What do YOU think about the Somervell County Hospital District Vote for Glen Rose Medical Center?


What do YOU think about the Somervell County Hospital District Vote for Glen Rose Medical Center?

24 January 2009 at 9:54:24 AM

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Let me recap what *I* think.

Didn't know what the hospital district even was until I attended the Town Hall Gary Marks did last week. I understand he did another one at Glen Lakes in the last few days and I think there's another coming up on February 3. Don't think it's right that early voting starts BEFORE all the Town Hall informational hearings are held. Don't think it's right that the actual voting day is Valentine's Day, only because, at least for some, there are obvious distractions. I would like it better if the whole process to put it on the ballot had been done AFTER some informational meetings.

Have spoken here about some of the details and posted audio of the meeting. Thought we were getting a copy of the slideshow from Marks but haven't yet so will put video snapshots of the slides.

Seems to me, cutting through all the fluff, although we can't know this for sure because the hospital/medical center is operated by a private foundation, that the Glen Rose Medical Center can't be run without public taxes. Right now it's run, again, by a private foundation and apparently doesn't make a profit. Why do I think that? Because they have gone at least twice that I know of to Chet Edwards to get earmark money, and, in March, went to the Somervell County taxpayers to ask for a 14 million plus certificate of obligation to pay for an expansion. That changed the amount they paid to the county from $1.00 per year (plus another $1.00 for the nursing home) to, generally speaking, 75,000 per year plus the $1.

Some questions that arise because of knowing this. We do not know what patients are charged for various procedures versus the surrounding clinics. Is there a difference? If so, what are those differences and are the prices for procedures higher because it is THE clinic/hospital in Glen Rose? We don't know what Glen Rose Medical Foundation charges for lease space for the doctors who work from that location. Mr Marks said there is no compensation (let's call it a spiff or kickback) to any doctor based on referrals to the GRMC for procedures (for example, that might involve the radiology department). But, less tangibly, can we be sure that unnecessary services are not being pitched to patients in order to bring in money? Now, when I say that, I suspect that ANY medical center in the area (or the nation, for that matter) would likely do the same thing. I went to the dentist in Granbury a few years ago and definitely thought i was being pitched services in order to pay for the fancy equipment the dentist had in the office.

What would happen if the hospital district does nOT pass and it remains in the control of the county? They, either way, have a vested interest in wanting to see the hospital succeed, especially since they just passed, this last year, that certificate of obligation for 14 mil. If the hospital somehow defaulted, what would happen? Or, suppose the hospital was sold off to some other entity, would that entity have to take the COO as a condition? I do think that the hospital, as an entity, would remain, and be bought by someone else IF conditions were that dire. But maybe I'm wrong.

I mentioned before that I was concerned that there mgiht be an attempt to keep some operational expenses, including doctors, nurses salaries, leases, etc private. But I would think that cannot be if the taxpayer is funding it. I looked at the Texas Attorney General website last night on that and seems like open transparency is the rule for hospital districts and any attempt to use the board as a front piece to a private medical foundation would fail.

If there were no hospital district, the county would still have the obligation to fund a certain percentage of their budget for the indigent. The only thing that changes for THAT part of the budget is a bucket change-ie, from the county bucket to the hospital bucket. But then, there would be additional taxes on top of that, which could also change shoudl the hospital district want to raise the cap (remember, in Texas, the cap is 75 cents per 1000). If, say, an election was poorly attended, it might be an easy thing to keep raising the taxes. How many people attended the hearing about the 14 million?

As a side note, we know that our precinct commissioner, Mike Ford, is president of the Roger Marks Foundation. Now, that is NOT the Glen Rose Medical Foundation, and we are not aware of any direct ties between the two as far as operating the hospital. But the appearance is not good and we think that Mr. Ford should recuse himself from any votes or actions that involve the hospital district, given that Roger Marks was Gary Marks dad.

Anyway, again, we welcome your comments.

