Concerns go unanswered during HCA monitor meeting

from Smoky Mountain News | April 14, 2021

Opinion

BY JESSI STONE NEWS EDITOR

The public had a lot of questions during an April 7 virtual meeting regarding Mission Health’s services and operations since being bought by for-profit HCA Healthcare in 2019. Unfortunately, Gibbins Advisors — the independent monitor hired to ensure HCA fulfills its contractual obligations — couldn’t provide them with many answers.

While the team of healthcare experts and accountants with Gibbins Advisors say they are continuously monitoring HCA operations at Mission-affiliated hospitals in Western North Carolina, their contractual scope is limited to the 15 commitments outlined in the purchase agreement between Mission and HCA, which was ultimately signed off on by Attorney General Josh Stein.

Those commitments can be broken down into four main categories — retention of services and hospitals, investments in community health and wellbeing, investment in facilities and other commitments. HCA now owns five hospitals in WNC besides the main Mission Hospital campus in Asheville — Angel Medical Center in Franklin, Blue Ridge Regional Hospital, Highlands-Cashiers Hospital, Mission Hospital in McDowell County and Transylvania Regional Hospital.

The only service commitments HCA made for Angel Medical and Highlands-Cashiers were to maintain emergency services, surgical services and acute medicine services. HCA also agreed to maintain Eckerd Living Center in Highlands-Cashiers. As far as facilities, HCA committed to building a new replacement hospital for Angel, build a new 120-bed behavioral health hospital in Asheville within five years of obtaining the necessary permits, complete the Mission Hospital North Tower in Asheville and spend $232 million in general capital expenditures within five years.

HCA has to provide an annual report and capital expenditure report to Gibbins every year that summarizes compliance under their purchase agreement. Gibbins reviews the reports, analyzes the supporting documentation and evidence, collects input from stakeholders and the public and completes a compliance checklist before releasing its own compliance evaluation report. The last annual report was released in July 2020, and Gibbins is now in the process of reviewing HCA’s reports for 2020. The next annual report will be released sometime in August. To see HCA documents and more information about the 15 commitments, visit www.independentmonitormhs.com.

Ronald Winters with Gibbins said during the April 7 meeting that HCA had no compliance issues in last year’s report.

Despite that fact, members of the public had many questions and concerns about Mission’s practices under HCA ownership. People had questions about the charity care policy under HCA. In the purchase agreement, HCA committed to maintain the agreed upon uninsured and charity care policy for 10 years.

When purchasing Mission, HCA committed to offering a more expansive charity care policy compared to what Mission had in place, which seemed like a good thing at the time. However, now people are expressing confusion over the policy.

One person at the virtual meeting claimed that HCA was requiring people to pay costs upfront even though they had applied for — and would likely get approved for — charity care services. If the person can’t pay upfront, their surgery or other services would be canceled.

“The HCA policy is better than Mission’s was, but the new policy is not well understood by the community,” said Tom Urban with Gibbins.

“As I read the policy last year, if patients couldn’t qualify for charity care immediately, HCA had the ability to ask you to pay immediately until you get qualified, which can take some time,” Winters added. “It’s difficult to qualify immediately for charity care and they have the right to ask you for a deposit and you don’t have the right to get it back.”

People also asked questions about physician retention at Mission hospitals, claiming that doctors are leaving the hospitals at alarming rates. Fewer primary physicians, specialists and surgeons makes it more difficult to schedule a procedure or get an appointment at one of the satellite facilities throughout the region.

Winters said HCA made a commitment to maintain certain services, but nothing in the agreement says anything about the number of physicians HCA must maintain.

“If departures impact services, that is something we will keep an eye on and inquire of HCA,” he said. “Surgeons leaving would impact the ability to provide surgery services. We will follow up with HCA about it. I hadn’t heard of that issue at Angel Medical until now.”

People also shared stories of changes to important vital community services, My Care clinics shutting down forcing them to find a new primary care physician, eight-hour ER wait times, unclean facilities, and processes in working with patients with dementia and Alzheimer’s Disease.

Gibbins Advisors assured people that every complaint would be documented and shared with HCA whether the complaint specifically fell into one of the commitment areas or not.

To share your feedback and concerns regarding Mission Health hospitals, email independentmonitor@gibbinsadvisors.com. To send feedback to HCA, email contactmission@hcahealthcare.com.

The Smoky Mountain News will dive deeper into some of these issues in the coming weeks.

