With a new wave of advertising and a new bill at the Georgia General Assembly, Cancer Treatment Centers of America has re-ignited its ongoing turf war with the rest of Georgia's hospitals.
The “destination cancer hospital” is again seeking to change the terms of a 2008 legislative deal that permitted the cancer-only hospital to come to Georgia, arguing that more in-state patients should be allowed to get treatment at the Newnan facility.
Meanwhile, Georgia’s general hospitals stand united in opposing legislation that would change the cancer hospital’s limits, saying the for-profit is focused only on serving Georgia patients whose insurance plans make them lucrative to treat.
"CTCA has the luxury of being able to cherry-pick only those cancer patients with the best insurance and no other health care complications," said Ethan James, the Georgia Hospital Association's executive vice president for external affairs.
The cancer hospital describes the criticisms from other hospitals as a “smokescreen.”
"They do not want to focus on what the real issue is – which is patient choice for cancer care," said Ray Williams, the cancer hospital's vice president for government and community affairs.
2008 deal at issue
Cancer Treatment Centers of America is a national chain with hospitals in Chicago, Philadelphia, Phoenix and Tulsa, in addition to its “Atlanta” facility, which is located in Newnan.
Through advertising that reaches potential patients from across the nation, the chain bills itself as offering a unique, patient-centered approach that’s worth the trip – even if a patient lives in another state.
When the chain decided it wanted to come to Georgia, it couldn’t just build a hospital and open for business. Georgia has a “Certificate of Need” law that is intended to hold down health care costs by preventing an oversupply of expensive medical facilities.
After a bitter legislative fight, hefty campaign contributions and fierce opposition by state’s powerful hospital lobby, the General Assembly approved a separate approval process in 2008 for a “destination cancer hospital” that would serve a national patient base. Under that legislation, CTCA was allowed to open a Georgia hospital, if at least 65 percent of its patients would come from other states.
The hospital opened in 2012. But it didn't take long for the hospital to come back to the Georgia General Assembly seeking to change its deal. It has sought both a legislative change and a rule change to lift its cap on Georgia patients, but the hospital lobby has blocked those efforts.
CTCA is pushing for the change again this year through a special advertising campaign that is focused on portraying the current law as limiting the choices of Georgia patients diagnosed with cancer.
Williams said the Newnan hospital had to turn away more than 70 Georgia patients because of the out-of-state requirement.
The pending legislation, sponsored by Sen. Hunter Hill, R-Atlanta, would eliminate the requirement that the cancer hospital attract most of its residents from out of state.
“What I’m trying to do with this bill is allow patients to have access to the care they want,” Hill said.
But he said if the bill passes, it would force a larger conversation about Medicaid rates that may not even cover the cost of providing care.
Opponents say the legislation would undo the very essence of the agreement that allowed the “destination” cancer hospital to come to Georgia in the first place.
“CTCA needs to live with the deal that they made with the state in 2008,” said Monty Veazey, president of the Georgia Alliance of Community Hospital.
Charity care questioned
The state’s general hospitals question how the Georgia General Assembly can consider giving the cancer hospital a more favorable law, arguing that CTCA isn’t even living up to terms of the 2008 deal.
The cancer hospital, whose official name is Southeastern Regional Medical Center, is required under the 2008 law to provide a certain amount of charity care and see Medicaid patients.
It has to file public documents to demonstrate that it has met those requirements. But every year, the filings raise questions about its commitment to caring for patients without private insurance.
In 2015, the cancer hospital had 11 inpatient admissions for patients covered by Medicaid, representing less than 1 percent of its admissions, according to records reviewed by The Atlanta Journal-Constitution. Medicaid, the public plan that covers some low-income people, is known for its meager reimbursement rates. The cancer hospital said with outpatients included, its Medicaid total was 17.
The cancer had just eight “self-pay” inpatient admissions, the classification used for uninsured patients, records show.
CTCA said it complies with all the state’s requirements. The hospital claims its Medicaid admissions for 2015 reflect what the cancer hospital should see, given the hospital’s market share and out-of-state requirements and the number of Medicaid patients statewide that would be eligible for its services.
Meanwhile, 83 percent of its hospital admissions were for patients covered by private insurance, which generally offers hospitals the highest rates.
No general hospital in Georgia has anywhere close to that favorable split, when it comes to privately insured patients. Statewide, 28 percent of all hospital admissions were for the higher-paying privately insured patients, while 18 percent were Medicaid and 7 percent were uninsured patients, whose bills generally go unpaid. Most of the other patients statewide were covered by Medicare, the government plan for the elderly and disabled.
It’s CTCA’s share of high-paying patients that prompts the state’s other hospitals to question the cancer hospital’s focus.
"We have 58 cancer hospitals through the state of Georgia that provide high quality care and treat all patients regardless of the ability to pay," said James, of the Georgia Hospital Association. "Their Medicaid and indigent care percentages are significantly higher than CTCA."
In 2016, for example, Piedmont Healthcare said the hospital it operates in Newnan saw 446 patients for oncology care covered by Medicaid for inpatient or outpatient care. At Piedmont Newnan, just 35 percent of its oncology patients last year were covered by private insurance, the hospital said. Most were covered by Medicare or Medicaid plans.
CTCA reported to the state in its 2015 financial survey that it provided $24 million in indigent and charity care, which it says meets its 3 percent charity care requirement.
Williams said the cancer hospital also provides screenings at a local free clinic. “It’s really an unfair and unsubstantiated statement by the hospitals that we do not see the uninsured and the underinsured,” he said.
The Georgia Department of Community Health told the AJC that the cancer hospital has provided information to the state, as required. “We have found nothing to indicate non-compliance,” said Lisa Marie Shekell, the DCH communications director.
Other hospitals point to the low number of uninsured patients CTCA reported and say if it is allowed to admit more Georgia patients, it will go after only profitable cases.
"If the very reasonable restrictions that CTCA agreed to back in 2008 are lifted," James said, "they can absorb all the well-paying patients and the least complicated cancer illnesses, leaving the most complicated, most expensive and lowest paying patients for our community hospitals."