AshevilleHendersonvilleNews StoriesRoger McCredie

The Kingdom of Mission: Private practice vs. Asheville’s imperial healthcare system


Item: “Mission Hospital plans to take over the Asheville Neonatology practice and its five physicians, another step in the hospital’s vigorous – and controversial – expansion moves.”
— From “Mission wants to acquire Asheville Neonatology” by John Boyle, Asheville Citizen-Times, March 31, 2012

Item: “CarePartners Health Services, the rehabilitation and home health care provider, will join Mission Health as an affiliate member …
“ ‘CarePartners will keep its name and its board, but you could call it a merger,’ said Dr. Ronald A. Paulus, president and CEO of Mission Health …
“ ‘Facing challenges in reimbursement and regulation, it made sense for CarePartners to partner more closely with Mission,” said Tracy Buchanan, president and CEO of CarePartners …But we’re not in dire straits financially. This is not a bailout,’ Buchanan said.”

— From “CarePartners to align with Mission” by Dale Neal, Asheville Citizen-Times, April 3, 2013

By Roger McCredie –

Two news items, four days apart, mark the freshest tracks of the Mission Health System’s path across the field of WNC health care.

Mission is already the largest employer in North Carolina west of Charlotte. If its 7,000-person payroll were confined strictly to Asheville, it would be equivalent to eight per cent of the city’s population; however, Mission also owns the former St. Joseph’s Hospital across the street, as well as McDowell Hospital in Marion, and Blue Ridge Community Hospital in Spruce Pine; it manages Angel Medical Center in Franklin and, through its subsidiary Mission Medical Associates, it controls some fifty medical practices, from cardiologists to family physicians to psychiatrists. Once the Asheville Neonatology deal is completed, another specialty practice will be added to the menu. CarePartners, the former Thoms Rehabilitation Center, brings its own campus and a full complement of services including orthopedic treatment, palliative care and hospice.

Mission sees its ever-expanding presence in the medical community as part of its commitment to becoming “A regional diversified health system providing superior care and services to patients and their families through a full continuum of integrated services, education and research.” Other health care insiders see it as a relentless takeover agenda that has so far managed to skirt state anti-monopoly curtailments. Patients, particularly those of the hitherto private practices Mission has acquired, are edgy about possible threats to quality of care, freedom of care provider choice, and impact on insurance coverage.

What some call Mission’s “hunting license” is a Certificate of Public Advantage (COPA), which it was granted by the State in 1995, when Mission made its first major expansion move by acquiring its across-the-street rival/sister — no pun intended — institution, St. Joseph’s Hospital. St. Joseph’s had been founded by the Sisters of Mercy in 1900, the same year that Mission Hospital, founded in the 1880’s as Dogwood Mission, acquired Biltmore Hospital on Reed Street in Biltmore Village, built on land donated by George Vanderbilt.

The COPA is in effect an exemption from state and federal antitrust law. It allowed the two hospitals to merge by their certifying that the merger would serve a specified public need. It sets certain parameters that must be met and is supposed to be overseen continuously by various state agencies including the state Department of Human Services Attorney General’s office. Nationally, the issuance of COPAs for similar arrangements is rare; in fact, in 2011 only three states were listed as having enacted them and two of those were being phased out, leaving only the Mission COPA alive and thriving in North Carolina. Critics say that Mission uses the 1995 COPA to support its manifest destiny-like cherrypicking of different private specialist practices so as to capture an entire spectrum of medical services under its umbrella. (Hence the CarePartners deal. Hence the pending acquisition of Asheville Neonatal, which, as the only neonatal practice in WNC, fills an inside straight for Mission in its pediatrics hand).

Both physicians and consumer advocates have complained that Mission mostly self-reports its COPA compliance, with little oversight from the state agencies that are supposed to police it. As a result, they say, Mission virtually runs free, unencumbered by the consumer protection restrictions placed on private businesses, or by the natural checks and balances of free market competition.

In fact, a year and a half ago a key Mission employee was fired for flatly describing her employer as a monopoly. In October of 2011, a legislative committee reviewing area hospital practices heard taped comments made by then Mission Communications Director Janet Moore at a professional conference earlier that year.

In the recording, Moore said, “There was a lot of talk about the fact that we are a monopoly, and we are … We’re kinda the 500-pound gorilla in Western North Carolina.”

Later on the same day the tape was played, Mission released a statement saying Moore’s resignation had been accepted, that she had apologized for her “ill-advised” remarks, and that “Mission remains committed to serving the residents of Western North Carolina with humility and respect.”

The tape had been introduced at the review committee meeting by officials of Fletcher’s Park Ridge Hospital, which earlier that year had said it feared a hostile takeover attempt by Mission and asked the state to protect it from Mission’s “predatory business practices” by “doing the job [of oversight] they were supposed to do since 1995.”

About the same time, Dr. Nathan Williams, a gynecological cancer surgeon and partner of HOPE Women’s Cancer Center in Asheville, took to social media to accuse Mission of playing a fees and charges “shell game” with insurance companies, and of using unchecked strong arm tactics to gobble up private practices or force them into rubber-stamp arrangements. Williams said Mission, a nonprofit, makes “hundreds of millions of dollars” which it “hides through acquisitions and capital purchases.” Mission, he said, “acquires private practices in order to drive referrals … those of us in private practice will not be able to survive” unless the COPA is enforced, he said. He added that at a meeting between the HOPE partners and Mission officials, Mission’s CEO stated that “anyone who attempted to challenge or compete with Mission would pay a price.”

Shortly after Williams came forward, Mission revoked his privileges to operate or otherwise use facilities there. Williams has sued the hospital, accusing it of harming his practice and denying his patients freedom of choice. The suit is ongoing.

Asheville Neonatology, as the only practice of its kind in WNC, has furnished staff for Mission’s Neonatal Intensive Care Unit since its founding in 1978. Mission points out that one Asheville Neonatology has retired and another is about to do so; and asserts that the firm has not “actively recruited additional physicians to join their group. In taking over the practice, Mission says, it could bring the operation up to strength and incorporate it into its own Level III NICU unit.

A typical agreement such as the one whereby Mission would take over Asheville Neonatology would tie the salaries of doctors – who would now be full-fledged Mission employees — directly to quality of service. This would probably involve initial salary cuts for doctors, with incentive bonuses for good performance, as determined by Mission. This is standard procedure in a takeover situation. The Tribune contacted Jerri Jameson, Mission Health’s Public Relations Director, for confirmation or comment about doctor compensation in takeover situations. Ms. Jameson indicated she would reply by e-mail; however no response had been received from her at press time.

Part of Mission’s evaluation system is random phone surveys of patients, asking them to rate their doctors’ performance in a number of categories, according to a worker in a family practice who also requested anonymity. One patient, who received a survey phone call, felt it violated doctor-patient confidentiality and “turns the whole process into a popularity contest.”

Meanwhile, one patient offered a ground-zero perspective on the WNC health care wars. “I made an appointment at [my GP’s] office and I noticed the card had a little Mission symbol on it and I asked about it,” one patient said. “They said nothing had changed but they were part of Mission now. I don’t get it. How could nothing change and them be a part of Mission now?” she asked.

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