In Transylvania County, community leaders say HCA’s governance of Transylvania Regional Hospital in Brevard is causing mounting frustration.
The discovery phase of the City of Brevard’s lawsuit against the massive hospital corporation is ongoing. Pardee Hospital, located in the adjacent Henderson County and operated by UNC Health, continues to build temporary facilities to fill the holes that HCA has poked in Transylvania’s health care options.
A new independent monitor , selected by Dogwood Health Trust to gauge the communities’ opinions of HCA and the company’s ongoing compliance with the terms of its acquisition of the Asheville-based Mission Health chain, is already losing the trust of Brevard’s leadership.
Transylvania Regional Hospital was constructed in 1971 using a $1 million fund raised by the community.
“It was just a beautiful thing to see,” Ora Wells , a pediatrician who practiced at Transylvania Regional Hospital for 40 years before his retirement in 2022, told Carolina Public Press .
“But we were going to go broke. Western North Carolina is burdened with a huge Medicare population, and it’s difficult to run a hospital if that’s all you see.”
So, the community sold the hospital to Mission Health system in 2011, when it was still a nonprofit enterprise.
Mission Health is now a group of six hospitals and related medical facilities across Western North Carolina, the biggest of which is in Asheville. Transylvania Regional Hospital, as well as the other four hospitals, are in small towns in nearby mountain counties.
The entirety of Transylvania County has a population of 33,355, a little over a third of the population of Asheville, and well below the much larger populations in adjacent Buncombe, Henderson and Haywood counties, as well as the sprawling metro area of Greenville, South Carolina, across the state line.
Changes did occur at the Brevard hospital under Mission Health prior to the HCA acquisition, such as the closing of the birthing unit in 2015, which impacted Wells’ work specifically. Expectant mothers in Transylvania County have to drive to Asheville for care, which can take over an hour.
If they are in Brevard, the drive is on a major four-lane highway. If they are in moral rural communities in Transylvania like Sapphire or Lake Toxaway, they must navigate sometimes narrow winding mountain roads, which often become icy and treacherous in winter months.
In 2019, the Tennessee-based for-profit hospital chain HCA, which stands for Hospital Corporation of America, bought nonprofit Mission Health for $1.5 billion. The acquisition required state approval, which came only with stipulations for continued levels and quality of care, as well as the mandate for an independent monitor to oversee compliance.
Since then, complaints about Transylvania Regional Hospital have skyrocketed, though HCA has also faced criticism at many of the affected locations.
Brevard’s lawsuit
“HCA makes their money by running hospitals with skeleton crews, which makes it difficult to provide good quality care,” Wells said.
The city of Brevard, under the leadership of Mayor Maureen Copelof , filed a lawsuit against HCA in 2022, accusing the hospital corporation of creating a monopoly that led to worse care for higher costs.
The lawsuit is now in the discovery phase, where the parties exchange information and ask one another to produce certain documents.
“Given the amount of information that needs to be exchanged, I would say it’s going to be about a year, or maybe nine months, of discovery,” Brevard city attorney Mack McKeller told CPP this week.
“The level of computer literacy it takes to do these cases is kind of insane. You have to essentially come up with your own algorithms to be able to sort through the information coming in and going out.”
Problems at the hospital
“Mission had agreed to honor the recruit-and-retain agreement we had with our physicians, even though that was above and beyond what they were paying other physicians in their system,” Wells said. “When HCA came along, they said: ‘We don’t do that. Here is our standard contract. Sign it or walk away.’”
And that is what many chose to do.
At least 10 of Mission Health’s physicians in Transylvania County parted ways with the company in 2021.
Wells estimates that these new contracts offered a salary that was 25% less than the physicians were paid under the old recruit-and-retain agreement.
“There was a mass exodus when almost all of the physicians under contract here in Transylvania County left HCA,” Mayor Copelof said. “A lot of services we used to have, you now get sent to Mission (in Asheville) for.
“Now, the doctors didn’t necessarily leave the area, they simply switched and moved to Pardee or Advent, which are hospitals in the adjoining (Henderson) County. They left HCA in our regional hospital, and you can still go to your same doctor.”
Pardee’s offices in Transylvania
A majority of the primary-care physicians — at least seven — who left HCA in February of 2021 went to work for Pardee. In April of 2021, Pardee opened temporary offices off Asheville Highway in northern Brevard to serve as a home for these doctors.
“We pay attention to trends that might require us to bolster specialties that are currently stretched or provide services that force our patients to travel for care,” Greg McCarty , Pardee Hospital’s chief medical officer, told CPP in an email.
