Fair care?

When the dedicated Ladies of the Mission Flower founded what would become today’s Mission Health System more than a century ago, they didn’t have to worry about complying with a certificate of public advantage. And at an Oct. 20 public hearing at the Western North Carolina Agricultural Center, Mission Health President and CEO Ron Paulus told state lawmakers that the health system shouldn't have to, either.

"To move forward, Mission must have the freedom to serve our region," Paulus told the 11 members of the N.C. House Select Committee on Certificate of Need Process and Related Hospital Issues and an audience of several hundred.

Mission became subject to the certificate of public advantage (which exempts it from antitrust laws) as part of its 1995 merger with St. Joseph's Hospital. Since then, however, larger systems have absorbed many local care providers, drasti cally altering the health-care landscape.

And while Mission Health officials say they’ve fully complied with the COPA, Paulus asserted that continuing to operate under its “restrictions on physician alignment, limits on cost and operating margin, significant reporting requirement and others place Mission at a very significant — and, over time, potentially fatal — disadvantage.”

Rescinding the COPA, he maintained, would enable Mission Health System to compete on a level playing field with other big regional care providers, such as Adventist Health System (which numbers Park Ridge Health in Hendersonville among its 43 campuses) and Carolinas HealthCare System (whose affiliates include three MedWest hospitals in WNC).

“Bottom line,” continued Paulus, “it means letting patients and physicians choose where to go, who to align with, and letting performance on quality, efficiency and service determine the winners and losers, not the government.”

Established Aug. 24, the select committee is at the center of a power struggle between competing care providers (see sidebar, “Who’s Who”).

Mission, said Paulus, is the only N.C. hospital subject to a COPA. And according to Mission attorney Richard Vinroot, it’s one of only three U.S. hospitals operating under such an antitrust agreement. "Times have changed," he asserted, adding, "I think the time has come for us to think about phasing out this COPA as well."

But representatives of other local hospitals — many of them allied with competing health-care groups — argued strenuously against the move, warning that it would lead to Mission’s further monopolizing health care in WNC.

“A benevolent dictator is a dictator nonetheless,” declared Graham Fields of Park Ridge Health. "Should any of us be surprised a monopoly should ask for anything short of everything?"

Gail Cummings, regional administrator for 21st Century Oncology, said the endoscopy center Mission wants to establish near Park Ridge in partnership with Henderson County's Pardee Hospital would draw cancer patients from outside Mission’s service area, making them drive longer distances. "Health care is local and should remain this way," she proclaimed, arguing that the new cancer center could not survive without siphoning off patients from other care providers. Dr. Nathan Williams of Hope Women's Cancer Centers made a similar argument, calling Mission's way of creating partnerships a "carrot-and-stick approach."

21st Century Oncology operates more than 80 facilities in 16 states; Hope is a small practice with locations in Asheville and Kingsport, Tenn. Williams, Park Ridge and 21st Century Oncology are all affiliated with the WNC Community Healthcare Initiative, formed earlier this year when its members called on Gov. Bev Perdue and other state officials to review the COPA and what they called Mission's "predatory practices."

The committee also heard often passionate public comment from patients, doctors and other medical professionals.

"If my family needed services that my hospital in Henderson County couldn't provide, then we could always go to Mission,” Renee Johnson told the committee. “But I like to have choices. I like Wal-Mart because of the enormous selection and prices, but I wouldn't want to shop there every day."

Asheville resident Aimee McNeil, on the other hand, praised Mission, saying the hospital should be allowed to continue providing the same quality of care she received when she was diagnosed with leukemia at age 9.

And Mission Chief of Staff William Hathaway made an impassioned speech arguing that in this whole dispute, business concerns are overshadowing patients’ needs. Still wearing his green scrubs and white coat, Hathaway said key words such as “patient” and “collaboration” have been replaced by the words “business,” “monopoly” and “competition.”

“As much as I appreciate your efforts as legislators, I don't want you deciding how we provide care in Western North Carolina,” he continued. “I want the patients at Park Ridge to get good care. I want the patients at Mission Hospital to get good care. I want patients in Murphy getting good care. That is the single most important thing that we can do together, and for us to waste time and energy having these ladies and these gentlemen make decisions that affect our lives is distressing," said Hathaway, choking up. "We've got to get our act together, each and every one of us, to work together to solve these problems. It's time — it's time to do it together."

— Send your health-and-wellness news to Caitlin Byrd at mxhealth@mountainx.com or news@mountainx.com.