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1 - Anonymous   4 Feb 2009 @ 2:12:21 PM  I think the hospital district will help ensure local medical care, without having to drive to a neighboring county. I think people should also be aware that the hospital is the second largest employer in the county!! Think of all the families that this could potentially effect. I say vote YES

2 - humanbeing   4 Feb 2009 @ 7:58:25 PM 

 Rebuttal for Salon:

1. Businesses usually borrow money to expand. This does not mean anything except That they don't have 14 million laying around. If GRMC is not in the red for at least the last quarter, I would be shocked. Most other healthcare systems are.

2. I'd be willing to bet that their charges are in line with others, otherwise, how could they collect reimbursements from Insurance and Medicare? There is very strict guidelines for this.

3. Unnecessary procedures? This problem is endemic to the healthcare system in general and is perpetuated by younger doctors who don't know how to do a physical. There is no reason to believe that GRMC is any worse than the rest of them on this.

4. Default? I imagine that the reason GRMC is wanting to become a Hospital District (a very common structure) is because of the many uninsured or underinsured patients that grace its doors. Yes, they want financial help so they WON'T default. Since healthcare has become a business, first and foremost, if GRMC does not continue to expand its services, it won't survive.

5. If GRMC is bought by an outside corporation, there is no guarantee that anything would improve (my opinion based on my experience) and could be quite the opposite. What if?

6. Would you please explain how Mike Ford's tenure as president of the Roger Marks Foundation  is a conflict of interest? Apparently, it is raising money that benefits GRMC. What's wrong with this?

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3 - salon   4 Feb 2009 @ 10:00:40 PM 


1. I don't disagree. But I don't think it's always in the business of the taxpayer to loan money to private entities. When Somervell County thought about loaning 14.5 mil to GRMC/GRMF, they had to have a couple of hearings to see if anyone had objecttions to loaning taxpayer money to a private foundation. The fact that there wasn't a lot of attention paid, particularly when it was in the heat of the primaries, doesn't mean there woudlnt' have been objections had people realized.

2. I don't know. Neither do you.

3. I also don't disagree with you about this. The healthcare industry is rife with stuff like this.

4. Right, They want taxpayer money to fund it. I might be mistaken about this, but it sounded to me, on Monday night, that it is a policy of GRMC to not ask if people can pay before giving them care, while other hospitals do. And then they can't collect from the indigent, quite a lot of whom apparently come over from neighboring counties. One of hte questioners on Monday also asked a good question, which is, perhaps GRMC doesn't need to try to be a larger facility but should lower expectations; Even Dr Davis said that for certain things people are going to be airlifted out right away and sent to Fort Worth, etc.

5. I'm not saying that I think that the hospital district should NOT be run by GRMC or by an outside corporation. What I am saying that, because this would then become a taxpayer issue instead of a private foundation running it, I believe there should be a set of qualifications drawn up and bidding taken. Not just on who's the cheapest but who would meet critieria for a price. Could be GRMC would fit that. But I do not agree with the idea that the board should just automatically attempt to contract with GRMC again after being elected, just because. i also don't agree with bypassing bid systems with congressmen *securing* money for entities.

6. I don't think you saw the post where I spoke with Mike Ford the other day and he told me that the Roger Marks foundation has not ever donated money to the GRMC/GRMF but only uses the money for scholarships. So it is not a conflict of interest in that case.

