HCA Healthcare-owned Mission Hospital in Asheville is still under scrutiny from federal regulators until June 5, according to a letter from the Centers of Medicare and Medicaid Services sent to Mission Hospital CEO Chad Patrick on March 8.
Regulators determined the hospital no longer has conditions of immediate jeopardy after surveyors went back to the hospital Feb. 23. This latest letter also confirms that it was removed, but states the hospital still has to come into full compliance by June 5, 2024, to avoid losing federal funding.
That’s an extended time period from the original date of Feb. 24, according to the letter, and gives the hospital 90 days to comply.
HCA also had to submit a plan of correction to the federal agency by March 13, which HCA spokesperson Nancy Lindell said just meant re-submitting the previously approved plan.
Management had earlier submitted its plan of correction to CMS detailing how it would fix violations at the hospital, which was made public Feb. 15.
“Mission’s status is the same now as it was on February 23 when the immediate jeopardy was removed,” Lindell said.
“This new letter is just part of the ongoing process and restates what was in the initial findings. The 90-day extension is simply to ensure ongoing sustainability with the already-accepted plan of correction. This is not abnormal.”
The latest CMS letter makes it clear that “all is not well still” and regulators continue to watch the hospital, said state Sen. Julie Mayfield, D-Buncombe. She also said the hospital should provide more staffing and resources to address the violations, but HCA has proven unwilling to do so in the past.
Hopes and doubts in CMS regulatory process
The delay in communications from CMS throughout this process has been “frustrating,” said Mayfield, as it means the public knows things later than the hospital. However, that seems to just be the way the agency works rather than purposeful slowness, she said.
Hannah Drummond, an emergency department nurse at Mission Hospital and union member, said some things have “already backslid” since the regulators left the hospital. Despite seeing improvements while the hospital was under watch for immediate jeopardy conditions, Drummond said less efforts to increase staff remain underway.
While the standard for the number of nurses is now higher, Drummond said, that level is not always maintained. One consequence of that is not being able to offload patients from ambulances into the emergency room as quickly, she said, which can leave ambulances stuck waiting instead of back out in the community.
Emergency department nurses were also temporarily getting more aid, such as phlebotomists to help things go faster, and that is no longer in place, she said.
Another issue is hospital management not taking full accountability, she said.
“The hospital is attempting to scapegoat staff, acting as if the nurses or other staff members are the issue as to why they’re out of compliance in these areas — when we the nurses’ union know that it’s actually due to a lack of resources,” she said.
Although it’s “validating” to see surveyors corroborate the issues staff originally raised, Drummond said she sees the nurses themselves as the ones ultimately responsible for forcing change.
“So even if CMS doesn’t keep watching, we’re still watching,” she said.
Michael Messino, a retired physician who founded Messino Cancer Centers, is part of a coalition of advocates and elected officials following developments at Mission Hospital. He said it’s frustrating to not have all the information on what’s going on inside the hospital, but regulators are likely being “cautious” because they realize shutting the hospital down would leave the region without care.
“They may have thought the process through a little bit differently, realizing maybe if we can get this fixed, at least temporarily, then we can look for a long-term fix,” he said.
Messino hopes that long-term fix will involve selling the hospital to a new owner, he said, as he isn’t confident the hospital will be able to stay in compliance with federal standards.
HCA also needs to cooperate more with regulators, he said, such as providing agencies with appropriate documents or access to staff.
Lindell said in an emailed statement that HCA will continue to collaborate with surveyors.
“We are especially appreciative of the countless members of our teams from numerous departments who came together over the past several months to help explore and develop ways that we could provide more expedited and better care in the Emergency Department,” she wrote over email.
“The results of their collective efforts have been noticed by patients, families, and EMS — in addition to the surveyors.”
Messino said he believes regulators listened to advocates’ concerns over a lack of staffing solutions in the plan of correction and will be “scrutinizing them a little better because of what we said.”
Attorney General Josh Stein’s office said in a statement over email that the office is “continuing to focus on our lawsuit to ensure HCA is fulfilling its obligations.”
Stein previously said the immediate jeopardy findings by CMS could impact the lawsuit his office undertook against HCA, Asheville Watchdog reported.
Hospital first to perform treatment
Meanwhile, HCA is touting Mission Hospital as being the first in North Carolina to perform a new surgical procedure for atrial fibrillation, or when the top two chambers of the heart beat too fast and irregularly, according to a company press release sent March 8.
Atrial fibrillation can cause blood clots in the heart and lead to a stroke, the press release said, and nearly seven million Americans live with the condition.
The new technology used in the procedure to treat the condition is safer and “avoids damage to surrounding structures,” according to the press release.
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