Hall on Patient Care After PE Acquisition of a Tax Exempt Hospital: A “Multi-Faceted Debacle”

From Modern Healthcare

Mark Hall has released another draft chapter in his longitudinal study of the impact of HCA Healthcare’s acquisition of a tax exempt nonprofit hospital.  This one concerns the quality of patient care and the amount of charity care after the acquisition.  Things are certainly not looking good, an outcome the report attributes to ownership’ focus on profit.  We reported just this month that folks in Ashville North Carolina were up in arms about whether HCA has kept its promise to maintain quality and charity care after the acquisition.  Hall’s preliminary report articulates conclusions that won’t do anything to reduce the level of dissatisfaction.  Here is a summary:

BACKGROUND AND KEY POINTS

This preliminary report is one part of a larger study examining what lessons can be learned from the events leading up to, and following, HCA Healthcare’s 2019 purchase of the Mission Health system based in Asheville, North Carolina (NC). Previous installments from the larger research study discuss Mission’s decision to sell to HCA, as well as changes in financial performance, charity care, and quality ratings following HCA’s acquisition.  Adding to that work, this report examines several ways in which patient care has changed under HCA. Connected with, and amplifying, this report is an extensive Appendix that collects, from a range of public sources, narrative accounts from many patients, physicians, nurses, and other clinical staff based on first-handed experiences at HCA Mission.

As a summary of this report’s key points: 

• Many physicians from Asheville’s esteemed medical community have left or have ceased using Mission Hospital regularly, due to dissatisfaction with either (or both) the quality of care at HCA Mission or with HCA’s reduction in their financial support. Most replacement staff are less experienced, and several key specialty areas remain largely or almost entirely vacant.

• HCA has slashed staffing among nurses and other patient-care functions, leading to a host of complaints, from both patients and medical professionals, about patient care and safety. These complaints snowballed into a widespread reputation of HCA Mission being an undesirable place to work, making it more difficult to recruit well-qualified replacement staff, which tends to further exacerbate working conditions.

• Serious understaffing issues have caused a multi-faceted debacle in Mission’s emergency room, resulting in an avalanche of complaints and a series of documented deaths and
substantial injuries arising from delays or mistakes in medical treatment. These adverse developments have been driven by HCA’s financially-focused management decisions, which have been enabled by Mission’s market position as the only hospital in the area’s largest county and the only tertiary care hospital in western North Carolina.

There is obviously a lot of hard work and real deep diving in this effort.  Prior preliminary parts are available via links in this and prior releases.  When the full report is finally released I’m betting it will have a hugely significant impact on debates and decisions regarding tax exempt healthcare. 

darryll k. jones