The president of MedWest-Haywood hospital suddenly stepped down this week after three-and-a-half years on the job.

Mike Poore’s tenure at the helm of MedWest-Haywood was marked by an aggressive strategy to restore a crisis of community confidence, rebuild plummeting finances and compete head-to-head with the much-larger neighboring Mission Hospital in Asheville.

The news that Poore was resigning came as a surprise to the medical community and hospital’s board of directors, who met for two-hours Monday to digest the news.

Dr. Benny Sharpton, a long-time surgeon in Haywood County, said the medical community is going to be disappointed at the loss.

“The medical staff was not only comfortable but optimistic with his leadership,” Sharpton said. “He opened up lines of communication that had been broken it he past. He had an open door policy. Not all CEO’s have good rapport with their medical staff.”

Poore will be best known for rescuing the hospital after a tumultuous period when it failed federal inspections and was forced to essentially shut its doors for four months in 2008. The previous CEO, David Rice, who had become a lightning rod of controversy even prior to that crisis, stepped down and Poore stepped in — not only filling a leadership void but also putting the hospital on a path to recovery.

“Within a relatively short period of time, we had regained the market share we had lost. That is not a small feat,” said Dr. David Markoff, an ophthalmologist in Haywood County. “I have enjoyed working with Mike. I am sorry to see him leaving.”

Poore’s family man persona and regular presence at civic and social functions not only built rapport for the hospital but made him generally well-liked around town as well.

“Mr. Poore is one of the finest men I have ever known,” said Dr. Charles Thomas, an oncologist in Haywood County and a hospital board member. “He has done us a wonderful job. We accepted his resignation with deep regret and lots and lots and lots of thanks and platitudes.”

While Poore’s departure seems amicable, many in the medical community are left asking “why now?”

Poore, 47, does not have another job lined up. Depending on where he goes next, his family may stay in Haywood a while before joining him to avoid being uprooted. His son, a football player for Tuscola High School, will be a senior year next year, while his daughter will be a sophomore. His wife is involved in various community civic groups.

Poore is receiving a severance package but the terms aren’t public for now.

Poore said he will look for another hospital CEO position.

“I am a hospital administrator. That is my animal,” Poore said.

Turn-around man

There wasn’t any detectable tension between Poore and the Haywood medical community or hospital board.

But, Poore technically had another boss as well. He answered to Carolinas HealthCare System, a network of 34 hospitals based in Charlotte that MedWest joined two years ago.

Carolinas didn’t have a problem with his performance either, according to John Young, the vice president for Carolinas HealthCare’s western region who Poore reported to.

“This moment is Mike’s choice. This is not because of anything,” Young said. “It is just a certain period of time when it is time for somebody else to come in.”

By all accounts, Poore was dealt a difficult hand when he took the job.

“We will always remember his great leadership in getting Haywood Regional Medical Center back up and running,” said Fred Alexander, the chairman of the full MedWest board of directors.

With no patients to speak of, the hospital’s cash reserves had plunged so low that it had less than a month of operating revenue left when it reopened its doors. Patients who had turned elsewhere for medical care during the closure had to be lured back. And, the historically robust medical community in Haywood County, which had rallied around the hospital, needed reassurance they still had a future in Haywood County.

“He has worked so hard in the past several years to bring this entity, our hospital, upright again,” said Jean Burton, chair of the MedWest-Haywood board and a Cooperative Service agent in family and consumer sciences. “We were so knocked down a few years ago, and Mike worked tirelessly around the clock and has really stuck to the priorities he set.”

With the crisis in the rearview mirror, Poore led the hospital into a new partnership with neighboring hospitals in Jackson and Swain counties. The three hospitals formed a joint venture under the new MedWest banner. At the same time, MedWest joined the Carolinas HealthCare Network.

“I came to the hospital at a time of transition. We have gone through that transition during the last three-and-a-half years. It is just time for me to move on to other things,” Poore said.

Poore’s tenure isn’t uncharacteristically short for a hospital CEO. While the average time at one hospital for a CEO in North Carolina is longer, nationally it is 3.8 years, Poore said. Poore’s time at Haywood was just under that.

“It is not unusual for that turnover, but especially in a circumstance where you have a transition of bringing two organizations together to form MedWest,” Poore said.

There are always rivalries, even if friendly ones, between neighboring hospitals, Poore said. Bringing together two medical communities to act and think like a single entity can be difficult and challenging, he said.

