Specifically, the letter named four issues — a surge in complaints about quality of care, the lack of a sexual assault nurse examiner at Angel Medical Center in Franklin, how Mission Health implements its charity care and uninsured patient policies and the way HCA discloses charges to patients. 

There’s no doubt that Stein has been paying attention to the complaints that have been made during recent public meetings hosted by Gibbins Advisors, the independent monitors hired to oversee compliance following HCA’s purchase of Mission Health. The meetings were held throughout the region and every community had its share of complaints about changes in services, a lack of providers, billing and a lack of communication from the corporation now in charge of their health care needs. 

“The meetings held by the Independent Monitor over the last month have been a constructive opportunity for HCA customers to publicly raise their concerns about Mission Health,” the letter stated. “We have received 30 written complaints about Mission since January 1.”

Many of the complaints have been about the quality of care, including the impact of staffing cuts — especially for nurses. Stein said some of the complaints are “harrowing to read” and are being taken very seriously by his office. 

“We have been told that Angel Hospital no longer has a Sexual Assault Nurse Examiner on staff. These nurses are trained to provide specialized support in emergency rooms to survivors of sexul assualt,” he said. 

Indeed, this concern came up at the public meeting held in Franklin when an employee with REACH of Macon County said she had to transport a rape victim to Asheville because a nurse wasn’t available at Angel Medical Center. 

Stein’s letter also stated that the charity care policy was not clear on what services it covered, which has caused confusion for patients. According to Stein, HCA has chosen to have the chief medical officer personally make the decision regarding whether someone will be covered, but “his busy schedule makes it impossible for physicians to easily contact him.” It seems HCA is only applying the charity policy to emergency care, which Stein said appears inconsistent with the Asset Purchase Agreement. Lastly, the charity policy on Mission’s website does not match the policy attached to the APA. 

Stein said the complaints also align with recent changes in patients’ satisfaction scores. 

“HCA’ facilities have generally maintained their star ratings from the U.S. Centers for Medicare & Medicaid Services, which measures patient care. However, the Mission Asheville hospital has declined in the Leapfrog Hospital Safety Grades,” he said. 

In Leapfrog’s Fall 2019 scores, Mission was a ‘C’ while it had previously received a ‘B’ in the spring of 2019 and earned an ‘A’ in the spring of 2018, 2017 and 2016. 

Stein said he planned to respond to the complaints in three ways — by providing HCA with copies of the complaints and ask for HCA to respond to them; sharing the complaints with regulators at the Department of Health and Human Services who investigate hospital quality-of-care concerns; and by evaluating the complaints to determine whether HCA is failing to provide any services that it promised to provide under the Asset Purchase Agreement. Complaints will also be shared with Dogwood Health Trust and Gibbins Advisors. 

The AG office requested the following information for the 12 months before and the 12 months after HCA’s acquisition of Mission:

1. Utilization rates for financial assistance policies in the Mission Health System under Mission Health System, Inc.’s ownership and under HCA’s ownership.

2. Dollar value of financial assistance provided under Mission Health System Inc.’s ownership and under HCA’s ownership.

3. Dollar value of all write-offs or write-downs of patient bills provided under Mission Health System Inc.’s ownership and under HCA’s ownership.

4. The overall percentage increase or decrease in charges for medical services since the consummation of the sale of Mission Health System.

5. The overall change in gross revenues from medical services since the consummation of the sale of Mission Health System.

6. A list of every individual involved in making coverage decisions for HCA’s financial assistance policies at Mission Health System, by name and title.

7. The average number of cases per week that are considered in the weekly charity care appeal process Dr. Hathaway described.

8. Mission Health’s policies and practices with respect to requiring payment in advance for services delivered in the hospital as they existed before the transaction and as they exist today.

9. A copy of the one-page description of HCA’s financial assistance policies that was distributed to doctors with admitting privileges in the 2019 third quarter meeting.

As for the billing issues, patients have complained about an “outpatient” fee HCA may be charging to patients at Mission-affiliated primary care providers even if the patient never sets foot in a Mission hospital. 

“We ask that Mission provide our office with all disclosures that it made to customers about this outpatient fee. Please respond to this portion of our letter by March 11, 2020,” the letter stated. 

Stein has asked the public to contact Gibbins Advisors and also file a complaint with his office by visiting ncdoj.gov/file-a-complaint/.

Read more about the Independent Monitor meeting held in Franklin by clicking here.