By Ted Clifford
The hearing August 19 at Asheville-Buncombe Technical College was a routine part of the North Carolina Department of Health and Human Services (DHHS) certificate of need process. It was an opportunity for state regulators to hear public comments and presentations on the competing proposals before them.
But today, even routine administrative healthcare proceedings have become highly charged.
With more than a hundred people packed into Ferguson Auditorium to comment on 92 hospital beds coming to Buncombe County, the hearing laid bare the anger the community still feels towards Mission Hospital and its corporate owner HCA, as well as distrust of the certificate of need process that recently awarded Mission 95 more beds over community opposition.
Mission, AdventHealth, Novant and University of North Carolina Health are all competing to be awarded the certificate of need for 92 beds earmarked for the region. The process requires that hospitals in North Carolina submit proposals to the DHHS in order to add beds, certain equipment or facilities.
Mission has proposed adding those beds to its existing campus, while AdventHealth seeks to fold them into the facility it is constructing in Weaverville in order to make a 185 bed facility. UNCH has said that if it were awarded the beds it would build a new facility on the site of the current Westgate Mall, which the hospital system recently purchased.
Novant’s more modest request is to add 20 beds to an already approved 34-bed facility in Arden.
Lobbying effort in full force
The lobbying effort outside of the A-B Tech’s Ferguson Auditorium was in full force Wednesday morning. Each healthcare system was there making its case, rallying supporters, handing out stickers and encouraging people to speak in support of their respective plan.
HCA offered fruit and Chick-fil-a chicken biscuits. AdventHealth, a Florida-based nonprofit hospital chain, handed out hats and branded miniature watering cans. UNCH handed out stress balls and jars of trail mix with Tar Heel blue M&Ms. Supporters of the state university health system dressed to match in blue jackets, shirts and dresses.
Support in the room was particularly strong for AdventHealth’s Weaverville hospital and the proposed UNCH West, which would be built near Asheville’s downtown.
“We’re honored beyond words to have the endorsements of all five county commissions, all five sheriffs, all five health departments, all five EMS agencies, all the county and city school systems and numerous municipalities in the service area,” said Graham Fields, assistant to the president at AdventHealth in his presentation.
Central to AdventHealth’s pitch was the argument that the Weaverville hospital would expand access and provide a life-saving reduction in transportation time for the rural counties north of Buncombe.
“Just the trip alone to HCA Mission can be life or death,” said Matthew Wechtel, a Madison County Commissioner who showed up in support of AdventHealth’s plan. Factoring in distance and traffic, a trip to Mission could take 45 to 75 minutes on a “good day,” Wechtel said.
Mission called out
Asheville Mayor Esther Manheimer said she backed UNCH’s plan, but pointed out that she signed letters of support for every hospital except Mission.
Asheville residents “should not have to accept diminished care simply because residents have nowhere else to go,” Manheimer told the crowd.
It was just one example of how Mission’s market dominance, which is largely unprecedented in North Carolina and a legacy of their former nonprofit status, casts a shadow over healthcare in the region.
“There is hardly a shift that goes by that one of our crews doesn’t hear some version of ‘take me anywhere but Mission,’” said Kristy Bryant, EMS director for Yancey County. Since HCA acquired Mission in 2019, Bryant said that she had seen less cooperation or support from the hospital, which in turn had put more strain on the rural county’s ambulance service.
For its part, Mission argued that its facility was best served by the additional beds. Mission was already operating close to capacity, said Chief Operating Officer Melina Arrowood in her presentation. As the largest hospital and the region’s only Level 1 Trauma Center, Arrowood argued that the beds would do the most good at Mission where patients would have access to more resources and more specialty care than at community hospitals.
“The challenge facing Western North Carolina is not simply whether we have enough hospital beds; it is whether we have the right beds in the right place, supported by the right level of clinical care,” Arrowood told the crowd.
Mission is currently licensed for 853 beds after receiving a certificate of need for 95 beds in March. As part of that decision, DHHS awarded 34 beds to Novant. That decision is currently being appealed by UNCH and AdventHealth.
That decision to award more beds to Mission was widely criticized. State Senator Julie Mayfield (D-Asheville) said that she was “shocked” and “puzzled” by the decision, which came after Mission Hospital’s fourth Immediate Jeopardy finding since 2021.
Immediate Jeopardy is one of the most serious sanctions handed down by the federal Centers for Medicaid & Medicare Services. It warns that a facility is in danger of losing access to Medicaid and Medicare reimbursements due to threats to patient safety.
“We have made significant progress in addressing the issues that have been raised,” said Dr. Peter DeYoung, Chief Medical Officer at Mission. CMS recently confirmed that Mission Hospital was back in “substantial compliance” with federal regulations.
But the extent to which anger at Mission has also begun to reflect back on regulators at DHHS was on full display Wednesday.
Before the meeting got underway, several members of the audience peppered the project analyst from DHHS, Greg Yakaboski, with questions about his credentials and authority to make decisions on the beds.
In response to one audience question, Yakaboski said that he was not involved in the decision to award the 95 beds to Mission.
Looking to drive home her post, one speaker urged anyone in the crowd to stand “if you share my thought that Mission Hospital should not get one more bed.” As Yakaboski watched, the entire room stood. Meanwhile, Mission Hospital’s speakers had already left.
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