Signups slow for vaccine appointments

Vaccination by the numbers

March 15 April 12

Partial/Full vaccination Percent population Partial/full vaccination Percent population

Haywood.......12,389/8,993................19.9/14.4...............16,856/13,294...........27/21.3 Jackson ........8,983/3,620..................20.4/8.2.................11,879/10,172...........27/23.2 Swain............2,752/1,467..................19.3/10.3...............3,365/2,611...............23.6/18.3 Macon...........8,679/5,378..................24.2/15..................11,690/10,682...........32.6/29.8 EBCI..............4,560/3,305..................30.4/22.3...............5,867/4,354...............34.2/30.0 Statewide .....2,047,269/1,288,094...19.5/12.3...............3,399,410/2,472,865.32.4/23.6

Tribal dose numbers from EBCI represent all doses given, while percent population figure reflects only doses given to tribal members. All other dose numbers from NCDHHS. Data may be subject to a 72-hour reporting lag and come from the COVID-19 Vaccine Management System. Population figures based on 2019 U.S. Census Bureau estimates, excepting tribal figures, which are from the EBCI.

BY HOLLY KAYS STAFF WRITER

After months of working breakneck speed to clear an ever-expanding backlog of people waiting to receive a COVID-19 vaccine, local health departments are reporting a marked slowdown in signups, even though only about 30 percent of the population has received at least one shot.

“Demand for COVID-19 vaccine has declined drastically over the past few weeks,” said Swain County Health Department Director Alison Cochran.

Slowing vaccine demand comes as cases increase somewhat. On April 9, 2,509 new cases were reported in North Carolina, marking the first time daily new cases surpassed 2,500 since Feb. 27. Between April 6 and April 12, the number of hospitalizations statewide surpassed 1,000, the first time the metric had hit four figures since March 16 — though still far below the peak of 3,992 Jan. 13.

Jackson County Deputy Health Director Melissa McKnight agreed that vaccine supply is currently outpacing appointment demand, while Haywood County Emergency Management Team Public Information Officer Allison Richmond said Haywood County expects to clear its backlog of registrations this week and will transition to a selfbooking appointment system.

This slowdown in demand comes on the heels of an exceptionally bad couple weeks for the single-dose Johnson & Johnson vaccine. A March 31 story from The New York Times revealed that up to 15 million doses of the vaccine had been contaminated after workers at a Baltimore plant, causing significant delay in future shipments of the vaccine. On April 12, Richmond said North Carolina was not expecting to receive any more J&J shipments until at least May.

Then, on April 13, even worse news came. In a joint statement, the U.S. Centers for Disease Control and U.S. Food and Drug Administration announced that it was recommending a pause in J&J vaccine distribution after six cases of a rare and severe blood clot called cerebral venous sinus thrombosis in combination with low blood platelet levels were reported. All six cases occurred in women between the ages of 18 and 48, with symptoms occurring six to 13 days after receiving the vaccine. People who develop a severe headache, abdominal pain, leg pain or shortness of breath within three weeks of receiving the J&J vaccine should contact their health care provider.

The CDC’s Advisory Committee on Immunization Practices will meet April 14 to review the cases and assess their significance, and the FDA will review that analysis. The recommendation to pause J&J administration will remain in effect at least until that process is finished.

Locally, no vaccine distributors have reported severe adverse reactions, and with 6.8 million doses of the J&J vaccine already administered in the United States, reactions like the one currently under investigation are extremely rare.

The pause will have a big impact on Jackson County’s vaccination efforts this week, as the health department’s allotment for April 11-17 consisted solely of J&J vaccines. Jackson County has cancelled a J&J vaccination clinic planned for April 15.

Many other vaccine providers will remain unaffected, as they had been receiving mainly Moderna doses. Haywood County and Haywood Regional Medical Center expect to receive a combined 1,200 Moderna doses this week. Swain County will receive 100 Moderna doses and Blue Ridge Health will receive 100 doses apiece for its Haywood and Jackson clinics, all Moderna. Harris Regional and Swain Community Hospital will receive a combined 100 Moderna doses.

Other major vaccine providers in the area include the Eastern Band of Cherokee Indians, Western Carolina University, Walgreen’s and the Western North Carolina VA Health Care System. So far, the VA — which includes community clinics in Franklin, Hickory and Rutherford County in addition to its main facility in Asheville — has administered 12,496 first doses and 9,712 second doses. WCU administered its 10,000th vaccine on April 7. The EBCI has given 5,867 people at least one shot and has fully vaccinated 4,354 people. Walgreen’s is not providing local or state vaccine data.