This fall, Asheville’s Mission Hospital faced Immediate Jeopardy, the most serious citation federal regulators can deliver, for the second time in two years. Once again, the beleaguered hospital system appears to have wiggled its way out of meaningful consequences.
The hospital has submitted a plan of correction by Sunday’s deadline, CMS told Carolina Public Press. The citation has now been removed, according to hospital CEO Greg Lowe. Now, CMS will send surveyors on an unannounced visit to Asheville to see whether Mission is really fixing its problems.
This year, those problems included preventable patient death, unsafe patient transport, patient misidentification and harmful infection protocol.
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The hospital failed to provide a safe environment for patients, according to the North Carolina Department of Health and Human Services and CMS. That finding put the hospital at risk of losing its Medicare and Medicaid funding — which would be a death knell for the biggest hospital in Western North Carolina.
Now, elected officials and nurses at the hospital are raising questions about whether Immediate Jeopardy findings have enough teeth to actually hold the hospital accountable. The punishment — which would likely result in the hospital closing — is so draconian that it may not be realistic to actually enforce, they say.
Last year, the follow-up survey visit was successful and Mission emerged from Immediate Jeopardy with only a spat of bad press to show for it. That will likely happen again, according to Sen. Julie Mayfield, D-Buncombe.
“I am 100% sure that Mission’s corrective action plan will bring it into compliance,” Mayfield told CPP. “They know how to do that all day long. Our assumption has to be that they may surge resources now and then allow staffing levels to abate over time. And then we’ll find ourselves in this situation again.”
Immediate Jeopardy accountability questions
Is it still possible for the follow-up visit to go so disastrously that the agency considers revoking critical funding? Yes. Is it likely? No, say both Mayfield and Mission cardiology nurse Kerri Wilson.
“We are the critical hospital between Charlotte and Knoxville,” Wilson said. “It’s not realistic for them to take that Medicare and Medicaid funding away. It would be detrimental for the people of Western North Carolina. People would not survive without Mission Hospital. I think (hospital owner) HCA counts on that, and they exploit it.”
So what would an actionable punishment look like for the hospital after repeated Immediate Jeopardy findings?
Mayfield thinks HCA should lose control of the hospital, and it should be taken over by a third-party administrator. That’s never happened with a hospital, but CMS has done similar things with nursing homes, she said.
“We are asking for the imposition of a third-party administrator,” Mayfield told CPP.
“Three Immediate Jeopardies in six years is too many. It shows too much of a pattern. We will continue to be in this pattern until HCA is forced to make changes that it does not want to make. We think a third-party administrator for some period of time is the thing that makes the most sense.”
On the ground at Mission
For now, though, HCA is still in control. Wilson says conditions at the hospital have felt more punitive than productive since the Immediate Jeopardy finding.
The focus of the corrective plan so far seems to be re-educating nurses on proper protocol, rather than relieving them of the stressed staffing conditions that lead to unsafe scenarios, Wilson said.
Mission announced that it spiked staff by 200 nurses over recent months to combat shortages. But the staffing spike is “not keeping up with the nurses that we’re losing every day because of the unsafe situations they’re put in,” Wilson told CPP. In late summer, 140 nurses left Mission in 90 days, she said. The spike doesn’t even help them break even, staff wise.
“My hope, as a nurse, is that we see real changes and real accountability from this, rather than it being a temporary solution to make things look good and get us out of trouble,” Wilson said.
“But what we’ve seen so far is very similar to what we’ve seen in the past. HCA is putting the blame on the staff, rather than taking accountability for systemic issues.”
Mission Hospital in Asheville is the flagship hospital of the Mission Health group, a chain of six rural hospitals across the region, all part of the formerly nonprofit Mission Health group that for-profit HCA acquired in 2019. It’s the only hospital in the group to face Immediate Jeopardy.
But Mission Hospital is also the only one of this group where nurses have unionized. It’s actually the only unionized hospital in North Carolina.
“The focus right now is on Mission Hospital’s main campus, because we are the ones who have been speaking out and getting surveyors in the building,” Wilson said.
“One can’t help but imagine that our other regional hospitals that are run by HCA are having the same issues. They aren’t being vocalized because nurses don’t have the same union protections we do. They’re not reaching out, but I feel like they probably have the same situations and we don’t just know it.”
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