Representatives from Gibbins Advisors, the independent monitor appointed to oversee the terms of the sale of Mission Health to Hospital Corporation of America in 2019, offered up a two-year progress report on Wednesday.
A virtual public forum gave Gibbins employees an opportunity to answer questions from concerned members of the public.
Before opening up the forum, Gibbins Advisors principal consultant Ronald Winters went over the company’s role as an independent monitor of a healthcare system.
“HCA’ purchase agreement holds the company to specific commitments over the course of the next 10 years and it’s our job to make sure HCA is fulfilling those commitments,” Winters said. “We at Gibbins are totally and 100 percent independent of HCA and Mission Health, and we are not paid by either entity.”
Winters explained when HCA acquired Mission Health in 2019 the North Carolina Attorney General’s office required the hiring of an independent monitor to approve the sale. That monitoring company had to meet certain requirements, such as not having any senior employees who previously worked for HCA, having a former hospital CEO on staff, and having an accounting department capable of analyzing HCA’s annual financial and capital expenditure reports.
Winters added that Gibbins works with HCA, Mission Health, the six local hospital advisory boards and the Dogwood Trust in its work to oversee compliance with the sale agreement.
“There are 15 commitments that HCA is held to in the purchase agreement, which is about 3,000 pages in length,” Gibbins consultant, and former hospital CEO, Tom Urban said. “We follow up to make sure those commitments are being met on a regular basis.”
The 15 commitments HCA is tied to are as follows:
• Keep all six Mission Health facilities open for at least the next 10 years, through Jan. 31, 2029
• Continue specified services at each facility
• Give the Dogwood Trust first bid if any facility is ultimately closed
• Continue services at St. Joseph’s campus (commitment expired Jan. 1, 2021)
• Build a new Mission Hospital north tower (completed)
• Build a new hospital to replace Angel Medical Center in Franklin
• Build a behavioral health facility in Asheville
• Spend $232 million in capital expenditures by Jan. 31, 2024
• Spend $25 million in healthcare innovation
• Make $750,000 in contributions to community health programs
• Continue comp programs for one year (completed)
• Maintain a charity care policy for 10 years
• Continue graduate medical education programs for 10 years
• Participate in both Medicare and Medicaid
• Submit annual reports to Gibbins Advisors for review
Winters noted that in the past two years Gibbins representatives have visited each Mission Health facility and held community meetings in each location. He broke down the most common community concerns into 10 categories including quality of care, patient billing, service changes, physician retention, staffing and communications.
During Wednesday’s question and answer session, many of the queries focused on quality of care, which Winters explained is not the same as services provided.
“At each hospital HCA is required to maintain certain critical services including emergency services, surgical services and acute medical services,” Winters said. “We are here to make sure those are provided. We do not police the quality of those services, though we do welcome public comments about that issue so if it grows to a point where the service is no longer offered or no longer effective we can be aware.”
Urban added that Gibbins’ responsibilities also do not include managing HCA, its facilities or its employees.
“There are managerial decisions regarding staffing and other matters that are not within our oversight,” Urban said. “We get a lot of questions about physicians leaving, nurses leaving, etc. and while we do monitor those vacancies as they relate to the core services being available, we do not have any control over the hiring practices of HCA.”
Several questions during the forum focused on HCA’s obligation to continue charity care for the next 10 years. Hospital users unhappy with their bills have been frequent respondents to Gibbins’ online comment submission form.
“I think the biggest issue here is that HCA’s charity care policy is not the same as Mission Health’s old policy,” Urban said. “HCA has to provide a charity care program, they do not have to continue Mission Health’s previous program for the next 10 years. The new program has clearly not been well explained or well understood in the communities.”
Winters indicated that he and his coworkers will be getting back into the communities of Western North Carolina for public listening sessions later this spring and into the summer. He encouraged anyone with comments about the levels of service they received at Mission Health facilities to reach out online by contacting Mission Health directly at contactmission@hcahealthcare.com or contacting Gibbins Advisors at independentmonitormhs.com.