Since Nashville-based HCA Healthcare, the country’s largest hospital chain, acquired nonprofit Mission Health for $1.5 billion on Feb. 1, 2019, the corporation has come under fire locally for business practices that staff and community members have said affect the quality and cost of patient care.
The COVID-19 pandemic, however, may give HCA an opportunity to counter those and other complaints by demonstrating an upside of corporate ownership: significant national and global purchasing power and supply chain leverage.
In an hourlong conference call held April 20 and open to the community, Mission officials gave new details about rapid coronavirus testing capabilities the hospital acquired two weeks ago. The Cepheid and BD Max molecular diagnostic tests, as well as the chemicals required to run them, are among the hottest products on the medical market.
“As you can imagine, with various parts of the country being affected at different levels of intensity, the competition for those [chemical] reagents has been fierce,” said Dr. Tony Spensieri, chief medical officer for Mission Hospital.
Through Mission’s affiliation with HCA, he continued, the hospital has been able to secure the necessary chemicals and test to identify infections in symptomatic hospital patients and health care workers who may have been exposed to the coronavirus on the job. But Mission isn’t offering the rapid testing to outpatients or other community members.
“Unfortunately, we simply don’t have the reagents and the resources for universal testing at this time,” Spensieri said.
State of the art
Mission’s Cepheid testing capability came online on April 4, just two weeks after the test for SARS-CoV-2 (the virus that causes COVID-19) received emergency approval from the U.S. Food and Drug Administration. The California-based company’s test provides results in about 45 minutes. According to a press release, the automated system does not require specialty training and is capable of operating 24/7.
“It’s pretty widely known that we lost an opportunity to gear up for testing back in January when we learned of the epidemic spreading throughout Asia and Europe and the Middle East,” said Dr. William Hathaway, chief medical officer for the Mission Health system. “We have rapidly, across the country, been seeing lots of companies developing tests similar to the [rapid molecular] test, but the availability of these tests has been terribly limited.”
Still, Hathaway said, conversations with members of the Buncombe County Board of Commissioners and interim county Health Director Dr. Jennifer Mullendore had confirmed that, “We are all 100% on the same page with wanting to increase the availability of testing. A critical step in us opening the community up is knowing where the disease is, so we can then make targeted interventions to liberate the restrictions on folks without exposing the community to a rapid advance of the disease.”
On April 8, the health system added BD Max batch testing, which has the potential to increase the numbers of tests that can be performed in a day. According to Spensieri, the tests are performed in batches of 48 samples and require three hours to complete.
Chief Nurse Executive Karen Olsen said HCA’s purchasing and inventory management power has allowed the system to stock up on masks, gowns, gloves and other supplies needed to protect health care workers treating COVID-19 patients or those who may be infected.
Of the ASTM Level 3 fluid-resistant surgical masks that make up “what, the majority of the time, we are using,” Olsen said, Mission Health has 3,400 on hand, with 1,700 more on order. In the system’s warehouse, 48,000 N95 masks — which filter out most airborne particles — are ready to go.
“By knowing exactly what our counts are here, that has made us feel more confident to ensure that we would not run short, that we have the supplies we need,” Olsen said. One employee has been designated the steward of the inventory, and daily reports track the supply.
That same level of rigor, Olsen continued, has been applied across the corporation. “So with that, should someone have a surge or have a further outbreak, they could have those redeployed to an area that might be in crisis or need more of that. … That’s been a big plus to help us stay safe,” she said.
On April 9, nurses advocating for the creation of a nurse’s union at Mission demonstrated in favor of removing restrictions on the use of N95 masks and other protective equipment, saying that the hospital’s policies were driven by supply considerations rather than the highest level of safety for staff and patients.
Without providing specifics of what she called “some of the public discourse that doesn’t represent the facts that we’ve shared here today,” Olsen said that “it hurt my heart more than anything to hear things that I know are not factual.”
Looking back over the past five or six weeks, Hathaway said, “Buncombe County and other local counties implemented some social restrictions earlier than some other communities and certainly earlier than the state edict came out.”
That early action “made a huge difference in what our health system has seen with respect to the number of cases,” Hathaway continued, noting that “a dozen or so” patients who had tested positive for COVID-19 had been treated at Mission hospitals. “We are very different than the more populated areas, in the Triangle and in the Charlotte area, and we’ve got social distancing to be grateful for that,” he said.
Hathaway celebrated the success of skilled nursing facilities in Buncombe County in preventing COVID-19 outbreaks by doing “an excellent job of controlling visitor access and restricting inflow and outflow into their facilities.” He also noted a “silver lining” of the crisis: increased collaboration among area health systems including Duke LifePoint, AdventHealth Hendersonville and Pardee UNC Health Care. Through regularly scheduled group calls, the area providers had “strengthened community relationships for us all, and I think in the long run, we’ll be forever grateful for that,” Hathaway said.
Lest anyone conclude that the danger had passed, Hathaway warned, “We’re not out of the woods by any stretch of the imagination. If we were to let loose the flood gates and open up the doors too quickly on eliminating these restrictions, we would be just as susceptible as anyone else.
“But to this point in time, our curve has been flat, we’ve been able to handle it in the health care system, and it’s been just a blessing in so many different ways.”