The clock is ticking for the region’s biggest hospital system, HCA Healthcare. The company bought Mission Hospital in 2019 and now faces the possibility of losing its Medicaid and Medicare funding.
BPR checked in with Andrew Jones, an investigative reporter with the Asheville Watchdog who has been covering the story.
BPR: This is a complicated story with a long history. Can you provide some background on how it all started?
Since the 2019 sale to HCA Healthcare, there has been a lot of tumult. Along with COVID-19, there were numerous issues surrounding the hospital's management that manifested in a number of ways, including nurses unionizing in 2020 and complaints from patients and staff. We reported on some of the complaints filed by nurses last year, and shortly after, investigations were launched by the Joint Commission, which accredits Mission Hospital, and by the North Carolina Department of Health and Human Services on behalf of the Centers for Medicaid and Medicare Services (CMS).
Those investigations resulted in the recent “immediate jeopardy” finding, which essentially means there are severe deficiencies in how health care is being provided at Mission Hospital.
BPR: What do we know about those deficiencies?
Not much at this point. There were nine deficiencies cited over 19 months. We know some specifics around why the “immediate jeopardy” designation was given, but we are still waiting for a document from CMS to tell us exactly what happened in these instances.
BPR: Mission/HCA submitted their plan of correction to CMS and has until February 24 to fix those deficiencies. If they don't, do you think CMS will pull the plug on Medicaid and Medicare funding?
It's possible. I don't think the outcome is common because that's the point of a plan of correction — to fix the issues. But it has happened to some hospitals, and it's definitely a risk that we have to acknowledge here. We will see.
BPR: Embracing the majority of patients that come to Mission Hospital here in Western North Carolina are on Medicaid, Medicare, or are uninsured — it would be devastating to this region and the patients here. Would it be devastating for HCA?
I think it would be devastating for HCA’s reputation. HCA is a very profitable company, and its revenues are up according to the latest earnings meetings. But in terms of reputation, having that funding pulled would be catastrophic for them — in some sense. And they have acknowledged that they have a responsibility essentially to fix these issues and do better. They have told me that in interviews and emails, and they have told their staff that in interviews and emails. So, I think there is at least some sort of commitment to repairing these issues. But that doesn't mean that they're not at risk of losing that funding at the same time.
BPR: Of course, happening at this same time is a lawsuit at the state level. Give us an update on that.
Those immediate jeopardies were handed out about at the same time as the Attorney General of North Carolina Josh Stein, and his office, were also investigating Mission this year. [He] found in a lawsuit that he filed...that HCA was not complying with some of the sale agreements, specifically in the emergency department and in cancer services. So he has essentially been trying to get Mission, HCA, to come to the table and at least have a discussion about how they can get back into compliance with the agreements.
This is completely unrelated to the immediate jeopardy situation, but it is another pressure that HCA faces at this point. The deadline to respond is February 13, and so we'll see then how they respond.
BPR: Andrew Jones is a reporter with the Asheville Watchdog a nonprofit news organization run by volunteer retired journalist and media executives and dedicated to producing strong trustworthy local journalism in the public interest.
It was a lot to unpack Andrew. Thank you so much for being here.
Thank you so much for having me.
This transcript has been edited for length and clarity.
