A. The Hospital Landscape in South Carolina

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A. THE HOSPITAL LANDSCAPE IN SOUTH CAROLINA

Hospitals and health care systems all across the United States are going through a historic transformation, and the hospitals and health care systems operating in South Carolina are no exception. Recently in South Carolina, several health care systems and physician groups consolidated into larger regional organizations, and these evolving health care systems are acquiring more types of health services, outpatient, and "outreach" care in addition to the medical care traditionally provided within the "four walls of a hospital." South Carolina's hospitals continue to provide critical emergency care for illness, births, chronic conditions, and injuries, but are increasingly also part of a national health care transition to large health systems with a continuum of care focused on keeping people healthy ("often called "population health") and, where possible, out of the hospital.

The health care services available to patients varies widely across South Carolina's public and private health care systems, and even between hospitals within the same health care system. South Carolina's many hospitals differ widely based on hospital size, staffing, location, resources, and multiple other factors.

1. General Acute Care Hospitals/"Safety Net" Hospitals

Most South Carolina hospitals provide medical and surgical care for short-term general acute illnesses or conditions. Hospitals commonly referred to as "safety net" facilities treat patients regardless of their insurance status or ability to pay.² Safety net hospitals across South Carolina often provide services that other hospitals may not offer, such as trauma, burn care, neonatal intensive care, ambulatory care services, and inpatient behavioral health.

Most safety net hospitals - both public and private - receive subsidies from the Medicaid Disproportionate Share Hospital (DSH) program³ because of the large amount of care they provide to uninsured people; however, the amount of DSH subsidies that hospitals receive is not necessarily a good indicator of a particular South Carolina hospital's capacity to care for uninsured and vulnerable populations.⁴ There is no specific threshold of the amount of care provided to uninsured people that clearly identifies an institution as being a "safety net hospital." Thus, safety net hospitals comprise a broader group than just public hospitals, but there is no standard, agreed-upon definition to fully delineate what exactly is meant by the label of a 'safety net hospital' that is operating in South Carolina today.

Some...