Local control makes a difference, and a bill proposed by state Rep. Jim Davis could take it away, says Angel Medical Center CEO Tim Hubbs. The Franklin hospital is close to signing an affiliation agreement with the Asheville-based Mission Health System, but Davis’ bill (which has been referred to the Committee on Rules and Operations) would bring the talks to a standstill. Specifically targeting Mission, it calls for a moratorium on the system’s partnerships and acquisitions (see “The COPA Debate,” May 4 Xpress).
“Mission’s expansion into other geographical areas [outside Asheville] may put other providers at a disadvantage,” says Davis. Citing a February study that raised concerns about the economic impact of the 1995 agreement that allowed Mission to merge with St. Joseph’s Hospital, as well as concerns voiced by other hospitals and practitioners feeling pressured to partner with Mission, Davis says, “We need to maintain competition.” He adds that his bill aims to start a dialogue and provide time to study the issue.
Hubbs counters, “I don’t believe Rep. Davis has bad intentions, but I think he has bad information.” Noting the financial and other challenges small hospitals face, he says, “We need a partner.”
Angel wants that partner to be Mission, though Hubbs notes that at least two other major hospital systems are active in Western North Carolina — the Charlotte-based Carolinas HealthCare System and the Adventist Health System, based in Winter Park, Fla.
Founded in 1923 by Dr. Furman Angel, the downtown-Franklin facilityAngel Medical focuses on primary care: delivering babies and performing minor surgeries. The 80-bed hospital is Macon County’s biggest employer, as Mission is in Buncombe. “Some people get it into their heads that small hospitals are insignificant, but they’re not,” notes Hubbs.
Still, like many community hospitals, Angel Medical isn’t equipped (and can’t afford) to provide complex, high-dollar services such as heart transplants. By linking with Mission, the Franklin facility shares the bigger system’s in-house expertise and greater purchasing power when buying supplies, medical services, insurance and equipment. The pending Mission/Angel deal “is not about the big guys getting bigger: It’s about collaboration and partnership,” says Hubbs. Angel, he emphasizes, has informally partnered with Mission in the past, and it’s a better fit for his hospital.
Adventist Health is a multistate, 7,700-bed organization run by the Seventh-day Adventist Church; its local affiliate is Park Ridge Health in Fletcher. “I respect their religion, but that’s not the best for our community,” says Hubbs. Neither is Carolinas Health, whose 6,300 beds include the MedWest Health System facilities in Sylva, Bryson City and Waynesville, he notes.
“It’s not that [Adventist or Carolinas] are bad, but Mission’s been affiliated with us for years,” Hubbs explains. And the Asheville campus is closer: a little more than an hour away.
“We want local input, local control, over our mission and the services we provide. But we also want the help” that a bigger hospital can offer. “We need to team up,” says Hubbs, remarking that Angel Medical is “coming late” to a national trend toward consolidation in the health industry.
Does he anticipate being bought by Mission, which already owns two other small WNC hospitals (Blue Ridge Regional Hospital in Spruce Pine and McDowell Hospital in Marion)? “We’re not ready to say yes or no to Mission owning us,” says Hubbs. But the current talks are “kind of like dating before getting married.”
Davis maintains that Mission has a monopoly in the area, but according to Hubbs, “Mission becomes a small player when you look at the other health systems. The [Davis] bill … puts Mission at a disadvantage.” The Asheville-based system has less than 1,000 beds, including its two affiliate hospitals.
Davis’ bill would also severely limit how many local doctors can work for Mission. The 1995 agreement capped it at 20 percent; Davis’ bill would slash that to 10 percent. Yet the same study Davis cites to support his bill recommends doing away with the restriction entirely.
“I don’t know why that is in there,” says Hubbs. The lower cap, he argues, would give Carolinas and Adventist, which face no such limit, an advantage. “That’s not fair,” he says.
Hubbs also cites another challenge. “The big issue for physicians is that, by the time they get through medical school and residency, they’re in their mid-30s and heavily in debt.” At that point, rather than attempting to set up a practice, buy or rent a building, manage employees, navigate insurance laws and other things, “A lot of young doctors — and even the older ones — just want to do medicine and not the administrative stuff,” says Hubbs. That makes Mission attractive.
Meanwhile, for Angel, it’s also about the local economy. Says Hubbs, “We need to keep as much money in our community as we can.”
— Margaret Williams can be reached at 251-1333, ext. 152, or at firstname.lastname@example.org.