ASHEVILLE -Lengthy documents revealing the competitive efforts by HCA Healthcare-ownedMission Hospital, Novant Health and AdventHealth to provide another 67 acute-care beds in Buncombe County show which prominent community members support which bid, including former Mission principal and current Mountain Area Health Education Center CEO Bill Hathaway.
Obtained by the Citizen Times through a public records request, documents comprising certificates of need for the three hospital systems show approximately 3,000 pages of detailed plans, timelines and justifications for why each hospital should be allowed to provide the beds.
More on moves to expand hospital services in Buncombe:
- Mission competition? AdventHealth applying for new Buncombe hospital. HCA close behind.
- Buncombe commission to show support for new 67-bed hospital, but not one owned by HCA
- Mission/HCA, AdventHealth apply for 67 new hospital beds in Buncombe
- Novant Health: 1 of 3 seeking to add hospital services in Buncombe. Here's its pitch.
Certificates of need or “CONs” are submitted to theNorth CarolinaDivision of Health Service Regulation and undergo about three to five monthsof public input and agency review before they are awarded.
Public input for the new hospital beds in Buncombe runs July 1-30.
A large portion of the CONs’ justification sections are letters of support, more of which can be submitted during that public comment period.
Hundreds of elected officials, business leaders, health experts, practicing physicians, community members and others throughout Buncombe, Graham, Madison and Yancey counties — populations the new 67 beds are meant to serve — cast their support for one of the three CON applicants in both personalized or signed boilerplate letters.
Many of these letters came from service providers and employees who work with or for each company.
Other letters were penned by people outside the organizations.
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Who is supporting Mission? Novant? AdventHealth?
Mission Health’s former chief medical director Bill Hathaway, for instance, noted his 25-year history with the Western North Carolina medical community, nearly 10 of which he was in Mission’s top brass.
“The increased focus on outpatient services along with the rising cost of care has made it prohibitive for smaller hospitals in the region to provide specialized services,” he wrote. “As a result, they depend on Mission as the region’s tertiary medical center, to provide trauma care, complex medical/surgical services, and specialty pediatric care. For these reasons, the extraordinary demand for Mission Hospital’s services in Buncombe County and the surrounding region actually generated the need for additional hospital beds.”
He also emphasized points prominent in many of the letters, regardless of the hospital system they supported.
Related coverage:Mission Health medical director Hathaway leaves HCA in midst of patient, nurse complaints
“This need is further exacerbated by the fact that our community is experiencing factors that increase the need for more specialized and advanced care, such as a growing and aging population, a larger number of people living with chronic health conditions and worsening social determinants of health,” Hathaway wrote.
Reached for comment on his letter, MAHEC spokesperson Michelle Morgan said Hathaway was on vacation with his family June 24 and was not immediately able to discuss his letter with the Citizen Times.
Hathaway was joined in his support of Mission's 67-bed expansion — which would entail construction at the already existing campus tower "J" at 509 Biltmore Ave.— by other leaders includingMAHEC CFO Zach Levin, Asheville area Chamber of Commerce CEO Kit Cramer, A-B Tech Vice Present of Instructional Services Beth Stewart,hospital administrators and board members from each of MissionHealth's WNC locations and hundreds of other community members, hospital employees and providers.
Hundreds of Mission employees and regional community members also signed onto to standardized support letters.
HCA and Mission are vying for the CON during a swelling storm of issues, facing one antitrust lawsuit filed by Buncombe Citizens, a case currently waiting for judgment in North Carolina Business Court.
On June 3, the city of Brevard filed another antitrust lawsuit, claiming Mission had already become a monopoly in the area and was depriving citizens— especially government employees— of a diverse health care market.
HCA lawsuit:2 NC officials backing Asheville HCA lawsuit call new Brevard case 'serious,' 'courageous'
The Novant Health and AdventHealth CON documents took advantage of these controversies, citing local reporting including articles by the Citizen Times as evidence Mission should not be able to provide 67 more beds in Buncombe.
Download the Mission CON using this link.
AdventHealth also logged more than 100 letters of support in its CON including many from mayors, county and city boards,fire chiefs, EMS officials, law enforcement leaders and community outreach organizations, higher education institutions and family practicesacross several counties.
Buncombe County Board of Commissioners' letter of support is one of these and was included in AdventHealth's list of letters, though it also voiced support for Novant Health.
Many AdventHealth support letters note a need for more health care options outside of Mission facilities.
"Since 1995, Mission has operated as the sole hospital provider in Buncombe County. After the not-for-profit health care system was sold to for-profit HCA in 2019, residents have been increasingly vocal about their desire for improved access and patient choice," said Asheville Mayor Esther Manheimer, using the exact same language as many other letters signed by local leaders.
"A new AdventHealth hospital in Buncombe County would mean more choices for patients to receive high-quality health care close to home and more opportunities for dedicated medical professionals to build their careers in our community."
A handful of physicians who signed pre-written letters of support also penned in personal notes.
