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Commission Meeting - January 7

To My Constituents:


On this past Monday night, the County Commission met along with the Hospital Board of Trustees to discuss the latest developments regarding the Hospital. After this meeting the Commission convened a Special-Called Meeting to further discuss the situation. In reading the report in the The Newsleader today, there are several pieces of key information that were not included. I hope that the text below will help to better clarify the Commission’s decision.


On December 10th, the Commission voted to entertain an offer to purchase the hospital from a group of investors called, Prime Medical Associates, LLC. At that time, the group proposed an offer of $1 Million to purchase the facility, land, etc. They proposed to begin managing the hospital on January 1st and, initially, said that from this point they would be responsible for the hospital payroll. The management agreement with Prime was initially to be for a limited time of 3-6 months. However, this term was agreed to be fluid as it depended upon the approval of the Tennessee Attorney General for the purchase. During this period, the County would continue be responsible for general operating costs, but with the exception of the first two payrolls, Prime would be picking up all payroll costs, while the attorneys develop the final purchase agreement. On advice from our counsel, we anticipated a lengthy delay on the actual purchase and closing as the State Attorney General’s office would have to approve the buyers and the purchase deal since the Hospital is a public tax-payer funded facility. 


  • [ I was very concerned after the meeting in December as the vote for Prime left the County continuing to fund the hospital for many months and it is losing almost $300,000 per month. The County simply doesn’t have the funds to absorb this cost. Additionally, I did not have confidence in some of the partners that comprised the Prime investor group and was concerned as to the legal problems of several of the partners. Hence, I did not vote for Prime on this initial vote in December. ]


Tracy Powell, the County’s attorney that specializes in medical legal matters, sent a proposed draft of a management agreement to Prime’s attorney in hopes of getting an agreement signed before the January 1 deadline when Prime had said that they intended to take over management. Additionally, he requested identity information (full name, address, SS#, birthdate, etc.) for each member of the Prime investor group for a complete background check. Several weeks went by with no response back to Mr. Powell from Prime’s attorney. Finally, on December 28, Mr. Powell received a response which included a heavily edited draft of the management agreement which contained completely different terms than had been presented to and used as the basis for the December vote of the Commission. This was forwarded to the Commission. The January 1st deadline passed, and no additional information or movement was seen from the Prime group.  This placed the initial offer from Prime in breach of their verbal presentation, and thus the vote we took in December was null and void. 


More troubling was the unwillingness to provide information on all of the investors. We finally received only the names of two additional investors over the weekend. I began researching with the limited information we had received to determine some idea as to who these people were and what their experience and business history had been.


What I discovered, even with limited information, was very troubling. Three of the investors had ties to companies that had been involved in lab schemes and fraudulent billing in other states. Additionally, they had ties to two major players that were currently being investigated for illegal and/or fraudulent practices in other small rural hospitals. 


In preparing for our January 7th meeting, I began diagramming the various links and ties to these companies, LLCs and persons on which I had discovered negative information. The web that developed was, frankly, astonishing. The method used by these players to acquire struggling rural hospitals sounded too similar to our situation. 


  • In the other rural hospitals, a hospital management group is brought in to upgrade services to the local community by contracting with outside entities, such as a lab management company, to bring in more revenues. In the cases that I researched, the lab would use the local hospital’s identity (i.e. billing numbers, name, etc.) to invoice the insurers for services. However, some lab samples were being drawn from other states, and rerouted through the local hospital for this enhanced billing. The lab management company would be paid the lion’s share of the profit and would allow the local hospital to keep a small percentage. When the insurers begin noticing large reimbursements to previously low-revenue hospitals, they begin to investigate. Many of these small hospitals have been cut off from their billing privileges, and in some cases, charges have been filed against the lab company and the local hospital/county. This is a death blow to a small rural hospital by taking away the revenue stream from insurance payments. The lab companies can withdraw and move on because the alleged fraud was done via the hospital’s billing system – not the lab’s. The small hospital is left with no way to continue their operation now having no billing options.


Over the weekend, our attorney also forwarded to us a new offer from Progressive Medical from Georgia. This offer was much more lucrative to the County, providing a faster payoff of the $ 1 Million purchase price, assumption of all hospital debt, a 15% profit-sharing plan for the first 5 years, and enhanced services of Integrated Medicine which would bring in patients from other areas.  


