CLARKSVILLE, TN (CLARKSVILLE NOW) – Documents filed with the state give insight into some of the arguments surrounding proposals for two new hospitals in Clarksville. Among them: that the patient outmigration from Montgomery County is almost 50%, yet we are the second-worst in the state for population per hospital.
Ascension Saint Thomas and TriStar have announced plans to build full-service hospitals with ERs in Clarksville, pending the approval of state Certificates of Need (CON) by the Tennessee Health Facilities Commission in a hearing on Wednesday, July 23. Both have filed CON applications, and the commission’s staff has sent back comments to both TriStar and Ascension Saint Thomas (AST) addressing some of the details in their proposals.
Need for new hospitals?
On both applications, obtained by Clarksville Now, the commission staff expresses some concern about adding hospitals, pointing out that Tennova is a 270-bed hospital that was staffed for 237 beds in 2023. At that staffing level, the hospital did not exceed 80% occupancy for the past two years. In fact, it operated at only 57% of its staffed occupancy in 2023. A 12-month occupancy rate of 80% is the suggested minimum for existing facilities before an expansion is justified.
For Level II NICU services, Tennova’s occupancy was only 27% – far below the suggested 80% to trigger expansion.
However, the excess capacity is due in large part to patient preference, both AST and TriStar contend. AST addressed the NICU numbers specifically: “The current out-migration of obstetric services is significantly reducing the number of births occurring within the Montgomery County service area. A growing number of expectant mothers residing in Montgomery County are choosing – or are compelled – to deliver at facilities outside of the defined service area. This trend reflects either a gap in local service availability or a strong patient preference for choice as it relates to comprehensive maternal and neonatal care.”
| GET YOUR MORNING NEWS: Sign up for the free daily Clarksville Now email newsletter
Also in its application, AST questions Tennova’s stated capacity of 270 beds, as the hospital likely cannot make use of its double occupancy-designed rooms.
“Although the THC hospital may be licensed for 270 beds, the actual number of usable beds is lower due to constraints such as infection control, gender mismatches, or behavioral health needs that prevent room sharing. This discrepancy leads to a higher functional occupancy rate than reported, as more patients are concentrated into fewer available rooms,” AST states. “This hidden over-occupancy underscores the need for accurate service area bed needs in relation to current state data, which would suggest that THC is operating well above 80% occupancy.”
Ascension estimates that Tennova’s true staffed capacity is 154 beds, which would put its occupancy at 87%-93% from 2021-2023. Ascension estimates that if no additional hospitals are approved, Montgomery County will have a shortage of 315 acute care beds by 2029.
High ‘outmigration’ rate
Overall, approximately 47% of inpatients “out-migrated” from Montgomery County in 2023, according to the Joint Annual Report cited by TriStar. That is the second-highest of all Tennessee counties with populations over 175,000, and three times the average of those counties:
- Williamson: 61.1%
- Montgomery: 46.6%
- Sumner: 43.4%
- Rutherford: 34.0%
- Knox: 8.6%
- Davidson: 6.8%
- Hamilton: 4.4%
- Shelby: 1.1%
- Average: 14.4%
Tennova has contended that a portion of that outmigration is to Fort Campbell’s Blanchfield Army Community Hospital, which doesn’t report its data to Tennessee. Tennova officials have said that if if the outmigration rate accounted for patients using BACH, Montgomery County’s rate would be comparable to other similarly situated counties.
AST states that of those who out-migrated, 41% sought care in Davidson County, approximately 50 miles away.
TriStar points out that outmigration from Stewart County is 100% – Stewart County has no hospital at all. Since TriStar’s geographic service area would include Stewart County, the need for placing another hospital here becomes all the more critical.
Low number of hospitals
As many have pointed out, Clarksville has only one acute care hospital, while Chattanooga, with a similar city limits population, has six. While Clarksville’s population is indeed soon to surpass that of Chattanooga, the geography of city limits plays a role. While the Clarksville, TN-KY Metro Area has roughly 336,000 population, the Chattanooga, TN-GA Metro Area is much higher at about 580,000.
Still, Montgomery County has by far the lowest number of hospital beds per 1,000 population in counties with 175,000 or greater population, according to the TriStar application:
- Montgomery: 0.94
- Williamson: 1.22
- Rutherford: 1.25
- Sumner: 1.42
- Knox: 3.32
- Shelby: 3.34
- Hamilton: 3.58
- Davidson: 4.67
- Statewide: 2.23
AST proximity to Tennova Sango ER
The staff also expresses some concern about the proposed AST hospital being in close proximity to the Tennova Sango ER, saying that while there are no acute care beds at the existing Sango ER, and a new full-service community hospital will expand consumer choice and access to acute care, “the proximity of the proposed site to an existing emergency department may not result in significantly improved access to emergency services for the residents of other population centers within Montgomery County.”
However, in recent weeks, the AST plan has evolved to make it far more than an acute care hospital with an ER. Both Tennessee Oncology and Tennessee Orthopaedic Alliance have announced plans to build separate facilities on the 96-acre AST campus, and Montgomery County plans to build an EMS station there, if the hospital’s CON is approved.
To get involved
The CON hearing will be on Wednesday, July 23, at 9 a.m. at 425 N. Representative John Lewis Way, Senate Hearing Room I, Cordell Hull State Legislative Building, Nashville. The meeting is open to the public, and decisions are expected during the meeting. Both TriStar and AST have announced transportation plans for those wishing to attend in support of the applications. The meeting will also be livestreamed at this site. Letters of support can be emailed to HSDA.Staff@tn.gov.
| PREVIOUSLY:
- Hospitals line up transportation to Nashville meeting, Tennova listed on agenda as ‘opposition’
- Tennova sends letters to state opposing Ascension Saint Thomas, TriStar hospitals in Clarksville
- How we got to Tennova: Clarksville’s hospital ownership history | ANALYSIS
- Tennova, TriStar, Ascension Saint Thomas make pitch for new hospitals to business leaders