From CPP: Feds say HCA ‘immediate jeopardy’ removed. Why troubled Mission can point to top rankings.

by Grace Vitaglione, Carolina Public Press
February 28, 2024

HCA Healthcare-owned Mission Hospital is no longer in danger of losing federal funding after regulators determined the conditions of immediate jeopardy were removed, a Centers for Medicare and Medicaid Services spokesperson confirmed.

CMS surveyors revisited the facility Feb. 23, and regulators are compiling and reviewing that information, the spokesperson said in a Feb. 28 email to Carolina Public Press. Although CMS lifted the immediate jeopardy status, the hospital now has 90 days “to complete the specific corrective actions and achieve compliance with the regulations,” the spokesperson said.

Regulators found violations at the Asheville hospital that posed “immediate jeopardy” to patients’ health and safety during a survey from Nov. 13 to Dec. 9, 2023. HCA had to rectify those issues by Feb. 24 or possibly lose federal funding, according to the letter CMS sent Feb. 1 to Mission Hospital CEO Chad Patrick.

HCA’s plan of correction to fix the violations was made public in a CMS report Feb. 15, yet advocates said it failed to address staffing shortages. In a Facebook comment on CPP’s story, a user named Cathy Kiser Ray wrote that Mission Hospital is ranked in the top 50 of the nation. Her Facebook profile lists her occupation as Market Director of Physician and Provider Relations at Mission Health.

Asheville Watchdog recently reported on the ranking, citing a draft report from Mark Hall, director of the health law and policy program at Wake Forest University, on why the rankings don’t tell the whole story.

The violations at Mission Hospital didn’t factor into Healthgrades’ list because the data to determine the ranking doesn’t include emergency room visits, while ED care was the focus of the deficiencies, said Healthgrades Chief Medical Officer Brad Bowman in a Feb. 27 email to CPP.

Healthgrades uses medical complications and patient deaths to compile ratings, Bowman wrote. Even if a patient dies in the emergency room, that isn’t taken into account, according to Bowman.

Hospitals don’t pay for the ratings, but they do need a “licensing agreement” to promote achievements and awards, Bowman wrote.

Hospitals from Duke Health and UNC Health systems didn’t make it onto the Healthgrades top 50 list, despite receiving high rankings from other entities.

To make it onto Healthgrades’ list of 50 best hospitals in the U.S., facilities must rank in the top 5% in “at least 21 of 31 conditions and procedures for at least 7 consecutive years. Mission Hospital was the only hospital in North Carolina to meet this criteria in 2024,” Bowman wrote.

Alan Wolf, director of news and media relations at UNC Health, said the organization wasn’t told why they specifically don’t appear on Healthgrades’ list, but that UNC Hospitals in Chapel Hill is expected to be among Business North Carolina’s top three hospitals in the state when the outlet releases their rankings later this week.

Behind Mission Hospital rankings

Mission Hospital also still ranks highly in part because Healthgrades doesn’t take patient views of their care into account, according to Hall’s working report, as those surveys put Mission near the bottom.

Hall told CPP on Feb. 27 that hospital rankings have proliferated and because so many exist, hospitals can more easily do well on at least one. Across various rankings, potential for skewed reporting exists, he said.

His report pointed to federal government data on “timely and effective care” that various rankings agencies use, which includes the percent of patients who leave the emergency room without being seen.

The statewide average is 4%, and prior to HCA’s acquisition, Mission Hospital tended to land around that level, he wrote. But after 2019, Mission Hospital has reported 0% of patients leaving the emergency room without being seen, despite complaints of long wait times and delayed care in the emergency room, he wrote.

That disparity may be due to how HCA defines “seeing” patients, as HCA may classify a cursory triage or screening of a patient as “being seen” as opposed to a full examination, Hall wrote.

Pat Merryweather, executive director of Project Patient Care, said many patients use these rankings to help determine where they should seek care, but because the entities all use different methodologies, it can be confusing for patients. Her organization helps patients figure out the data behind the rankings and how to use it in their decision.

To accurately use any ranking, she said patients should look at the timeframe of the data it’s using and what specific indicators were measured. As “a good number” of patients enter the hospital through the emergency room, she said it’s important to take those visits into account – as well as patient experience, which she said can be harder to measure accurately.

The different methodologies and rankings are complicated, but “nobody yet has figured out how to make it less complicated,” she said.

Asheville Watchdog reported that Hall’s work is funded through a grant from philanthropic group Arnold Ventures to Wake Forest University. Arnold Ventures helps fund Fairmark Partners, which takes on antitrust lawsuits against hospitals, and Fairmark attorneys are representing plaintiffs in a Western North Carolina antitrust lawsuit against HCA and Mission Hospital.

This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.