The St. Joseph's building is one of the older facilities belonging to Mission Health in Asheville. Colby Rabon / Carolina Public Press

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N.C. Attorney General Josh Stein is giving HCA Healthcare more time to explain its actions in four key areas of service.

On Feb. 25, Stein sent a letter to Greg Lowe, president of HCA’s North Carolina Division, asking him to respond to complaints that his office has received about the quality of care at Mission hospitals and about the staffing of Sexual Assault Nurse Examiners at Mission’s rural hospitals, its new charity care policy and patient billing.

Specific answers concerning the staffing of one or more Sexual Assault Nurse Examiners at one rural hospital, Angel Medical Center, were due by March 4. Responses to questions related to the remaining three categories of activity were due Wednesday.

The attorney general’s letter followed a series of contentious community meetings conducted by Gibbins Advisors, the independent monitor hired to ensure that HCA complies with a series of obligations it agreed to as part of its purchase of nonprofit Mission Health, which became effective Feb. 1, 2019.

In an interview with Carolina Public Press on Wednesday, the attorney general said HCA now has until the end of this month to provide all responses to remaining questions before he holds a sit-down discussion with hospital management.

Stein’s request to HCA for more information on the staffing of a Sexual Assault Nurse Examiner was prompted by a complaint from REACH, a domestic violence and sexual assault nonprofit, about the lack of a SANE nurse on staff at Angel Medical Center, located in Franklin.

In his March 4 response to Stein, Lowe seemed to suggest that HCA had no legal duty as part of its acquisition of Mission Health to place such specially certified nurses on staff at any of its rural hospitals because nonprofit Mission had discontinued staffing “FNPs” – forensic nurse practitioners – at outlying rural facilities before HCA assumed ownership.

“I don’t know how I interpreted it,” Stein told CPP Wednesday. “I’ve read the letter and I’ve seen what they’ve said. We’re going to have follow-up discussions with them so that we understand fully all what they meant with the words that they used on the paper.”

Specifically, Stein said, he needs to know which forensic nurses worked exactly where before HCA took control.

“It wasn’t entirely clear to me whether a nurse moved from where it was to Mission headquarters in Asheville, so these are the kinds of follow-up questions we need to have where we’ve read the letter, we understand the words, but now we have to actually understand fully what they mean. And that comes from a conversation.

“HCA has been very responsive throughout this whole process,” Stein said. “We expect they’ll continue to be and we hope to have a good dialogue.

“They’re in the process of responding to the other areas that we’ve also asked about, and once we’ve gotten all those responses together, collected, we will sit down and have a conversation with HCA and understand exactly what they’re talking about.

“On one of the issues, the charity care, it involved much more work on their end, so we’ve given them an extension until the end of the month to respond to that.”

Charity care and billing under HCA

Lowe, HCA’s division president, has publicly said his corporation provided “approximately $252 million in charity care, uninsured discounts and other financial assistance in our first full year of operation.”

According to Lowe, that sum represents about $100 million more under the new HCA policy than under nonprofit Mission’s charitable plan.

But in his Feb. 25 letter to Lowe, Stein said HCA’s charity care policy “is not transparent about what services are covered” and the hospital system’s decision to focus on emergent care “appears inconsistent” with the asset purchase agreement.

A group of elected officials has also expressed concern that HCA’s charity care policy no longer allows for preapproval of services, and those officials have met with Lowe on the topic.

The officials, led by N.C. Sen. Terry Van Duyn, have heard from constituents that charity care patients know whether services are covered by HCA’s new policy only after they receive them, sometimes leading to financial hardships and bills being put out for collection.

Also now due by the end of the month to Stein are detailed responses to 30 written complaints received by his office about quality of care as well as disclosures made about a new “outpatient fee” imposed on patients of Mission-affiliated primary care providers, even if customers had never set foot in Mission hospitals.

HCA announces plans for wheelchair clinic

As the attorney general was explaining his decision to extend the deadline for some HCA responses, Mission Health issued a joint statement with MountainCare, a Western North Carolina nonprofit, saying that MountainCare will assume the operations of the former CarePartners Wheelchair and Seating Clinic on March 23.

The clinic helps wheelchair users with seat-fitting for comfort and health. It has continued to see existing patients during the handover of operations, which Lowe had mentioned in a paid message appearing in several regional news media platforms in recent days.

The facility will remain on the existing campus at 68 Sweeten Creek Road in Asheville but will now be located in a different building.

New patients may make appointments at MountainCare’s wheelchair clinic by calling 828-820-2828 starting March 16.

The clinic will now be known as MountainCare Seating and Wheeled Mobility Clinic.


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Neil Cotiaux

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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