"I left Mission/HCA after 12 years of full-time employment, April 2021," said Dr. Stacia Moore, a psychiatrist in the AdventHealth system. "I would not want that hospital to acquire these beds due to numerous safety and patient care concerns."
Dr. Anna Hicks works in geriatrics and internal medicine with AdventHealth and also penned in a personal note next to the standardized support language.
"Competition in health care drives quality care as well as more affordable care," she said.
Other community leaders showing support for AdventHealth included the sheriffs of Buncombe, Graham, Madison and Yancey counties, Asheville Buncombe Community Christian Ministry Executive Director Scott Rogers, A-B Tech President John Gosset andSenior Vice President of Human Resources andGovernment Relations with the Biltmore Co. Vicki Banks— who is also on the board of the AdventHealth Hendersonville Foundation.
Download the AdventHealth CON using this link.
Novant Health had the fewest support letters of the three CONs.
They included votes of confidence from Paul Vest, president and CEO of the YMCA of WNC, Stephanie Twitty, president and CEO for Eagle Market Streets Development Corp., Buncombe County Board of Commissioners— which also showed support for AdventHealth— and other community members.
One of these was Maria Roloff, once vice president of human resources for Mission Health before it was bought by HCA in 2019.
"During the years that I worked forthe Mission Health system, I was proud to be associated with the organization as an administrator, as an employee, as a patient and as someone who witnessed first-hand Mission Health's quality of care and commitment to our community," Roloff said in a personalized letter.
"Sadly, the picture changed drastically once HCA began to manage and operate Mission. I have heard countless stories from family, neighbors and staff about their concerns regarding poor quality of care, diminished attention to patient and community needs and low morale among staff."
What nurses say about working at HCA-owned Mission:
- Mission nurse on HCA fallout during merger hearing: Shocked and horrified
- Mission health care workers demand safer working conditions, join national nurses action
Roloff went on to describe a bad hospital experience after a hiking accident and followed that with praise for Novant Health, where she said her daughter is preparing to have surgery.
Letters of support play a role in the DHSR's final decision on which competing health care systemwill win aCON.
During the first 30 days of a CON review period, "any person may file written comments or letters of support concerning proposals under review," according to DHSR public comment rules.
When asked if the Buncombe hospital bed expansion may take longer than usual, N. C. Department of Health and Human Services spokesperson Catie Armstrong said it likely will not.
"There are frequently competing CON applications for the same project – it’s part of the nature of the CON process," Armstrong said."The process and timeline remains the same whether there is one application or multiple."
Download the Novant Health CON using this link.
Where will the new beds go?
Aside from the letters of support, each CON contained details on what a 67 acute-care bed expansion would entail.
AdventHealth and Novant Health are proposing to build new facilitiesin Buncombe County that would serve a four-county region.
Novant Health has proposed construction on 200 Technology Drive, directly across from the WLOS TV station in South Asheville on land currently owned byBiltmore Park Three LLC.
AdventHealth proposed building at264 Enka Heritage Parkway, also known as the Enka Center, a site that contains the iconic Enka clock tower.
Mission does not intend to build a new facility. Rather it would expand its flagship campus facilities in central Asheville.
"Mission Hospital has seen significant growth in demand for its acute care services – so much so that it often cannot accommodate certain transfers and patients must wait for extended periods of time in the ED for hospital admission," its CON states.
Mission currently has 733 acute care beds, according to the2022North Carolina State Medical Facilities Plan, which first heralded the 67-bed need.
"We are confident we are the best hospital situated to provide this care because of the outstanding, advanced services we are already providing including trauma care, complex medical/surgical services, and specialty pediatric care," Mission and HCA spokesperson Nancy Lindell said after the system submitted its CON applicationmid-June.
When does each hospital plan to offer services? What will they look like?
Each CON also contains a proposed schedule of work, showing when the hospital systems plan to make their 67 new beds available for use.
AdventHealth, which estimates the project will cost$254.1 million,commitsto the earlier opening date of the three: Jan. 1, 2025.
The proposed hospital would include a labor and delivery unit with 13 beds and a dedicated cesarean surgery suite, 42 medical/surgical beds, two intensive care beds, a surgery suite with five rooms and emergency department with 12 beds.
Mission would have its new beds ready for service by July 1, 2026. Its expansion efforts would cost$125 million.
Another lawsuit:HCA, Mission hit with 2nd WNC antitrust suit in a year, this one from a Transylvania city
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Its proposed expansion would include ICU beds and MedSurg beds "to serve the communities’ growing need for complex and specialty care," Lindellsaid in an email June 16.
After it spends an estimated $328.7 million, NovantHealth proposes openingits new facility Jan. 1 2027.
Novant's proposed Buncombe investment would include 53 medical-surgical beds, eightICU beds, sixlabor, delivery, recovery and postpartum beds, eightobservation beds, one operating room in partnership with Surgery Partners, threeprocedure rooms, oneC-section operating room, andonegastrointestinal endoscopy suite and an emergency department with 35 bays.
Andrew Jones is Buncombe County government and health care reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or arjones@citizentimes.com. Please help support this type of journalism with a subscription to the Citizen Times.
