Mission Health North Tower hospital in Asheville, NC, is owned by HCA.
Mission Health North Tower in Asheville. Colby Rabon / Carolina Public Press

“We are writing with deep concern regarding the state of Mission Hospital Systems since the purchase by Hospital Corporation of America last year.”

So began a scorching condemnation of HCA Healthcare’s performance in a letter read aloud to a packed room of community and health care leaders who turned out Monday night for a listening session with Gibbins Advisors, the Nashville, Tenn.-based firm hired to monitor HCA’s compliance with 15 obligations stemming from its acquisition of Mission Health.

But the mood grew dark quickly as Ron Winters, Gibbins’ principal and co-founder, called Buncombe County lawmakers, Sen. Terry Van Duyn and Reps. John Ager, Susan Fisher and Brian Turner; Buncombe County Commission Chair Brownie Newman and Asheville Mayor Esther Manheimer to come forward.

Lined up in formation before the crowd, Van Duyn began reading a letter into the record for Gibbins to share with HCA as part of its watchdog duties.

But representatives of Mission’s new management were in the audience, already paying attention.

Speaking for the group of officials, Van Duyn cited concerns “pouring in from distressed patients, practitioners and HCA employees” to the office of the attorney general, Western Carolina Medical Society, Western North Carolina Health Equity Coalition, state legislators and members of City Council.

The officials cited charity care, patient safety and physician disenfranchisement as outcomes of HCA’s acquisition that are “simply unacceptable and must be corrected.”

Charity care

The group blasted HCA for a lack of transparency concerning the system’s agreed-upon charity care policy, one of the 15 items under the purview of the independent monitor.

“The full, written policy is not available to community providers and the public,” with the group receiving its copy only through an Open Records Act request made to the attorney general, the delegation said.

“This lack of transparency has resulted in confusion among providers and patients and, more importantly, in patients possibly not receiving care they should.”

In addition, the group said, the current charity care policy does not allow for preapproval for up to a year of care as before and is only retroactive, “meaning patients know whether their services are covered only after they receive them,” the officials charged.

“This has resulted in patients being billed for services that they thought would be covered and now cannot afford. Some of these patients are now the target of collection agencies.”

Patient safety

Continuing to plow through the letter, Van Duyn said there had been “numerous, aggressive staff cuts over the past year, putting patient safety at risk.”

Certified nurse assistants and unit secretaries have been cut dramatically or eliminated altogether, putting fresh pressure on nurses, and patient-to-nursing staff ratios have also increased, Van Duyn asserted.

A letter from a Mission employee provided to the elected officials said emergency room nurses “can be seen weeping in the hallways, stress levels at their max.”

Physician disenfranchisement

“HCA has aggressively pursued contract renegotiations with multiple physician practices, resulting in unfortunate outcomes,” the group continued.

“Due to HCA’s insistence on significant cuts in physician pay, PML Pathology and the Cancer Center of Western North Carolina, both of which have long had contractual relationships with Mission, have ended their contracts with Mission/HCA.”

At Asheville Hospitalists Group, a group of 50 hospitalists, “six hospitalists have announced their resignations, and at least five more are expected to turn in their resignations shortly.”

A copy of a recent internal physician engagement survey was attached to the submitted letter showing percentile ratings by 307 physicians on a range of 14 services from radiology to administration. Radiology received an “excellent” rating of 41.9%, the highest rating in the batch. No category reached the 50% mark.

The elected officials closed their presentation by saying they stood ready to work with the independent monitor to address their concerns.

As Van Duyn wrapped up, applause burst forth from a sizable portion of the audience.

A Mission Health official could not be reached for comment on the group’s blistering critique following the meeting.

Billing issues

Separately, and in advance of last night’s independent monitor session, Mission Health apologized to patients left confused after they were billed for outpatient fees in the aftermath of visits to hospital-affiliated primary care offices.

But while the Asheville-based system now owned by HCA Healthcare has apologized for initially failing to explain the fee, it did not roll it back.

Mission instead announced a dedicated number for patients to call, 833-258-8030, if they have questions about the fee, which has troubled many patients since first being imposed last fall.

“We fully acknowledge we did not effectively communicate this change to all our patients in a timely way, and for that, we sincerely apologize to our patients, their families and our communities,” a statement provided to CPP read.

“Moving forward, we will provide information to each of our patients at the time of their appointment, and are committed to providing clear, concise information on what they can expect in terms of our billing procedures.”

The fee drew criticism in recent months for what patients said was a lack of transparency by Mission in rolling out the fee and its cost, which adds to primary care copays through outpatient fees that patients have said can surpass $100 a visit and that are taken out of their deductibles.

Multiple patients told CPP that they never received treatment at one of Mission’s hospitals and never saw a specialist before they were charged the outpatient fee.

Within Facebook’s We Are Brevard NC public group, opposition to Mission’s outpatient fee has become more intense, with posts expressing displeasure over a lack of transparency and discussions about switching doctors.

Some of those irate patients are expected to show up at Tuesday night’s independent monitor’s meeting in Brevard.

Meanwhile, some staff at Mission-affiliated offices appear concerned that patients affected by the outpatient fee will take their annoyance out on physicians, nurses and other caregivers rather than Mission’s administrative departments.

Laurie Jenkins Hunter, an employee at one Mission-related provider, posted her concerns on the We Are Brevard page.

“We don’t know the billing process from our end so, please, please before you throw blame make sure you know who you are blaming … we are caregivers and we work our butts off every day to provide this care.”

Additional independent monitor sessions

HCA’s Independent Monitor continues to hold community meetings. Doors open 30 minutes before each event. The remaining sessions are as follows:

  • Transylvania County meeting (Transylvania Regional Hospital)
    Tuesday, Feb. 11, 2020 / 5:30 to 7 p.m.
    Unitarian Universalists of Transylvania County
    24 Varsity St., Brevard, NC 28712
  • McDowell County meeting (Mission Hospital McDowell)
    Wednesday, Feb. 12, 2020 / 11:30 a.m. to 1 p.m.
    Marion Community Building
    191 N. Main St., Marion, NC 28752
  • Mitchell County meeting (Blue Ridge Regional Hospital)
    Thursday, Feb. 13, 2020 / 5:30 to 7 p.m.
    Auditorium, Burnsville Town Center
    6 S. Main St., Burnsville, NC 28714

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Neil Cotiaux is a contributing writer for Carolina Public Press. He is based in Wilmington. Send an email to info@carolinapublicpress.org to contact him.

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