Future of CRMC? (Knoxville, Clarksville, Murfreesboro: fit in, sales, insurance)

[JRR]

With it being a tough time to me a community owned hospital, it seems that at some point CRMC might be acquired by a large hospital system. If that happens it might or might not be good overall. An example would be where I lived in Florida many years ago. The local hospital was acquired by Cleveland Clinic and the hope was that it would improve significantly. Several years later those hope have been pretty much dashed.

Any thoughts here on the future of CRMC?

[tragenvol]

I'd rather it not be acquired by a for profit like HCA.

[Jumeby]

I also think the future of CRMC is in question.

[JRR]

With Vanderbilt Health system in the Lebanon hospital and Covenant Health in the Cumberland hospital in Crossville, we are sort of in between. As CRMC already has an association with Vanderbilt, maybe that would be a logical fit?

[Jumeby]

Ascension Saint Thomas could also expand more in the area.

[JMT]

The Upper Cumberland is a very fragmented area for medical care. The hospital in Livingston is owned by an outfit in Louisville KY. Crossville's hospital is owned by a Knoxville company. Carthage's hospital is owned by the hospital in Gallatin (north of Nashville). And the hospitals in Sparta, Smithville, and McMinnville are owned by Ascension St Thomas. CRMC is the only hospital in the region and one of only a handful in the state owned by the community and not by some corporation. It's also the busiest hospital in the state that's not in a metropolitan area and is even busier than the hospitals in two of the state's metropolitan areas: Cleveland and Morristown.

For the region, CRMC is far and away the largest and busiest hospital with 2/3 of the total hospital discharges in the entire region. Last year's numbers:

CRMC: 13,531
Cumberland Medical Center (Crossville): 5,600
Ascension - McMinnville: 2,037
Livingston Regional - 1,209
Ascension - Smithville: 429
Ascension - Sparta: 323
Carthage's hospital is apparently not an "acute care" hospital and is not listed.

https://www.ahd.com/states/hospital_TN.html

Here's how CRMC compares to hospitals in other towns in Tennessee.

Bristol: 13,733
CRMC: 13,531
Columbia: 13,204
Clarksville: 11,183
Maryville: 9,578
Cleveland: 9,332
Franklin: 8,943
Oak Ridge: 8,694
Morristown: 6,724
Gallatin: 5,743
Sevierville: 4,739
Lebanon: 4,509
Tullahoma: 2,811

What we see is that hospitals in comparably sized cities--and even larger cities--have smaller hospitals because they're a) owned by an out-of-town entity without local interests which leads to b) patients channeled to the larger "parent" hospitals. Maryville's hospital is the only exception; it's owned by Blount County. The hospitals in Clarksville, Columbia, and Maryville are also larger than CRMC but see fewer patients.

I think the ship has sailed, but it would've been ideal if CRMC were the parent hospital for the region. My fear is that if CRMC sells out to, say, VUMC, we could see a reduction in specialized medical care locally as more and more patients are referred to VUMC in Nashville. If CRMC were to sell, I think it should be to Ascension since Ascension already owns three other regional hospitals, and it would probably be cheaper for Ascension to beef up the specialties offered at CRMC than to keep expanding its Nashville hospitals. Ideally, Ascension would also buy the hospitals in Livingston and Crossville which would then make CRMC the legitimate parent hospital for the region. Personal anecdote: a friend of mine in Sparta has an Ascension-affiliated doctor, and my friend is tired of being shipped off to an Ascension hospital in Nashville for anything more than a sore throat. He'd much rather go to CRMC but his insurance is with Ascension.

At any rate, I don't think the city is even remotely interested in selling the hospital, but I suppose if someone were to offer an ungodly amount of cash for it, maybe they'd reconsider.

[justindb29]

I've been told that the hospital is worth between $600-800 million. If it were to sell out, that is an insane amount of new property that would suddenly go on the property tax rolls for the city and county. I'd rather they stay local, but if that ultimately becomes an issue of whether the city approaches bankruptcy or not, sell it.

