We’re not going to walk away,:" he said. "I’ll come work for you as a free consultant. I want my career to make a difference."


Chairman Noah Lockley questioned what the scenario would be in the event the company’s losses exceed its expectations. "How long will Ascension stay if they keep on losing money?" he asked.


"We’re going to be smart, we’re not going to leave Franklin County," said Hall. "We have no intention; that’s not who our mission is. (In other communities), we stood by what we said we’ll bring."


Lockley said that jobs losses would also involve the loss of licensed practical nurses, which are less prevalent at Ascension facilities.


Creamer also pressed Hall on what would be the fate of the county’s roughly 1,200 members of Capital Health Plan, a health maintenance organization whose coverage area does not extend to Gulf County.


"We will accept CHP in all our clinics," said Hall. "(Sacred Heart in Port St. Joe) is out of network. We’ll continue to send the patients to where CHP wants them. We will help that patient go there. We won’t put that patient to have greater financial responsibility. We’ll honor that authorization and get them to where that insurance plan goes."


Commissioner Smokey Parrish pledged to review the revised proposal in detail, and both Bert Boldt and Ricky Jones offered more extended comments.


Jones noted that the existing transportation disadvantaged services program could be an asset in transporting patients to sites within Franklin and Gulf counties. In response to one of his questions, Greenberg said that Hurricane Michael has prompted the temporary closure of maternity services at Ascension’s hospital in Bay County.


"We still have 24-7 OB coverage for OB trauma," she said.


"I have always thought since I got to sit in this seat, that a new facility is a first step towards having better health care in the county," said Jones. "I think if the county plays their cards right, there’s enough money in one 1- cent tax, and I think we can open our clinics even more if the demand is there."


Boldt called for a "very specific and detailed contract with the providers of services," and for a community health needs assessment. He invited Hall to take a walk-through all the county facilities, and asked that he create a timeline and estimated costs of all the equipment Ascension would be providing.


County Coordinator Michael Morón encouraged commissioners to pay careful attention to the long-term prospects of Ascension’s entry into the county.


"What options are there if Sacred Heart says ‘this isn't working out we’re leaving," he asked.


"The question is very hypothetical," Hall said. "We will continue to be here. We’ll sign a contract in good faith."


Morón told commissioners "I’ve been a Catholic from the cradle. I’m trying to get people to understand we have to look beyond it (the current proposal). If they leave we’re back in the same situation we are now."


Hall said he supported the county seeking a low-interest USDA loan to finance the new facility. "I’d get the USDA loan tomorrow," he said. "You’re not going to get better financing."