Asheville – The vilification of Mission Hospital, since its acquisition by HCA, continues to be perpetrated in the press. One family of complaints concerns staffing shortages that force those who did not partake in the Great Resignation to feel overworked and undercompensated. Another rues the hyperregulatory environment that prioritizes paperwork over healing. For all the backlash, Mission leadership claims to be making strides to get ahead of the problems.
Most recently in the news, Mission Hospital completed the public input requirement for the certificate of need (CON) application for a $29 million, free-standing emergency department on Crowell Road near the West Asheville Cracker Barrel. Back in May, the North Carolina Department of Health and Human Services (NC DHHS) issued a public notice announcing the application. If approved and uncontested, the new facility could begin providing emergency, radiology, laboratory, and pharmacy services within the next two years.
Over the last couple of years, Mission has announced several other capital improvement projects. Among these were a $20 million expansion of the McDowell campus and a new Angel Medical Center. In Asheville, Mission is slated to open Sweeten Creek Mental Health & Wellness Center in August. The hospital has already opened a campus for the Galen College of Nursing in Biltmore Park Town Square in order to address local staffing shortages.
Mission had hoped to get a CON for a 67-bed facility on the AB Tech Enka campus. Novant Health and AdventHealth also applied. While it appeared Mission was destined to win the CON, local leaders, state legislators, and even Attorney General Josh Stein piled on to convince the NC DHHS to deny the “local monopoly’s” request. In November, Advent announced it had secured the CON, but the other two hospitals said, “Not so fast.” They are now challenging Advent’s victory.
Mission filed another request for a CON to build two satellite emergency departments. One would be in Candler, and the other would be near the intersection of Hendersonville and Airport roads. Both facilities would have 12 patient rooms and be open 24/7. The facilities were originally slated to open toward the end of this year.
Anyone who has had the experience of visiting Mission while overflow patient beds, occupied by the infirm and maimed, line the halls and nooks of the emergency department can appreciate the need for the new facilities. Mission’s spokesperson, Nancy Lindell, explained at the time of the announcement that the facilities were planned proactively to counter long wait times. Since the pandemic, emergency departments across the country have commonly experienced a significant backlog due to higher utilization. The new emergency departments were also needed to serve a growing population and work around the traffic congestion that plagues Asheville’s major arteries.
The state awarded Mission CONs for both facilities, but AdventHealth and Pardee Hospital appealed the decision, and the judge ended up ruling in favor of reversing the award for the Candler facility. The decision was based on Mission’s failure to provide a public hearing, something Lindell said the state did not require due to the COVID shutdown. She added that many other CONs were awarded to healthcare facilities that did not hold public hearings during that time.
Undaunted, Mission licked its wounds and returned to square zero with a new application for a certificate of need. This time, the plan was to build on Crowell Road.
Meanwhile, work in South Asheville proceeded with the groundbreaking for what Lindell described as “an urgent care facility that we hope to one day be able to turn into a freestanding emergency room.” Construction costs were estimated at $13.3 million.
CONs have long been criticized. They are allegedly based on the premise that if more facilities and technology are offered than are necessary, medical practices will overcharge patients in order to maintain profits in the face of dwindling market share.
In practice, they are more easily attained by large, incumbent organizations and thus serve as barriers to lateral entry. Statistically, they even appear to reduce overall access to healthcare while increasing costs of treatment. Just last month, South Carolina joined the ranks of states that have repealed their CON laws.
As a general rule, regulation increases the amount of effort needed to accomplish a task. In Mission’s case, CONs added a political impediment.
Making large hospitals support legal staff to research, draft, and defend applications and appeals for CONs and compliance with other regulatory measures comes with costs of compliance. These costs, of course, are passed on to consumers, most of whom have complained for decades that healthcare costs are too high.