[tragenvol]

Several years ago, the city contemplated selling CRMC to Covenant Health/Fort Sanders of Knoxville....there was a reasonable revolt by many citizens and many more CRMC employees.

[BuffaloHome]

Originally Posted by JMT

For the region, CRMC is far and away the largest and busiest hospital with 2/3 of the total hospital discharges in the entire region. Last year's numbers:

CRMC: 13,531
Cumberland Medical Center (Crossville): 5,600
Ascension - McMinnville: 2,037
Livingston Regional - 1,209
Ascension - Smithville: 429
Ascension - Sparta: 323
Carthage's hospital is apparently not an "acute care" hospital and is not listed.

https://www.ahd.com/states/hospital_TN.html

Here's how CRMC compares to hospitals in other towns in Tennessee.

Bristol: 13,733
CRMC: 13,531
Columbia: 13,204
Clarksville: 11,183
Maryville: 9,578
Cleveland: 9,332
Franklin: 8,943
Oak Ridge: 8,694
Morristown: 6,724
Gallatin: 5,743
Sevierville: 4,739
Lebanon: 4,509
Tullahoma: 2,811

Those numbers for Sparta, Smithville, and McMinnville are very telling. It looks like Ascension almost automatically refers patients to Nashville. I mean, the entire Sparta hospital has 30 beds but averages less than one patient per day? I suspect it's because some in Sparta bypass Ascension altogether and go straight to CRMC, while others who are contractually obligated to use Ascension (insurance) are routinely shipped off to Nashville.

Originally Posted by justindb29

I've been told that the hospital is worth between $600-800 million. If it were to sell out, that is an insane amount of new property that would suddenly go on the property tax rolls for the city and county. I'd rather they stay local, but if that ultimately becomes an issue of whether the city approaches bankruptcy or not, sell it.

That is a staggering amount of money. The city's entire annual budget is less than $37 million. It should be pointed out that CRMC does give money to the city in lieu of paying property taxes. This past year it was just over $800,000. I don't know how the property taxes would work if a for-profit hospital chain like HCA were to buy the hospital as opposed to a non-profit corporation like Ascension or Vanderbilt. Either way, I can see why some in the city would be dazzled by an influx of a half billion dollars into the city coffers in one fell swoop. In theory, the city could fund itself for 10 years with 0 property and sales taxes and still have enough money for pet projects like the water park. Imagine what that would do to Cookeville's already robust housing and retail markets.

Originally Posted by tragenvol

Several years ago, the city contemplated selling CRMC to Covenant Health/Fort Sanders of Knoxville....there was a reasonable revolt by many citizens and many more CRMC employees.

I wasn't around back then but I've become acquainted with someone who was on the city council back then. He said that the fear was that whoever bought the hospital would water it down to the point where it would become just a glorified ER. Whatever money the city would receive from the buyer would be offset by the loss of revenue from all those medical specialists and medical supply stores which would be shipped off to Knoxville or Nashville. One of the offers was from HCA which wanted to build a completely new hospital on the outskirts of town, and that was completely out of the question as it would've decimated the area of town where the hospital currently sits.

IF (and that's a big if) the city decides to sell the hospital, it would have to insist that the buyer--especially if it's Ascension St Thomas--make CRMC the referral hospital for the region so that CRMC would keep all the specialists it currently has and even add some more. And it would almost have to also include buying the Livingston hospital so that Ascension would "own" the Upper Cumberland region.

I know that CRMC has plans to add another patient tower in the near future (<5 years) and whoever buys the hospital would have to keep those plans and maybe even expand on them.

Anyway, all this is an interesting question. I hope the city maintains control of the hospital, too, but I can definitely see a scenario where the city could sell it and have it be good for the city and region.

[Jumeby]

Ascension Saint Thomas Highlands in Sparta is not a full-service hospital. Ascension Saint Thomas Rutherford in Murfreesboro is a full service hospital.