Asheville – Mission HCA is no longer in immediate jeopardy (IJ). This means that state and federal inspectors have determined that the “conditions” that threatened patients’ lives and safety are now under a plan of correction, and the hospital will continue to receive Medicare and Medicaid funding. Having secured approval from the Centers for Medicare and Medicaid Services (CMS) for its correction plan, the hospital is now working to meet a 90-day implementation deadline.
Leading the charge against Mission are NC Senator Julie Mayfield and NC Attorney General Josh Stein. Mayfield referenced data provided by the Service Employees International Union. The nurse’s union reported that, in 2020, staffing at HCA hospitals, on average, was 30% below the national average. “This is part of their playbook,” Mayfield said. “They run hospitals on as few resources as possible.”
Mayfield continued, “Mission has the second-highest per patient revenue of any of their 180+ hospitals. There’s plenty of room for them to invest more, but they choose not to…. While they told everyone they would (turn profits) by consolidating back office jobs and through their bulk purchasing power, their real strategy, all along, was to cut staff, close services, close primary care practices, reduce pay to doctors that caused over 200 to leave, etc., etc. They cut anything that didn’t make money or enough money. They also raised prices and changed practices in the hospital that ensure patients pay more.”
It was hard to believe Mission’s kindly leaders were getting high on self-devouring greed. It makes sense that a turnaround artist would purchase a retail outlet, streamline overhead, and make a profit, but cutting essential services and staff when health and safety were at stake is “murderous.”
An unnamed source spoke off the record, corroborating Mayfield’s claims. He said understaffing and a dysfunctional corporate culture were the main problems, and that people were intimidated because those who spoke up or filed reports felt their jobs might be threatened. He has heard stories of leadership inviting squeaky wheels to meetings with HCA attorneys, who would tell the complainant not to file reports. He added that many of the 200 doctors who signed an open letter to Mission, first published in October, were anonymous for fear of retaliation.
Dr. Clay Ballantine, whose name has been at the top of lists of physicians signing open letters demanding adequate care at Mission HCA, was contacted. He said Mission had been a great hospital until then-President and CEO Ron Paulus had the Certificate of Public Advantage (COPA) lifted and engineered the sale to HCA. Without the antitrust legal instrument, HCA was able to cut services to patients to maximize their profits with limited state or federal oversight.
Patient bills went up so much that local governments are now suing Mission. The City of Asheville and Buncombe County are self-insured, and they don’t want to spend taxpayer dollars on hospital bills that have skyrocketed beyond rates of inflation.
Ballantine also explained that industry analysts thought HCA’s purchase of Mission was a bad fit. Except for their flagship hospital in Nashville, Ballantine said HCA’s hospitals are often smaller facilities. HCA’s model works for smaller, economically troubled hospitals that tend to send patients with costly specialty needs to larger facilities.
Mission, however, is that bigger hospital, serving the whole region. It has dozens of operating rooms, over 800 patient beds, and hundreds of physicians providing care in many subspecialties. “In Western North Carolina, for healthcare needs, the buck stops at Mission Hospital,” he said. As the regional center for tertiary and quaternary care, no scaling up of that small, rural hospital cost-cutting model is going to fill the needs of the region’s sick and afflicted.
A blind rule of thumb for cost-cutting is to go after the largest line item, and Ballantine said that generally, in hospitals, about 60% of expenditures are on personnel. At Mission, departments have been spun off, and positions have been cut. What Ballantine described was a typical scenario of cutting too much and leaving the remaining staff to burn out.
While Ballantine couldn’t comment on the degree to which Mission’s statistics deviated from the mean, he did applaud the nurses for compiling the list of 91 incidents that were brought to the attention of regulators, precipitating the inspections that led to the IJ designation. He also encouraged anyone with concerns about operations at Mission to file a complaint within the 90-day probationary period, which ends at the end of April. Whether Mission remakes the HCA model into something workable or another organization takes its place, humane compassion begs that the sick receive adequate care.