Correction: An earlier version of this story misstated the last occurrence of potential noncompliance findings against HCA. There have been two other instances since 2019. This version has been corrected.
HCA Healthcare was in potential noncompliance last year with the terms of its agreement to purchase Asheville’s Mission Hospital, according to a newly-appointed independent monitor.
The decision by Affiliated Monitors, Inc., a Boston-based firm selected for the job in April, marks the first potential noncompliance finding by an independent monitor related to patient care at Mission Hospital. Earlier, there were two instances of potential noncompliance in HCA’s broader Western North Carolina system.
HCA purchased Mission Health System in 2019.
Dogwood Health Trust, the foundation responsible for hiring the independent monitor, said in a press release Tuesday that HCA had been found in potential noncompliance with three areas of the purchase agreement.
“These concerns include the provision of Emergency and Trauma Services and Oncology Services at Mission Health; failure to remain ‘enrolled and in good standing’ in Medicare and Medicaid; and issues with Uninsured and Charity Care policies,” Dogwood said in the release.
The foundation notified the state attorney general’s office in a letter Monday and said it intends to officially notify HCA. North Carolina Attorney General Josh Stein’s office has 30 days to inform Dogwood whether it agrees with its findings. The full independent monitor report is available here.
In a statement, HCA spokeswoman Nancy Lindell said the hospital company had reviewed the independent monitor’s report and agrees with “the findings of compliance in the majority of the report.”
“There are two areas where the IM noted the potential for non-compliance relating to findings from CMS at Mission Hospital that were resolved earlier this year,” Lindell said, referring to the Centers for Medicare and Medicaid Services. “Mission Hospital is in compliance with governing regulations and at no time was the hospital suspended from treating Medicare or Medicaid patients.”
On the third instance of potential noncompliance, related to Charity Care, Lindell acknowledged that HCA had made “a minor clarifying change” to its policy.
“Our intent was to make clear that, unlike Mission Health’s charity care policy prior to HCA Healthcare, as an organization we do not pursue litigation activity that involves suing patients or filing liens on patient debt accounts,” Lindell said. “We value the work of the Independent Monitor and are confident that we continue to be in compliance with the terms of the Asset Purchase Agreement.”
Stein’s office said it welcomed Dogwood’s transparency regarding the independent monitor’s findings.
“Dogwood’s letter and the Independent Monitor’s report each highlight potential areas of noncompliance that are consistent with the serious concerns that led our office to sue HCA last year,” Stein spokeswoman Nazneen Ahmed said in a statement. “We appreciate Dogwood’s transparency with the people of western North Carolina and our office, and we’ll continue our fight to ensure HCA delivers on its promise of quality health care.”
The independent monitor’s work includes holding community meetings and issuing an annual update about compliance. For the past two years, the previous independent monitor, Gibbins Advisors, found HCA in compliance at Mission Hospital, as detailed in annual reports posted on Dogwood’s website.
There were two instances of potential noncompliance within Mission Health System in 2021: One related to services at Highlands Cashiers Hospital, and the other regarding the SafeKids program, which had been overseen by Mission and is now part of the Mountain Area Health Education Center (MAHEC).
The most recent potential noncompliance finding represents yet another dilemma for HCA, which has faced mounting lawsuits, an exodus of staff and heightened scrutiny from federal authorities since it purchased the previously nonprofit Mission Health System for $1.5 billion in 2019.
Late last year, the Centers for Medicare and Medicaid Services declared that conditions at Mission Hospital put patients in “immediate jeopardy,” which temporarily put the facility at risk of losing its Medicare and Medicaid funding. The designation was lifted in June, but a lengthy report by state investigators revealed the details of multiple patient safety issues, including delayed treatment and understaffing, that in some cases led to patient deaths.
HCA also faces a lawsuit from Stein, who is the Democratic nominee for governor. On Monday, Stein’s office urged state health officials to deny Mission Hospital’s bid to add 26 more beds to the Asheville facility, citing the need for increased competition in the region and the recent spate of complaints against HCA.
Susan Mims, Dogwood’s CEO, said during a call with reporters Tuesday that the foundation is working to provide Western North Carolinians with greater transparency about the oversight process.
“We have heard from the attorney general and from the communities that people want more education of the process … as well as more transparency in our work. And that is really why we are making this information available much earlier in the process,” Mims said.
The previous independent monitor had emphasized that it was limited in its ability to conduct oversight of HCA since the asset purchase agreement did not specifically mention quality of care. Gerald Coyne, managing director of state monitoring services at Affiliated Monitors, told reporters Tuesday that the “immediate jeopardy” finding by CMS made it easier to address quality of care issues.
“Quality does come under the provision of the Medicare and Medicaid requirement, even though it's not independently mentioned in the agreement itself,” Coyne said. “And that was made clear candidly at every meeting that we hosted.”
Dogwood or the attorney general’s office is required to notify HCA of any potential compliance issues by October 27, the foundation said. Discussions on addressing the issues will follow, and Dogwood is expected to share a summary in early 2025 of how the issues were addressed.
Mims told reporters that if discussions with HCA are ultimately unsuccessful, the foundation can ask the courts to order HCA to comply with the purchase agreement.
“If the parties are unable to come to a resolution, then Dogwood has the right to move toward resolution through the courts,” she said.
