For three hours on the evening of Oct. 20, a litany of area residents, doctors, health-care professionals and a few patients spoke out about competition and choice, giving a state legislative committee plenty to think about. The general topic was health-care needs in North Carolina, but there’s no mistaking that the main item on the agenda was Mission Health System. Is it too big? Are its competitors getting a fair shake? Is Mission? Are patients?
The answers depended on your point of view.
The evening’s meeting was one of several being held by the recently convened North Carolina House Select Committee on Certificate of Need and Related Hospital Issues. Held at the Western North Carolina Agricultural Center, the committee meeting featured presentations by Mission Health System, Park Ridge Health and the WNC Community Healthcare Initiative (which includes Park Ridge, 21st Century Oncology and HOPE Cancer Center physician Dr. Nathan Williams).
At issue: the 1995 agreement that allowed Mission and St. Joseph’s Hospital to merge. Park Ridge and WNC CHI say that agreement — a Certificate of Public Advantage — turned Mission into a monopoly that has been aggressively expanding and pressuring doctors, medical practices and small hospitals to partner with it. Mission counters that it has honored all aspects of the COPA, which is monitored by the state and is meant to “mimic competition,” an economist told committee members.
Mission wants the COPA to be modified and possibly ended (Mission is one of just three hospitals in the country operating under such an anti-trust agreement; the two other ones are either inactive or have been allowed to sunset).
Park Ridge and WNC CHI want the COPA rules tightened, saying that Mission has grown too large. They point to a county-line project spearheaded by Mission that seeks to partner with Henderson County’s Pardee Hospital and place a new endoscopy center just a few miles from Park Ridge. Dr. Nathan Williams of the cancer-treatment group, the Hope Center, accuses Mission of trying to force his affiliation or shut him down (Mission is building a new cancer center).
Mission counters that in the realities of the modern health-care industries, small hospitals must partner with larger ones to survive, and in their view, Mission is the smaller entity operating in WNC (Park Ridge, a faith-based provider that has a 100-year history in WNC and just about 100 beds at its Fletcher location, is affiliated with Adventist Health, a 44-hospital system; three MedWest hospitals are affiliated with Carolinas Healthcare, a two-state system that includes about 30 hospitals; Mission, which either owns or is affiliated with such small hospitals as Angel in Franklin, has about 1,100 total beds — about a quarter the number of either of the larger systems).
Many speakers noted that they appreciate Mission but are worried about the potential lack of choice. Some decried what one woman called Mission’s “Pac Man” expansion practices. Others lauded Mission’s pediatric care.
But Mission’s Chief of Staff, Dr. William Hathaway, called on all sides to end the quarreling about competition and expansion and get back to focusing on patient care. A cardiologist, Hathaway noted that all the hospitals in WNC can offer good care. “But there’s been little talk of patient care [here tonight], and that’s distressing.” He told committee members — and only a handful of the 11-member group was present — that he didn’t want the state telling him or any hospital how to provide care.
Committee member Rep. Jeff Collins said he didn’t want the state doing that, either. But finding a way to make sure Mission feels it can compete fairly, Park Ridge doesn’t feel threatened, practices like Dr. Williams’ don’t feel pressured, and patients get good care … “It’s a dilemma,” he acknowledged.
Several hundred people attended the hearing. The 11-member committee is comprised of eight Republicans and three Democrats. There are no Buncombe County representatives on the House committee, but Rep. Ray Rapp (Democrat) of Mars Hill attended.
Stay tuned for a report in the Oct. 26 issue of Mounntain Xpress.