Mission’s independent monitor lays out its plan

Representatives from Gibbons Advisors – the Independent Monitor of the HCA/Mission Health System – got an earful last week at public meetings in Cashiers, Highlands and Franklin.
Citizens irate about decreasing or lack of services at area clinics and on hospital campuses had a lot to say and questions to ask Gibbons Advisors’ representatives Tom Urban and Ron Winters.

Though they were more than willing to listen, the two made it clear from the start that they weren’t there to solve problems, but would listen, take note and pass the questions and complaints onto Hospital Corporation of America (HCA). However, HCA is encouraging people to go directly to their hospital – in Highlands and Cashiers cases that’s CEO/CNO Tom Neal.
In addition, Winters encouraged people to go to their website at IndependentMonitorMHS.com to log complaints or suggestions – even anonymously.

“We won’t be cycling back to you with answers, but we will get the information to HCA,” said Winters.
As per the Asset Purchase Agreement (APA) an independent monitor was to be in the mix to make sure certain undertakings, commitments and obligations HCA made when they obtained Mission Health System are fulfilled.

Participants at the forums had similar complaints – the lack of primary care physicians in Highlands and Cashiers – there is only one in each location;  the one in Cashiers starts in May; the lack of consistent services; the lack of providers; billing; and communication problems.

“We won’t be able to answer a lot of your questions. We are not operating the health system,” said Winters. “We are operating within the bounds of the purchase agreement. One way we find out if there are noncompliance issues is from what is bubbling up from the community. So that’s what we’re here for.”
He said they speak to HCA every other week at the NC regional level, are due reports in April and May and though HCA wants to hear from community members it is encouraging people to speak to the local leadership because they have the machinery and ability to address issues themselves. For Highlands and Cashiers that CEO/CNO Tom Neal.

Gibbons as the Independent Monitor was hired by the seller of the Mission Health System with the consent of NC Attorney General Josh Stein who inserted things into the APA that HCA/Mission has to adhere to. Winters said Mission’s current role is to assure high quality healthcare in WNC and as the seller, they wanted an independent monitor to participate.

Winters said there are 15 commitments outlined in the APA that span four categories.
They must retain services in certain hospitals; invest in community health and well-being; invest in facilities; spend $232 in five years within the system; $25 million in an innovation and investment fund; keep material facilities open for at least 10 years; if closing allow other entities to bid on them; need to continue certain services for 10 years (and can only vary from that with the consent from the advisory committee); build a replacement hospital in Franklin; spend $750,000 a year for 10 years in community contributions; continue a list of certain activities and service programs for at least year; not change the uninsured patient and charity care policy for 10 years; continue to fund graduate medical education at no less than the current levels for 10 years; and continue to operate within the Medicaid and Medicare programs for at least 10 years.
Highlands Cashiers Hospital is one of the material facilities mentioned in the 15 commitments. Specifically, its emergency services, surgical services, acute medical services and the Eckerd Living Center must remain intact for 10 years.

Winters said Gibbons will be advising the six advisory boards [boards whose purview are specific areas/campuses] throughout the process.

“There are some things that can be varied over the 10 years without the boards’ consent, and also some that the advisory boards will have to consent to,” he said. “There are some things they can modify after five years, but only under special conditions. Regarding that, there could be a dispute as to those conditions and that’s when we would get involved.”

At the Highlands meeting, Wednesday, Jan. 29, Mayor Pat Taylor said he was glad to see “boots on the ground and glad Gibbons as the Independent Monitor will be meeting with all the different stakeholders in Mission and HCA

“I am very optimistic.  I and others in the community went to AG Stein about the hospital’s longevity of operation and we wanted a monitor so we were really pleased when he put these stipulations in his approval of the APA,” said Mayor Taylor.  “The fact that we have a monitor makes this a better situation for not only the community but HCA, and the health foundations. Everyone will benefit from having this process in place.”

Mayor Taylor said the charity care promise was an AG stipulation that HCA embraced as well as the commitment to reinvesting and contributing to the community.

“That 10-year commitment is so important, and services and the quality of services will be really critical,” he said. “The charity case and community commitment is very positive, not just for the community but also for HCA. I’m very impressed about the $750,000 a year that HCA will be putting into community services and community activities that we can all benefit from.”

Winters said he didn’t know what the ramifications of noncompliance by HCA will be.

“I believe the contract calls for them to comply; calls for the seller to enforce the compliance and allows the AG to go in and enforce the obligation on behalf of the seller if the seller doesn’t do it,” he said.
Regarding the mention of “surgery continuing” at H-C Hospital, though the surgery unit was shut down about seven years ago, Winters said “surgery” is described in a general way so, colonoscopies would fit in that category.

A retired doctor of 50 years who lives full-time in Highlands said it was critical that HCA do something to bring in providers to generate revenue. Without them there is no reason to have a hospital other than emergency services, he said.

“The ER is great, the hospital facility is great, but it’s a ghost town over there. It’s really sad. It looks like the hospital has abandoned the community, not that the community has abandoned the hospital,” he said.
He said the economic engine of a hospital is the providers. Without the providers there aren’t patients.
“The hospital can’t exist off revenues from Medicare and Medicaid. It has to have some private pay and some commercial insurance,” he said. “Right now, the economic engine at the hospital is running on two cylinders — it’s sputtering. If you don’t offer the services provided by the providers, it’s going to be a self-fulling process that the hospital will die and dwindle. If people go to Gainesville and Greenville for services, it will be because there are no providers.”

He said he hopes HCA can do something to bring in some providers and it’s clear they are going to have to supplement the incomes to get young doctors to come and stay. He suggested pushing the quality of life aspect and understand that for years the income of young doctors will have to be supplemented until they get their patient-base built up.

“That’s the only way we are going to get anything at the hospital,” he said.
Mayor Taylor suggested forming a nonprofit healthcare hub to partner with HCA to populate the current Doctor Desert.

“Maybe form a partnership with our H-C Health Foundation, the Dogwood Health Foundation, and community leadership with HCA where we bring in a nonprofit organization that can address the issue of doctor shortages. Maybe the Jane Woodruff building could be the location for that type of operation. This is a great opportunity for us to advance through partnerships, not just with HCA but with all the different stakeholders and all the different groups. In the long run, if we can form these cooperative relationships it will be a positive outcome for HCA and the entire community.”

Winters asked people to go to IndependentMonitorMHS.com to log complaints or suggestions.

By Kim Lewicki, Highlands Newspaper

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