Today’s edition of The Newsleader reports that the Commission “reversed course,” but this is not exactly accurate. During our meeting on Monday, we were forced rescind the vote of December as the terms of the proposed offer from Prime were no longer valid. 


We reopened the bidding process and heard from Prime and Progressive with their latest proposals for purchase. After each presentation, we asked questions in order to gain as much information as possible about the investors, their backgrounds, and their experiences. 


It surprised me that Mr. Alvarez from Prime was still unwilling to provide information for a background check on himself and two other investors. Additionally, the proposal from Prime was very unprofessional, unorganized and incomplete; which, to me, implied a complete lack of professional business experience. As I questioned the Prime members that were present, the tone of their responses seemed defensive rather than cooperative. Together with the research that I had done, I became convinced that Prime was not a group with which I felt comfortable to hand over the hospital and its critical importance to medical and economic welfare of our County and her people.


  • NOTE: I will say that my decision did not, and should not, impugn the medical expertise of three of the six investors, specifically Dr. Chris Marshall, Dr. Steven Averett, and Glynn Mooney. These local gentlemen are, indeed, professional in their medical practices.  My decision to vote against Prime should not be seen as any indication in their abilities to continue providing medical services, nor should it imply any misdeeds on their behalf. I did not base my decision solely on the fact that several of the Prime members were “local folks” with good intentions. This decision was a business decision that must look at all of the aspects of a deal, both positive and negative. My decision was based on the “total package” of Prime Medical Associates, its investors and affiliations, and my responsibility to the people of our County, my district and their best interests. 


After hearing the Progressive’s presentation and considering their history and experience, coupled with the results of my research which showed only a few disgruntled employees and did not produce major legal issues, it was clear to me that, of the two options placed before us, this company had more experience in running a large clinic/quasi-hospital with a sizable group of employees for more than 20 years. Additionally, they appeared to have deeper pockets to fund this endeavor. 


They do have a different approach to health care than a traditional hospital, and I believe that this was of concern to several of the Commissioners. Progressive is involved in Integrated Medicine, which is a blend of Holistic and Traditional medicine practices. This is seen in several other large hospitals such as Cancer Centers of America and The Mayo Clinic. In doing my research, it appears that many large hospitals are beginning to incorporate this approach in addressing conditions such as Diabetes, Heart health, Cancer, etc. 


After experiencing the fiasco with Impeli, our County DOES NOT need to be involved in another problem. History shows that we, as a County, have not properly investigated our options. Moreover, we have not worked on progress through a global plan for the County’s future. Instead, we have allowed things to happen to us rather than be proactive in making our own positive decisions. Our hospital is only one example of this problem. 


When the Commission voted on which offer to accept for purchasing our hospital, the majority and I voted for Progressive as it was the best decision – given these two options - for our citizens. In stating this, I will tell you that my FIRST CHOICE was neither of these companies. 


I would have preferred that we had been proactive and looked at our option with Ascension/St. Thomas Health as a permanent solution to health care for our County and her people. As I have explained previously, the other Commissioners and the Mayor did not want to pursue the Ascension/St. Thomas Health option. I have never been provided an explanation – other than they were looking for someone to “pay off our debt” rather than a solution to our medical care issue. I think that this is very short-sighted and is a continuation of reacting rather than planning for our future. Additionally, I think that egos and prejudice play a large part in ideas that come from a woman. This is sad, but a real fact in dealing with our local government. 


I sincerely hope that the Progressive group will provide a sound medical solution for our people. I am willing to support any and all efforts to make healthcare available for our citizens and to provide a hospital/ER to encourage growth.


As always, I encourage you to speak up to voice your opinions, your ideas and your complaints. It is only through communication that we can discover what is important to you and what is an issue that needs addressing. Please feel free to contact me at: abarrett@decaturcountytn.org or through my webpage communication at: www.commishconnect.com or www.aprilbarrett.com


I wish each of you a Happy and Prosperous New Year!


Kind regards,

April Watkins Barrett

SEE THE VIDEO OF THE MEETING ON TNL TODAY ON FACEBOOK



VIDEO OF MEETING - January 7, 2019

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