Asheville – Mission spokesperson Nancy Lindell recently responded to gubernatorial candidate Attorney General Josh Stein’s letter encouraging state authorities to deny Mission Health’s application to build a 26-bed acute care facility. When, in December 2023, inspectors from the North Carolina Department of Health and Human Services placed the hospital in “immediate jeopardy” (IJ) for receiving Medicare funding, complaints of overcrowding in the emergency department saturated their report. They told of patients lined up on stretchers “on the wall,” waiting to be roomed.
Mission has been trying to expand its emergency room for years, though. Unfortunately, the hospital must first go through a political process to obtain a certificate of need (CON). The stated intent of these certificates is to encourage competition, although it is well-known that regulatory programs conducted in the name of deregulation are easily manipulated by money and influence and thus only protect incumbent industries with well-funded expert legal teams.
And so, instead of having three new hospitals in Buncombe County by now, every few weeks, reports fly that Mission, Novant, or Advent Health has made a move to win the coveted CON. In her reply, Lindell simply noted that “the current utilization of Mission Hospital’s services is very high, including services related to the ICU and adult medical and surgical beds,” adding, “Currently, Mission Hospital accepts thousands of patient transfers from other hospitals across the region.” In other words, no matter who builds the new hospital, they will likely still send a lot of the patients needing “complex medical and surgical care services” to Mission. Lindell added that Mission would likely be able to get the new beds operational before the competitors could.
Stein’s office’s July 29 letter argued, “The large market share for acute care services that Mission already enjoys in Western North Carolina makes it a poor candidate to promote competition in that region. And Mission is failing to provide safe, quality, accessible, and affordable care in the region at its existing facilities.”
The letter extols the virtues attainable through free-market competition and then ironically holds them up as the projected outcome for politically awarding the CON. Too many economists to name have argued megamonopolies can’t last long without government connections. After all, it’s not the little hospitals that persuaded almost all 50 states to adopt some form of CON laws.
Referencing the IJ report, the letter asserted, “It would be inadvisable to give the hospital more acute care beds when it is not properly serving the region with the beds it already has.” This implies that personnel shortages factor more than inadequate facilities in Mission’s weaknesses and that Advent and Pardee would be better able to staff a new facility, perhaps by offering better wages and working conditions.
If the CMS is worth its salt, then the processes that cleared Mission of its IJ status should have resolved the letter’s complaints about “inappropriate and unsafe settings [that] placed patients at risk of serious injury and death.” Cogently, the letter criticizes Mission for its policy of loading the ED with patients that could, perhaps, be moved to rooms if the hospital could maintain adequate staffing levels. Less germane but concerning is the hospital’s jettisoning of departments and professionals.
A week after this exchange, the North Carolina Court of Appeals ruled 3-0 in favor of Mission’s appeal of a former decision that disqualified the hospital from competing for the CON. The judge ruled in favor of the other competitors, Pardee and AdventHealth, on a technicality: Mission had not held the requisite public hearing. Mission countered that the hearing was not convened due to the inadvisability of meeting live at the height of the pandemic. While Judge Hunter Murphy agreed that Mission had “erred” in not holding the hearing, he did not see how that would have been sufficient to “substantially prejudice Advent and Pardee.”
Since then, Law Professor Mark Hall of Wake Forest University released another “draft research paper.” This one critiques HCA’s purchase of Mission. Mission was dismissive of the paper, noting it was funded by the same group that is raising money for the litigation against them. This would not be the usual suspect, George Soros’ Open Society Foundations. Instead, it is none other than the highly capitalized and professional Arnold Ventures, whose mission is to “maximize opportunity and minimize injustice.” Fighting hospital consolidation, AV is currently supporting Fairmark Partners as they represent plaintiffs in litigation against Mission HCA.