What's Changed Since HCA's Takeover of Mission Health?

Medical professionals and local leaders discussed their views on the state of healthcare in western North Carolina and what may be done to improve it during a panel at the Take Medicine Back virtual summit last week.

Specifically, panelists focused on for-profit HCA Healthcare's $1.5 billion acquisition of nonprofit Mission Health, based in Asheville, North Carolina, in 2019. The deal has not been without scrutiny, including reports of declines in service and a number of physician departures.

Overall, Thursday's event focused on doctors "losing their profession to corporatization," leading to possible moral injury and patient harm, according to Take Medicine Back, an organization aimed at helping to address the issue. The panel on healthcare in western North Carolina centered on some of the same themes.

Barbara Durr, a reporter with Asheville Watchdog, moderated the panel, and began by stating that, following HCA's takeover of Mission Health, costs have been cut to increase profits. She added that many physicians and nurses have departed the system in the wake of the deal -- as have entire medical practices -- and that primary care services have been cut.

Karen Sanders, RN, an Asheville-based patient advocate who spoke on the panel said that most of the patients she interacts with are from Mission Health. The most common issues that patients report are call bells going unanswered, having difficulties being transferred to highly-rated rehabilitation centers of their choice, and obtaining medical records, itemized bills, and cost estimates of services mandated by the federal government to be posted on hospital websites.

"Now, at almost every turn, it's profits over patients," said North Carolina Treasurer Dale Folwell (R) in opening remarks for the event. In particular, Folwell pointed to a recent report from his office that found North Carolina nonprofit hospital executives had made over $1.75 billion since 2010.

Another panelist, North Carolina State Sen. Julie Mayfield (D), who represents Buncombe county in the western part of the state, highlighted proposed legislation she co-sponsored that she said would "vastly expand" the authority of the state attorney general when it comes to reviewing healthcare transactions over $5 million.

Introduced and now under committee review, North Carolina Senate Bill 16 would give the state attorney general power to examine the potential impact of a transaction in regard to cost, availability, accessibility, and quality of care, Mayfield said. "If the attorney general determines that the deal would have a negative impact on any of those four things ... the attorney general can take action to stop the transaction."

Ben Aiken, MD, a family physician and founder of the direct primary care practice Lantern Health in Asheville, has remained a proponent of changing the way that healthcare is delivered, he said during the panel.

Aiken said he launched the direct primary care practice he now operates independently as a pilot with Mission Health in 2018, shortly before its acquisition by HCA was announced. However, he was then one of the first physicians to transition a practice out of the system in the wake of the deal, he said.

In contrast to a traditional fee-for-service model, "in direct primary care, you replace that by a monthly fee. So, it becomes much like a gym membership, where you pay a monthly fee and for that monthly fee you get unlimited access to your doctor or your care team as well as access to various other things," Aiken said.

"So, the incentive is actually flipped," Aiken said. "And at the core of direct primary care, I think that's the foundational value in the sense that my incentive is to keep people as healthy as possible. In my previous model, in previous practice, the sicker someone was, the better I did."

"Now, if somebody in my panel is extremely sick, and they come and see me every week, and that happened with all of my patients, the model would break," he said, adding that, "the incentive is for me to keep people as healthy as possible."

Some people may say, "'Well, hey, you know if that's the case, why don't you just avoid seeing somebody altogether? If they don't come at all? Wouldn't that be ideal?'" Aiken acknowledged.

However, "[the] counter incentive there is really that, if somebody doesn't like their experience with me, because their ability to see me is not tied to their insurance company, they can simply fire me," he said. "So, the incentive is for me to deliver an excellent experience, and really to kind of change the experience of what somebody has from a primary care perspective."

For its part, Mission Health pushed back on some of the claims made during last Thursday's panel.

Nancy Lindell, an HCA spokesperson for its North Carolina division, said in a statement that Mission Health has "roughly the same number of physicians today as we have had in previous years and more staff overall than this same time last year," and that it continues to "recruit and hire nurses despite the challenges of a national nursing shortage."

"Mission Health is recognized as a Healthgrades 50 Best Hospital, and we are grateful for our many caregivers who provide exceptional care to our communities every day," the statement continued. "Additionally, we are proud of the investments we have made to expand access and improve healthcare in Western North Carolina, including more than $20 million in salary increases for our direct patient care staff."

According to Mission Health's website, there are pricing estimates as well as resources to request billing information and medical records available for patients.

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