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4 - avoter   4 Feb 2009 @ 10:12:04 PM  I think "salon" is now on to the chief issue in this whole ordeal. The underlying issue IS the maintaining of a monopoly. How long will it take for us Somervell County residents to realize that health care delivery in this county has been carefully monopolized by those (or he) who runs GRMC. Competition IS NOT a welcome sight to GRMC. This turns out to be a great shame and a greater disservice to us all. And why is it that so many have taken the bait about the function of the hospital being at risk. No matter which way this vote goes, the hospital will continue to function, and Mr. Marks will be the one in control. The actual meaning of the vote boils down to being a vote of confidence for Mr. Marks. So, the result will determine whether or not other health care providers (like a private Lab or X-Ray businesses) consider Glen Rose as "Fair Ground" on which to compete. Lord knows, our taxes are already going to sustain and empower a private foundation's monopoly. If we vote in a tax district, our very own tax money will further ensure unfair advantage and monopoly for GRMC. Just think, local competitors (like, say, a Dr. who is not affiliated with GRMC) will be forced to pay TAXES to sustain the very entity that is actively hoping and trying to drive them out of business (which is GRMC's/Mr. Marks' goal). So much for the free market. And so much for fair pricing in our own county. I remember a few months ago when GRMC's obvious ally, The Glen Rose Newspaper (Mr. Marks' mouthpiece of late) asked "Where are the Price Wars?" about the high gas prices locally. Well, they need to ask the same of GRMC. But is becomes a rhetorical question, because GRMC has no need to lower very high prices (I challenge you to call Quest Labs or One Source Diagnostics to find how low prices can be) because THERE IS NO COMPETITION. I think we need to vote to allow GRMC to hold its own WITHOUT MORE TAXES (in other words NO to the hospital district), and hope for new health provider businesses to establish here. Wouldn't it be wonderful to do business with a motivated provider who will not mess up your billing and turn you over to a collections agency before your head could spin? Wouldn't it be wonderful to simply have a local choice when the doctor orders X-Rays or MRI? Maybe a single-minded business would bring in a better MRI? Maybe we could pay 1/2 to 1/10 of GRMC's price LOCALLY? (Again, please compare the other's prices, it may be worth the 16 mile drive to Quest or One Source) Maybe? Well, no chance until the monopoly (and hopeful 3 county empire) is placed on level ground, where competitors can get some footing. A NO vote buys us some time to really consider the issue. And a NO vote will not close our hospital or put more anyone out of a job. Let's be reasonable and rational, please.

5 - salon   4 Feb 2009 @ 10:21:16 PM 

One more short note on that-do you agree, in a different context, with ending, at the federal level, congress awarding no bid contracts?

No-bid contract is a popular term for what is officially known as a "sole source contract." A sole source contract implies that there is only one person or company that can provide the contractual services needed and that any attempt to obtain bids would only result in one person or company being available to meet the need. [1] It is awarded usually, but not always, by a government after soliciting and negotiating with only one firm (see 48 CFR § 2.101). These contracts can be negotiated much more quickly than a typical competitive contract but they are often fraught with suspicion that the company used illegal or immoral means to exclude competitors (usually cronyism or bribery).

Or, as I mentioned in a different post, with congressional representatives allowing companies that want money to bypass the government grants program by earmarking the money directly?

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6 - avoter   4 Feb 2009 @ 11:26:52 PM 

humanbeing, about #5 above, when did GRMC get the upper hand in Pecan Plantation? Before Lake Granbury Medical Center could gain momentum (after Hood County General Hospital sold out to a private coorporation).  And nowdays, who is Mr. Marks greatest fear?  Yep, LGMC.  The privately run, for profit hospital, is improving more and more.  Are they out-competing GRMC? Maybe.  It sure appears that Mr. Marks is worried by them.  He has taught us all that we must keep our hospital local.  Remember who started the fight in Hood County? That would be GRMC. Now GRMC is running scared of LGMC. We could conclude that LGMC is more motivated to be competitive and provide a service that people will CHOOSE to return to (they obviously realize that health care service is up for the client's choosing).  In Somervell County, GRMC assumes you do not have a choice and they assume (accurately) that we here in little ole Somervell County are ignorant  of the fact that as soon as a doctor mentions that you need a service, there exists a choice of where you get that service.  The patient is the most powerful player in this decision, and doctors know this. (By the way, why don't the doctors here offer any type of lab or X-Ray service. I sincerely beg you to research and respond to this. I know the answer.) Anyway, it all get back to the monopoly issue and people scratching each other's backs.  Have you asked any of the Hood County Officials how they view the change in operation there?  Now I agree that you never know how an outside company would do here, but it is more likely to be a better run and differently motivated desire than our current situation.

