Frequently Asked Questions

Can we get HCA to sell Mission Hospital? Have you considered raising private funds to purchase Mission Hospital?

The simple answer is that HCA Healthcare isn’t willing to sell Mission. The hospital is one of the most profitable in HCA’s system of more than 190 hospitals across the country. We can’t know precisely, but our best estimates are that Mission is now “worth” at least three times the purchase price of $1.5 billion that HCA paid in 2019. Even if HCA wanted to sell–and it’s adamant that it does not–it’s not feasible for our community to raise five billion dollars.

What is Immediate Jeopardy and why is the hospital allowed to operate this way?

An Immediate Jeopardy designation by the federal Centers for Medicaid and Medicare Services (CMS) represents "the most severe and egregious threat to the health and safety of [patients]”. Immediate Jeopardy is defined as “A situation in which the provider's noncompliance with one or more requirements…has caused, or is likely to cause, serious injury, harm, impairment, or death…” (See 42 CFR Part 489.3.) When such a situation exists, immediate corrective action is needed or the hospital faces the most severe sanction of losing Medicare and Medicaid reimbursement. 

CMS works closely with state agencies (such as the North Carolina Department of Health and Human Services) and accrediting organizations (such as The Joint Commission) to routinely survey facilities, respond to complaints, and take action when they identify noncompliance. Generally, a facility is given the opportunity to submit a plan of correction to address deficiencies. Most facilities take these findings seriously and implement corrective actions to come into compliance in order to retain Medicare and Medicaid funding. (Source: Becker’s Hospital Review)

Unfortunately, state and federal regulators do not have enough power or oversight to hold hospitals accountable in meaningful and lasting ways. So what we’ve seen at Mission can continue to happen–an IJ is issued and conditions improve for a short period of time, then once the IJ is lifted, patient care and quality of service once again is diminished.

How do present conditions compare with what was happening before HCA’s ownership? What are the key performance indicators that could provide measurable data around some of the concerns being raised? 

HCA does not share all of its data, however, we do know the following: 

Patient satisfaction ratings have declined. (Source: Mission Hospital’s Quality Ratings Following HCA’s Acquisition: A Preliminary Report by Mark Hall, Wake Forest University)

Staffing has declined. (Source: Mission Hospital’s Financial Performance Under HCA: A Preliminary Report by Mark Hall, Wake Forest University)

Prices have increased. (Source: Mission Hospital’s Financial Performance Under HCA: A Preliminary Report by Mark Hall, Wake Forest University)

What role does Dogwood Health Trust play in the oversight of Mission/HCA?

In 2019, when the non-profit Mission Health System sold to for-profit HCA, under NC law the proceeds of the sale had to be put to charitable use. The result was the creation of the Dogwood Health Trust (DHT) as a new, independent foundation focused on addressing the upstream factors that influence the well-being of individuals, families and communities, otherwise known as the social determinants of health. DHT is completely independent from HCA, and HCA has no control over DHT or its assets. In addition to investing in the health and wellness of our region, one of DHT’s roles is to ensure that HCA complies with the terms it agreed to when it purchased Mission Health. 

What is the role of the NC Attorney General in all this?

The NC Attorney General also has the ability to make a finding of noncompliance and to bring a lawsuit against HCA. That office did exactly that in December 2023 (Attorney General Josh Stein Sues HCA Healthcare), and that case is ongoing in the courts. Two of the three findings of noncompliance DHT made this year were based on the same set of facts used by the Attorney General in its lawsuit.

How far back can I report a situation I experienced at a Mission Health facility?

If you or someone you know experienced a problem with a Mission Health facility within the last six months, please report it to us here: https://reclaimhealthcarewnc.org/report-your-experience

What do you mean by Mission Hospital staff and their “fear of retribution?”

Physicians, nurses and staff who work at or with Mission cannot speak up openly about what is happening at Mission for fear of retaliation, such as being suspended, losing their jobs, experiencing diminished resources to properly do their jobs, or being bullied and threatened on the job.

We hear a lot about Mission Hospital. What about the HCA-owned satellite hospitals in Brevard, Cashiers, Franklin, Marion, and Spruce Pine?

The impact of the sale varies for the satellite hospitals. The impacts in Transylvania County, for instance, have been significant, with many doctors leaving and fewer types of care being available at Transylvania Regional Hospital. But other hospitals have not seen the same degree of change. And we should mention that, pursuant to a commitment in the Asset Purchase Agreement, HCA built a new Angel Hospital in Franklin.

Will ambulance services automatically take you to the closest hospital? After the new AdventHealth hospital is built in Weaverville, will you be able to choose between Advent or Mission, since both are in Buncombe County?

It is EMS’s general policy to transport patients to hospitals of their choice that are a part of their EMS System. These include Mission, Advent-Hendersonville, and the VA Hospital. EMS may transport patients to other facilities, most commonly Pardee and/or Haywood Regional, depending on the condition of the patient and status of the EMS system at the time of transport. The on-duty operations supervisor approves transports to non-system hospitals.There are certain conditions that the EMS treatment/transport plans require the patient to be taken to Mission Hospital due to the level of care required. These include: heart attacks, strokes, pediatrics, obstetrics, trauma and burns. Additionally, any critically ill patient will be taken to the closest appropriate facility.