Ruckus in RuCo

In April, amid lockdowns from the emerging COVID-19 pandemic, Ascension Saint Thomas executives sought permission from the state to build a neighborhood hospital at the intersection of Veterans Parkway and Shores Road near rising development on the west side of Murfreesboro.

The nonprofit health system wanted to invest $24.6 million in a 32,000-square-foot facility that would host eight inpatient beds and eight emergency treatment rooms transferred from an existing hospital and create imaging and lab services and medical offices. Dubbed Westlawn Satellite Hospital, the space would serve as an extension of the 286-bed Saint Thomas Rutherford Hospital for the fast-growing neighborhood.

Days later, Vanderbilt University Medical Center leaders filed a bolder plan — nearly five times Westlawn’s size — for a property just two blocks away.

The Vanderbilt application proposed a 48-bed, 154,000-square-foot hospital at the intersection of Veterans Parkway and Interstate 840, on a plot of land the medical center purchased in 2017. The facility would cost $134 million and include eight observation beds, diagnostic and therapeutic cardiac catheterization services and neonatal intensive care services.

And so commenced the bureaucratic battle — funded by $190,000 in filing fees — mediated by the Health Services and Development Agency, a branch of Tennessee government that manages growth in health care services by considering market needs.

Rutherford County is the fifth-most populous county in the state, and the surrounding region is projected to grow by more than 10 percent in the next four years. Researchers from the Boyd Center for Business and Economic Research at the University of Tennessee predict that by the end of this decade, Rutherford’s growth will have taken it past Hamilton County. By 2050, it is expected to be larger than Knox County.

According to the study, the county’s senior population is also expected to grow by nearly 47 percent in the next 20 years — bringing with it the need for more medical services. In 2018, however, total staffed bed occupancy in Rutherford County averaged below 80 percent, the state’s “need standard” for counties.

Ascension and Vanderbilt have both had their eye on the burgeoning corridor — and for several years have been expanding their services in the area. Ascension in October 2010 opened the $268 million Saint Thomas Rutherford near Thompson Lane, replacing an aging downtown campus. Its planned satellite facility, which was approved by the state in August, will be an extension of that hospital. The faith-based health system also runs wellness centers, medical offices and other ancillary services in the area.

Most recently, the leaders at Saint Thomas have been building relationships with local government to provide on-site care to individuals covered under the Rutherford County municipal health plan and are breaking ground on a new surgery center on New Salem Highway.

For its part, VUMC offers various clinics and outpatient services in Murfreesboro, including cardiology, ophthalmology, weight loss, women’s health and urgent care.

In 2018, the medical center broke ground to build a $27.6 million, 37,500-square-foot expansion of Monroe Carell Jr. Children’s Hospital in Murfreesboro. That came a year after Vanderbilt officials paid $8 million for the 82 acres of land on which their proposed hospital would sit. The plan was denied.

The nonprofit health system is the only big name in Middle Tennessee without a full-service hospital in Rutherford County. Despite this, Vanderbilt is the second-largest provider of inpatient care to residents in the area. According to census data reported to the state, in 2019, more than 58,000 residents in Rutherford, Bedford, Cannon and Warren counties traveled to Vanderbilt’s main campus in Nashville to receive care. The new facility was meant to give those patients a closer access point to Vanderbilt services while easing occupancy at the Nashville campus, which regularly runs at or near capacity.

HCA Healthcare’s TriStar Stonecrest Medical Center and Williamson Medical Center opposed both VUMC’s and Ascension Saint Thomas’ plans, arguing that the projected emergency department and inpatient censuses for the area did not support the need for either plan. Ascension opposed the Vanderbilt project because it “failed to offer any new services that are not already sufficiently available in Rutherford County.”

Vanderbilt representatives said they supported both projects and argued that the satellite hospital proposed by Ascension did not eliminate the need for their larger facility two streets away, citing a different patient population and service lines. Local elected officials agreed — writing letters of support for each. State Sen. Shane Reeves, a former health care executive who represents the neighborhood where both projects were proposed, said he did not view Vanderbilt’s certificate-of-need application as a threat to the existing market.

In the last legislative session, Reeves co-sponsored a bill to reform the certificate-of-need process “that had a heavy emphasis on simplifying the front end application process, making it faster and more affordable,” he said then.  The bill failed after the House and Senate could not agree on the scope of reform — some representatives wanted to remove the requirement entirely, calling the process “overly cumbersome” — and as the General Assembly’s major priorities took a backseat to the COVID pandemic. Reeves hopes to return to the matter next year.

Meanwhile, his constituents have expressed frustration to the state about the decision to deny Vanderbilt’s hospital plan.

“As a resident of Murfreesboro, I can tell you we often make the trek to Nashville on the highly congested I-24 for care,” Rena Goins, a Murfreesboro resident, wrote in an email to HSDA after the denial. “The board who denied Vanderbilt’s application to build a new hospital here is hurting patients, families and the environment in creating more congestion.”

Evan Cox, a paramedic in the region, told HSDA that Vanderbilt’s facilities are “much needed to alleviate the strain on the Murfreesboro health care system.”

“It would also bring much-needed competition into Murfreesboro’s health care system, which would incentivize both Vanderbilt and Saint Thomas to continue to provide better and more comprehensive care to the citizens of Murfreesboro and the surrounding area. Put simply, it is a win-win for patients in Murfreesboro,” he said.

Representatives with Vanderbilt University Medical Center have appealed the decision to the state. They declined to comment for this story until that process is complete.

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