HCA Pushed Out Providers, Downgraded Care After Acquiring Mission Health: Report

Dive Brief:

• A new working draft study from Wake Forest University alleges HCA has driven doctors away from Mission Hospital and drastically decreased nurse and emergency department staffing since acquiring North Carolina-based Mission Health in 2019.
• The analysis, which draws on dozens of interviews, alleges doctors left Mission following HCA’s $1.5 billion acquisition due to care quality concerns.
• HCA is currently being sued by the North Carolina’s attorney general’s office over allegations the for-profit giant degraded services at Mission following its acquisition.

Dive Insight:

Reports of employee discontent have swirled since HCA took over Mission.

Mission nurses unionized for the first time in 2020, a year after the hospital was acquired by HCA, citing concerns about staffing and resource shortages.

More than 200 doctors left the health system in 2022, according to a report from local outlet the Asheville Watchdog. Some of the departing physicians wrote a blistering open letter detailing concerns about patient care and staffing levels under HCA’s leadership prior to departing.

HCA allegedly closed or reduced funding for less lucrative specialties, causing physicians to leave Mission. Some specialties, including otolaryngology, urology, rheumatology, orthopedics and neurology are now severely depleted or gone, according to the report.

In total, the report said two-thirds of Mission’s 750 physicians left following the acquisition.

A former financial adviser to Mission’s board was quoted in the report saying internal medicine physicians were viewed by HCA as “cogs in a machine”:  readily and repeatedly replaceable.

Leadership also did not respond to physicians’ concerns about quality of care slipping, according to report — particularly cancer care.

One physician said HCA “was seemingly incapable of addressing physician concerns …. Physicians were routinely left out of any of the decision-making processes. Although physicians were given titles of medical director, service line leaders, and committee chairs, they were frankly powerless and often ignored/sidelined in the decision-making process.”

The report also alleges HCA both reduced some patient care roles and struggled to hire staff to fill other positions. Staffing shortages have built on each other, according to the report. For example, the head of the cancer service and his entire oncology staff, who HCA recruited, allegedly left over the space of just a couple of years due to concerns over inadequate resources and staffing.

Nurses have also taken to online forums to urge their peers to avoid working at Mission.

The shortages have allegedly led to delayed procedures and higher risk of complications for patients — particularly in the emergency department.

Emergency department wait times are a focus of ongoing litigation against HCA. Other problems with the emergency department include patients being treated in inappropriate areas, such as open areas, according to the report and lawsuit.

The report was authored by Mark Hall, an independent academic researcher and a member of the National Academy of Medicine. Hall cited nearly 50 sources, who he calls key informants, including physicians and members of the board at Mission Hospital, as well as government officials and those who work in healthcare.

This isn’t the first time Hall has criticized HCA and Mission.

Hall has written other draft reports accusing HCA of decreasing charity care for lower-income Mission patients post-acquisition. He also examined how Mission’s profits increased in 2021 while bedside staffing declined. 

The work is funded through a grant to Wake Forest University from Arnold Ventures. The philanthropic group is also helping to fund a law firm pursuing an antitrust lawsuit against Mission — Fairmark Partners. 

In a statement, a spokesperson for Mission Health called out that connection.

“This is yet another ‘study’ written by the same academic who is taking money from an out-of-state advocacy group that is currently funding litigation against Mission Health,” the spokesperson said. “It is neither serious nor impartial, and is filled with recycled news and opinion.”