Lexington Medical Center’s NE expansion could drive down Midlands health care costs

Jun. 14--LEXINGTON COUNTY, S.C. -- Lexington Medical Center made its name by being laser-focused on serving Lexington County. While that still holds true, the hospital's radius is expanding little by little into Richland County, to extend the hospital's reach to covering the Midlands.

That pattern of growth, marked by a network of smaller facilities throughout the region, is reflective of a broader shift in the way health systems operate and what they prioritize.

"Our eggs are in this basket," hospital CEO Tod Augsburger said in an interview with The State, referring to the Midlands.

The main campus of Lexington Medical Center remains in West Columbia -- on land residents Lillian and Harvey Hulon donated half a century ago for the hospital -- but is orbited by more than 360 physicians at nearly 70 private practices, a nursing home and three (soon to be five) community centers in the Midlands.

The largest addition will be a 225,000-square-foot medical outpost in Northeast Columbia that's scheduled to open in 2020. LMC Northeast, at the intersection of Clemson Road and Longtown Road, will include outpatient services like those at LMC Lexington, but will be almost twice as large.

Patients will have access to urgent care, imaging, outpatient surgeries, occupational and physical therapy, as well as a walking trail and classroom space in the five-floor building, according to a news release from the hospital.

Augsburger said there are already nine private practices in the LMC network in northeast Columbia, so the project made sense. Those physicians wanted outpatient services available closer to their patients, including after-hours urgent care, according to Augsburger.

Creating a network of facilities where patients can go for less serious concerns and procedures also helps alleviate pressure on the main Lexington Medical Center emergency room, which saw more than 100,000 patients two years ago, according to Augsburger.

Emergency departments can be pricey for patients -- especially uninsured or under-insured people -- but they are also expensive for hospitals to operate. Having other options is a good thing, according to Emerson Smith, a health care researcher and consultant.

Plus, the trend of health care has shifted from investments in "big, concrete buildings" with lots of inpatient beds and specialists to a constellation of quick-turnaround ambulatory care providers closer to where patients live.

"The model on which hospitals were built even as soon as 20 years ago is just gone," Smith said. "And so now the model is for a lot of clinics and some outpatient surgery centers."

Medical technology has also evolved so many procedures that used to take days to recover from now require much less time, Smith said. That also means insurers can avoid the cost of paying for an overnight hospital stay.

Prisma Health, the South Carolina hospital system that resulted from a merger between Palmetto Health and Greenville Health System, has taken a similar approach with Doctors Care facilities. Prisma partnered with Doctors Care in January 2018 to run about two dozen centers around the state, according to Prisma spokesperson Tammie Epps. Those facilities are generally family medicine practices, but also provide urgent care.

Prisma Health also runs 18 hospitals and more than 300 physician practices throughout the state, Epps said. The system recently conducted a community needs assessment from the Upstate and down to the Midlands, she said, so its future expansion or consolidation strategy will be based on those findings.

Prisma does not have a facility in northeast Richland County like the one Lexington Medical Center is building. Providence Health has a hospital building now used as urgent care and a primary care center off Farrow Road near I-77, less than four miles from the new LMC facility.

Providence Health could not be reached for comment.

To Lexington Medical Center, ambulatory care centers are a way to reach a hand out into the Midlands and recruit more patients while maintaining a strong hold as a county hospital, Smith said. (Smith was hired as a medical consultant to Lexington Medical Center during the hospital's first several years being open.)

For a system like Prisma, which lost its "hometown hospital" identity when it merged with an Upstate entity, Smith said, community clinics can keep profitable preventive care roots in the Midlands.

And Providence Health system, which opened a spot for LMC to be born when it stopped delivering babies, has the unique advantage of being a for-profit hospital, which has little financial regulation and as such "can do whatever they want," according to Smith. The Providence system also has two sister hospitals in South Carolina that are owned by the same parent company, LifePoint Health, out of Nashville. Those sister facilities, Kershaw Health and Carolina Pines Regional Health Center, operate as larger versions of community outposts and can direct patients to Columbia for care.

The more patients a hospital system has over a broad geographic area, the better the reimbursement rate from insurers, Smith said.

"Everybody is trying as hard as they can to look for new ways to bring in more money," he said. "It's sad to say that, but it's really good for us that they're expanding everywhere because it means you and I have a choice of physicians and you and I have a choice of hospitals."

Patients having options also means a better chance of finding more affordable health care, said Smith, who is a clinical research assistant professor at the University of South Carolina School of Medicine. (USC School of Medicine does patient work at Prisma hospitals, but Smith is not directly affiliated with the system.)

"The more competition we have, the lower the cost and the better the outcomes," he said.

In northeast Columbia, Smith says it's not a coincidence both Providence and Lexington Medical Center have settled down in the area -- the demographics are good for raking in additional revenue.

"It's people who have full health insurance, compared to coming to the center of Columbia or Lower Richland," he said.

Lexington Medical Center expects to begin construction on the northeast center by July and complete it by fall 2020. The facility will also bring 125 jobs to the area upon opening and could create hundreds of more jobs "as new physician practices are added."

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