An independent monitor has found HCA Healthcare in potential noncompliance with three sections of the agreement it signed when it purchased Mission Health System in 2019.
The report was sent to the office of the North Carolina attorney general, which has 30 days to decide whether it agrees with the findings.
The latest report by Affiliated Monitors, Inc. covers the 2024 calendar year. It cites issues with the provision of emergency and cancer care at Asheville’s Mission Hospital; HCA’s Uninsured and Charity Care policy; and Mission’s failure to remain “enrolled and in good standing” in Medicare and Medicaid for the duration of the year.
The independent monitor cited the same three issues in its 2023 compliance report. Two of the three issues have since been resolved, the monitor said in the report released Tuesday.
The report comes amid continued scrutiny of HCA’s ownership of Mission, with critics arguing that the hospital giant has overseen a decline in quality of care amid an exodus of staff and multiple legal battles.
The full report is available online here.
“This review process can be confusing at times,” Dogwood Health Trust general counsel Rachel Ryan said in a statement. “The Asset Purchase Agreement guides our monitoring and assessment process, directing us to conduct an annual review of HCA’s compliance with the APA for the previous year. At the same time, we know the community is interested in sharing their experiences that happen in real time, and that is why engaging with the Independent Monitor is so very important.”
HCA spokesperson Nancy Lindell said Mission Health remains “confident in our compliance with the terms of the Asset Purchase Agreement.”
“As noted in the report, CMS accepted our corrective action plan more than a year ago and we were found to have zero deficiencies at the conclusion of another survey in June,” Lindell said. “The report mentions again our improvements to Mission Health’s charity care policy. Since joining HCA Healthcare, Mission Health has not engaged in litigation against patients over unpaid medical bills, including filing liens. Mission Health remains committed to serving the community of Western North Carolina and providing the quality healthcare that our patients deserve.”
The Dogwood Health Trust foundation was created when HCA purchased Mission in 2019. The foundation has a responsibility to ensure that HCA fulfills the 15 commitments it made as part of the deal. As part of that work, Dogwood hires an independent monitor, who produces an annual report on HCA’s compliance.
Affiliated Monitors, Inc., was selected for the job last year, succeeding the previous independent monitor, Gibbins Advisors.
In its report Tuesday, Affiliated Monitors said HCA resolved the issues related to Mission’s standing with the federal Centers for Medicare and Medicaid Services and its Uninsured and Charity Care policy.
In late 2023, CMS said that conditions at Mission Hospital put patients in “immediate jeopardy,” the most serious designation a hospital can receive. A 384-page report by CMS last year detailed numerous safety issues at Mission, including understaffing and delayed treatment, that inspectors say led to patient deaths in some cases.
HCA detailed its plans for addressing the issues, and the designation was later lifted.
“Based upon its compliance with the approved Corrective Action Plan and the results of subsequent follow-up surveys, we find that the deficiencies that resulted in the Emergency Department of Mission Hospital being recommended as probably non-compliant with CMS standards have been satisfactorily resolved,” the independent monitor said in its latest report.
The monitor also said HCA made changes to its Charity Care policy related to the placement of liens for medical debt, as well as other changes mandated by North Carolina’s Healthcare Access and Stabilization Program.
“Although the revisions to the ‘Charity Financial Assistance Policy for Uninsured and Underinsured’ did not become effective until January 1, 2025, the concerns we expressed have been addressed, and we recommend that no further action be initiated based upon that finding,” the monitor said.
The one remaining issue is the quality of Emergency and Oncology Services at Mission. The state filed a lawsuit over that matter in 2023, and the litigation is ongoing. The state accuses HCA of inadequate staffing at Mission, leading to long wait times and subpar care; HCA counters that it has not breached its contract because it has not discontinued emergency or oncology services.