And about #4, I think it could be proven that the enitre plan regarding the $14.5 Million CO was to do it quietly and quickly, then to immediately get this hospital district going.  Think about it.  Last March, Dr. Coker was already gone, Dr. Snider was already gone, Dr. Hess was already gone (and they were not  "recruited" by LGMC until after their decisions to part with GRMC were apparent), and Mr. Marks still pitched a positive financial situation.  Then, by April, the doom and gloom was pitched.  Mr. Marks says what he needs to and we good ole folks hear what we want to (including at the town hall meetings).

Now about # 2.  What's the difference between $35 and $500?  About 15 miles.  But why don't we just stay ignorant to that one.

#3, right on.

#6, maybe later I will divulge, maybe never.

7 - humanbeing   5 Feb 2009 @ 9:19:46 AM 

 Just a few comments to the above: 

Of course GRMC and the surrounding hospitals are in competition with each other.

Monopoly? There's not enough market share in this tiny county to bring in something like a private laboratory. Also, one can chose to go to HM Erath, HM Cleburne, Lake Granbury or the metroplex. 

Lab and X-ray: it costs a fortune to purchase the instrumentation for these services and to pay accredited personnel to operate them. Also, these areas are heavily regulated by the government and must meet stringent requirements and frequent proficiency inspections and testing of methods and personnel. Of course a lab such as Quest can offer the lowest price due to its high volume. However, there are other issues when using a lab such as this, like how much was the specimen quality compromised while in transit to this lab? Also, you may remember a recent artlcle that Quest had been turning out erroneous Vitamin D results for a year. 

Pecan Plantation: I assume that GRMC decided to branch out with the clinic in Pecan since so many residents from that area were already using our doctors and GRMC as their hospital.

Lake Granbury: I have worked for the corporation that owns Lake Granbury (Community Hospital Systems) in the past. It was the only job I have ever resigned from because the level of mismanagement and incompetence had become so intolerable.

Keep up the good discussion, everyone.

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8 - avoter   5 Feb 2009 @ 9:43:08 PM 

humanbeing, I am with you. It is good to have healthy discussion.

It is true that hospitals are in competition with each other.  But Glen Rose does NOT have healthy competition for people to choose from. And if people knew how much money they could save, they would probably head to Granbury, Cleburne, even Fort Worth or Dallas or Waco or Temple even Lubbock or Houston.  When it comes to ingrequent procedures, gas is cheaper, even last year, than the price differences for "ambulatory" services.

And my point about LGMC is that Mr. Marks and select commissioners won't admit that private, for profit management is an option.  Didn't I hear audio of someone asking Mr. Marks if Hospital District was the only option.  I was suprised to next hear Mr. Marks say that there was no other option.  Well, keeping my point, LGMC is private and for profit and all of that other unmentioned option, and LGMC must be doing something right, because it appears that Mr. Marks is scared of their competition.  Sounds to me that one of the two is quite the competitor while the other needs to stay on the porch.

How many doctors has GRMC recruited away from LGMC? Hmm. How is it that LGMC appears to be growing its physician group and spreading its wings across Hood County and even over into Glen Rose, if they are so mismanaged? Do you have any opinion about GRMC's management principles? Do they compare to LGMC's or what?

Now about Pecan Plantation, I just do not see things being as simple as you seem to think they are.

Now, about Glen Rose's future, have you not heard that Luminant has applied for permission to install 2 new units?  Have you noticed how many presently empty hotels there are in Glen Rose?  Somebody knows something.  They are expecting growth. I know a lot of people do not want Glen Rose to grow, but it can't be prevented (except with high taxes).  GRMC, too, is anticipating growth. The problem is that GRMC is positioning itself for monopoly. If GRMC were not relying on our tax money, and they could compete so pwerfully, I would have no complaint. But I foresee Glen Rose trying to grow up with a single, government-funded entity enjoying its carefully planned monopoly.  GRMC will hold back healthy development of private competition.

And I do realize that either way the vote goes, GRMF dba GRMC is still going to be funded by our taxes. Like I said before, the hospital district is merely a moot point. It truly boils  down to approval of how sloppy things have been handled.  I cannot approve.

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