Hundreds of articles have been written about the proposed buyout of Mission Hospital by HCA Healthcare. None of them has talked about whether or not HCA will continue to serve people on Medicaid or Medicare, or those who have no health insurance at all. Mission Hospital, as a nonprofit hospital, must take care of these folks. As a profit-making organization, HCA can refuse to provide care to any of them.
At the end of a rather long article in the Dec. 30 edition of the Citizen Times — “If Mission Health is Sold to HCA, What Happens to Quality of Care?” — Mission leaders remarked that Medicare and Medicaid do not always cover the actual cost of care. HCA may be able to save some money by merging Mission’s administrative services into theirs, but our region has an exceptionally high number of people who are uninsured or getting their health care through Medicaid and Medicare.
If HCA continues to lose money after purchasing our Mission Hospital system, they will stop providing care to the uninsured first, followed by cutbacks or restrictions on Medicaid and Medicare patients (I assume that they will continue to provide services to Medicare patients as long as they have supplemental insurances to cover what Medicare doesn’t).
This issue is the elephant in the room, an issue that Mission leaders, some medical practitioners and local politicians are reluctant to address. All of their talk has been on continuing the quality of care, keeping all of Mission’s facilities open in outlying counties and what will happen to the “windfall” of money that HCA will be paying for the Mission system. No one, and I mean no one, is asking whether or not HCA will continue to serve everyone who comes to them for care.
Local politicians are salivating about how they are going to spend the money from this sale that will be managed by a new Dogwood Health Trust. Some of them see it as a windfall to their budgets. Shouldn’t this money be used instead to pay for the cost of caring for sick children and adults when HCA turns them away because they can’t pay for any or all of their care?
Western North Carolina stands to lose “big time” if our primary health care system becomes a profit-making business. I can guarantee you that HCA will not lose money on this deal. Eventually, after the initial transition, you will begin seeing them turn away people who come to them because they are sick. The devil is in the details — follow the money!
— Mary Ann LaMantia
(Retired administrator, New York State Health Department)
Asheville
Editor’s note: HCA Healthcare’s 2017 annual report to shareholders (avl.mx/5jq) notes that it receives payments for patient services from Medicare, Medicaid, managed care plans, private insurers and directly from patients. Mission Health’s website about the sale includes a FAQ page (avl.mx/5jo) that responds to a question about whether HCA currently provides charity care and whether it will continue to do so. The response: “Yes, HCA Healthcare hospitals provide charity care at all of their locations. In addition, HCA Healthcare led the way for the hospital industry by being the first to provide a discount to uninsured patients who do not qualify for Medicaid or charity care. HCA Healthcare has one of the most generous charity care policies in the industry, even more generous than Mission Health. HCA Healthcare provides charity care to those below 200 percent of the federal poverty guidelines and a sliding-scale discount with an out-of-pocket cap for those between 200 percent and 400 percent of the federal poverty guidelines. Additionally, HCA Healthcare has interest-free payment arrangements. To best serve patients, HCA Healthcare has experienced financial counselors available to provide estimates prior to receiving care and to answer billing questions following care. HCA Healthcare provided charity care, uninsured discounts and other uncompensated care at a cost of more than $3 billion in 2017.”
As you’ve probably discovered, NC’s Attorney General approved the HCA’s buy-out of our Mission Hospital system. Unless I’m mistaken, Mr. Stein’s approval was the final hurdle for this project meaning that the buy-out is a “done deal.” All I can do is hope that I’m wrong because, if not, people in western NC are in big trouble.
There are a couple of points in the Editor’s Comments that concern me…probably because I was a bureaucrat for over 30 years and know how to write “around a sticky issue.” The main one being “HCA Healthcare has experienced financial counselors available to provide estimates prior to receiving care (I.E., THE PATIENT WILL DECIDE IF THEY CAN AFFORD THE CARE, OR NOT, BEFORE BEING TREATED) and to answer billing questions following care ( I.E., THEY HAVE A COLLECTION PROCESS THAT MAKES SURE YOU PAY).” Also, HCA proudly talks about their charity care but implies that many may not qualify for it. Like I said earlier…I hope I’m wrong.