HCA’s independent monitor faces tense public meeting

Ronald Winters, CEO of the independent monitor for HCA Healthcare, faced an unhappy crowd at a community meeting Oct. 19.

Current and former physicians, nurses and patients from Mission Hospital implored Gibbins Advisors to monitor the health care system’s quality. Throughout the 90-minute public meeting, Winters repeatedly told the audience that quality of patient care is not one of the 15 obligations the Gibbins Advisors is assigned to measure. HCA made 15 commitments as part of its purchase agreement when it acquired nonprofit Mission Hospital.

HCA, a Nashville-based for-profit health care system, bought Mission Hospital for $1.5 billion in 2019. Gibbins Advisors, a Nashville-based health care operations and restructuring consultancy, was hired by Dogwood Health Trust, a nonprofit that was created as part of the sale. According to Carolina Public Press, Attorney General Josh Stein selected Gibbins Advisors as the independent monitor.

HCA’s management of Mission Health has drawn scrutiny since the sale. Nurses have expressed alarm about what they say are unsafe nurse-to-patient ratios, and patients have complained about longer wait times and surprise fees.

During the meeting, Dr. Robert Kline, a former member of Mission Hospital’s board of directors, read a letter aloud addressed to Winters that was signed by dozens of current and former physicians. (Fifty-nine physicians, both open signers and anonymous, have added their names to the letter as of Oct. 25.)

“Many of the for-profit driven changes that HCA has wrought, despite advocacy and protests from multiple sectors, have gutted the heart and soul of our community health care system,” the letter said. “The relationships and deep personal investment that historically mattered to staff across the board have been stifled. Emblematic of this is the loss of over 200 physicians and countless health care staff who have left Mission and/or the medical community since the sale.” Read the entire letter here: avl.mx/d4g.

State Sen. Julie Mayfield, D-Buncombe; Susan Mims, CEO of Dogwood Health Trust; and Holly Jones from the N.C. Department of Justice Office of the Attorney General also attended the meeting.

Helpful or hopeless?

Winters outlined the 15 commitments HCA made that Gibbins Advisors can monitor, such as participating in Medicaid and Medicare programs for at least 10 years and keeping “material facilities” open for at least 10 years. [Available here: avl.mx/d1o] He emphasized Gibbins’ role isn’t to oversee billing or how HCA runs the hospital and noted each table in the room had fliers listing public resources (avl.mx/d4e) to help with those concerns, such as the Mission Health System Quality Office, an agency to report concerns about patient experience.

Following the presentation, Winter fielded questions from the audience who had gathered in a meeting space at The Scenic Hotel in South Asheville. He frequently said he didn’t know the answer or that the topic of the question was beyond the independent monitor’s purview. One person asked Winters whether a commitment to quality is an “industry standard” among health care systems. Another attendee asked about HCA’s commitment to invest $25 million over five years for an investment and innovation fund and whether any had been invested and in what. In both cases, Winters said he didn’t know.

Nurses request surprise visits

The independent monitor performs site visits at Mission Hospital to assess whether the 15 commitments are being followed. During his presentation, Winters explained that under the purchase agreement, Dogwood Health Trust is entitled to visit each of the hospitals during the 30 days that follow the publication of HCA’s annual reports.

A nurse in attendance asked Winters, “Who participates in those visits, and how do we identify the veracity of the reports?” He responded that Mission Hospital’s president, a chief nursing officer and representatives from Dogwood Health Trust usually attend. Alleging that those site visits aren’t an accurate portrayal, several nurses asked Gibbins Advisors to make surprise visits to Mission Hospital instead of scheduled ones.

Patient safety

Asheville resident John Nicolay told Winters that he and his wife retired to Asheville partially due to the city’s “stellar reputation” for health care. But that hasn’t been fulfilled, he said. “The experience my wife and I have had in the [Mission] emergency room more than once was unpleasant, awful — it’s a zoo,” he told the audience.

“That ER could kill five people a day, and that would not make it into your 15 commitments,” he said. “The labor and delivery could drop five babies a day, and that would not affect anything [in the 15 commitments].” He concluded that his family is considering whether Asheville was the best place to retire after all.

Nicolay was one of several attendees who questioned whether there was any way to add quality of patient care as a 16th commitment.

“We understand the public is frustrated by limitations of the asset purchase agreement,” Winters responded to Nicolay. “We didn’t write the asset purchase agreement. We’re charged with the responsibility to umpire everybody. … Changing, adding things — I’m sorry to disappoint you, but it’s not our role. It’s going to take people other than us to do that.”

Winters repeatedly encouraged attendees to share concerns with Gibbins Advisors via email so they could be incorporated into the independent monitoring assessment. The company takes the feedback, aggregates it and then shares it anonymously with HCA, he said.

The Asheville community meeting is part of a series held by Gibbins Advisors in Western North Carolina. (The independent monitor held similar community meetings in 2020.) The group held a public meeting regarding Transylvania Regional Hospital on Oct. 17, and will hold meetings regarding Angel Medical Center and Highlands-Cashiers Hospital on Nov. 1 and 2, respectively. (Community meetings for Blue Ridge Hospital and Mission Hospital McDowell haven’t been scheduled.)

For more information about meeting details visit avl.mx/wordcapg.