Piedmont Medical Center would face significant, but not insurmountable, challenges from a Fort Mill hospital operated by Carolinas HealthCare Systems, healthcare experts say. The biggest challenge will be retaining patients with well-paying insurance. Healthcare choices are like most other consumer decisions, experts said: People equate new and shiny with something being better. "Competition in healthcare is not conducted on price or quality, but on the latest technology, perceived quality and reputation, and who has the nicest rooms, the biggest television," said Alwyn Cassil, director of public relations for the Center For Studying Health System Change. A flight of patients with well-paying insurance to the new hospital would result in Piedmont having more patients paying with Medicare or Medicaid, thus affecting revenues. Piedmont, some fear, would become a hospital of last choice.