“They’re nice offices, but basically big double-wides up on the hill by the Chinese restaurant,” Wells said. “There’s adequate parking and handicap access and good doctors and staff inside, but I think they were always meant to be temporary.”
Those temporary facilities have now been in place for more than three years.
The opening of the primary care offices followed the 2020 introduction of Pardee Urgent Care, a sports medicine and orthopedics office, and a physical therapy center. In 2021, Pardee opened two more offices: a primary care office and a facility for surgeries. In 2023 came Pardee Neurology Associates. Just this year, Pardee opened an office dedicated to cardiology.
“Pardee has plans to build a permanent medical office building in Transylvania County that would include primary-care services, specialty services, pharmacy and other services needed at the time of construction,” McCarty wrote.
No timeline is yet in place for construction, but the design and pre-construction phases, in partnership with the architectural firm LS3P out of Greensboro, is well underway.
HCA doesn’t see any loss of services for Transylvania County residents, according to spokesperson Nancy Lindell .
“Our primary care locations (in Transylvania County) continue to be available to the community for their care needs,” Lindell told CPP in an email.
“While the employment relationship with some may have changed, these physicians continue to care for the Transylvania County community …. The number of physicians on medical staff at Transylvania Regional Hospital is about the same as it has always been.”
According to Copelof, HCA is guarded about sharing data on staffing numbers.
However, Transylvania Regional Hospital received a five-star rating from the Centers for Medicare/Medicaid in 2023. The 2023 patient survey rating came to three out of five stars.
Affiliated Monitors transition in Transylvania
HCA’s acquisition of Mission Health resulted in the creation of the Dogwood Health Trust, to hold the $1.5 billion HCA paid to the nonprofit, for use in philanthropic endeavors in Western North Carolina.
Dogwood was also tasked with hiring an independent monitoring company to assess whether HCA is abiding by the state-imposed purchase terms that HCA agreed to back in 2019.
A new monitoring company, Affiliated Monitors, came on board earlier this year. The previous monitoring company, Gibbins Advisers, deemed HCA compliant each year, even as tensions between HCA and its employees, as well as the communities which it serves, rose to a boiling point.
Brevard’s federal lawsuit against HCA over its alleged monopolistic practices in the region has been joined by other jurisdictions including Buncombe County, Madison County and the city of Asheville.
Despite Gibbins’ evaluation, North Carolina Attorney General Josh Stein has sued HCA for alleged breaches of the Mission Health acquisition agreement. HCA, a company with strong ties to Republican politics in Tennessee, has implied in its public statements that Democrat Stein’s actions have more to do with his campaign to become North Carolina’s next governor than a serious legal claim against the company.
In June, Affiliated Monitors completed the first round of its annual community meetings, in which the company asks each of the six communities served by Mission Health’s network for feedback on their respective hospitals.
“I don’t even know if we’ve heard anything critical about a community hospital yet,” Gerald Coyne , managing director of Affiliated Monitors’ state monitoring services, told CPP. “The people are very, very supportive of their community hospitals.”
But Mayor Copelof has another theory for why they didn’t hear much in the way of constructive criticism.
“The reason they didn’t get a lot of comments at their sessions is that they didn’t advertise them effectively,” Copelof said.
“They scheduled the session at the same night as our City Council meeting , so no city leadership could attend. Of course, there were not a lot of people speaking out. People didn’t know about it.
“I went to them a week before and said, ‘nothing has been advertised anywhere about your meeting next Monday.’”
According to Coyne, the monitor’s advertising consisted of a press release sent out to Dogwood Health, a reminder sent out about the availability of one-on-one interviews with the monitor, and an invitation sent out to a list of 600 names that signed up for news updates from the previous monitor. CPP also published an advance article with the dates, times, and locations of all six meetings.
“We didn’t have the opportunity to reschedule the meeting (on account of the city council meeting),” Coyne said. “We were only there for two weeks, and we’re trying to do six meetings.”
Neither Gibbins Advisers nor Affiliated Monitors keeps data on their meeting attendance numbers. But in 2020, meetings were full and people served by the community hospitals had much to say, most of it highly critical of HCA’s early management of the hospital network.
Lindell denied that HCA-run Mission facilities are out of touch with concerns in their individual communities.
“The CEO of Transylvania Regional Hospital, Michele Pilon , has a community council that she meets with quarterly, with participation from community members who have used the hospital and including persons from the county commission and sheriff’s (office),” Lindell wrote.
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