As is sometimes the case in corporate mergers or turn-arounds, the person to affect change does not stay on as the long-term leader, Young said.

“Mike was the man to move the ball,” Young said of Poore’s role during the past three years.

Poore’s total compensation package was $444,000 a year.

Bumps in the road

Poore’s tenure wasn’t without snags, however. His honeymoon period began to fade in recent months, as the financial recovery initially witnessed under Poore began to backslide.

Despite a workforce reduction of 52 employees last year, MedWest has embarked on another round of cuts — 120 positions will be eliminated by July 1.

“It is what we need to do to right-size our organization with the reality of the revenue coming in today,” Poore said. Poore said MedWest is operating under austerity measures until the tide turns.

The layoffs amount to about 5 percent of the 2,100 employees across MedWest, including all three hospitals plus the 16 doctor practices now owned by MedWest.

In the midst of the financial troubles, MedWest-Haywood has seemingly been on a building and spending spree during the past year — from the very necessary replacement of a broken down generator to the very optional construction of a new surgery center.

In the end, MedWest-Haywood saw its cash-on-hand dip so low it had to turn to Carolinas HealthCare for an emergency $10 million line of credit. It was the first time Carolinas has ever loaned money to any of the 34 hospitals in its network.

While Poore defended the loan as no big deal, as Haywood has no other debt on its books, getting bailed of a cash-flow crunch by Carolinas clearly wasn’t ideal.

The loan was precipitated by a series of unexpected costs. Namely, MedWest-Haywood spent more than $10 million to replace a broken generator, upgrade its electronic medical records system and pay out judgments in two lawsuits dating to the previous administration.

Like Poore, Young characterized MedWest-Haywood as a victim of circumstances. Nonetheless, it revealed just how critical the financial status had become.

Build and they will come

While some costs indeed couldn’t be helped, Poore also oversaw an expansion campaign far more voluntary in nature.

A hospice center, a new surgery center and a new urgent care center are in various stages of construction, costing MedWest-Haywood a total of $2.35 million. The amount put up by the hospital is a fraction of the total cost — the lion’s share was paid for by the non-profit hospital foundation and a private group of physician investors.

MedWest also has new MRIs, a new diagnostic lab and new heart catheterization services.

“The hospital is very well positioned to serve patient needs and to grow and to prosper,” said Dr. Charles Thomas, an oncologist in Haywood County and former chief of staff of the hospital.

Young agreed.

“Mike started us down a track. A lot is already in place,” Young said.

The attention Poore gave to MedWest-Haywood didn’t sit well with some doctors in Jackson County, who felt their hospital was being slighted in favor of making Haywood the flagship of the MedWest system, another bump in the road for Poore in recent months. Disatisfaction among the Jackson medical community led to Poore being replaced as CEO of MedWest-Harris and relegated to being over MedWest-Haywood only.

Perhaps the most expensive piece of Poore’s expansion campaign was buying out several Haywood doctors’ practices. The exact cost of the private transactions are not known, but up-front costs aside, the newly bought doctor’s practices will continue to be a drain on the bottom line for another year or two before turning the corner. The hospital has to foot the bill for salaries, equipment, and overhead before the billing for patients begins to pay off.

While costly and perhaps outside the hospital’s realistic budget, it had to be done, according to Dr. Benny Sharpton, a long-time surgeon.

Mission Hospital in Asheville was courting the same physician practices, and Haywood had to make a competing offer. So Poore acted swiftly despite perhaps not having the money to do so.

“It was done in an extremely short period of time primarily due to outside threats from Mission hospital trying to siphon the loyalty of our doctors off,” Sharpton said. “He took that on in a difficult time. It needed to be done. It had to be done.”

While Poore has taken criticism from some for overspending or failing to enact austerity measures sooner, others disagree. When faced with embattled finances and dwindling market share, MedWest-Haywood had a choice. It could retrench and scale back. Or it could move forward with guns blazing.

Rather than resigning Haywood to being a rural second-fiddle hospital in Mission’s shadow, Poore chose to push Haywood onto a bigger stage.

“He has already laid the foundation,” said Cliff Stovall, a MedWest-Haywood board member. “The person that does all the spade work doesn’t always get to enjoy all the glory.”

The track set in motion by Poore will hopefully continue by the leadership team still in place, said Stovall.

“As much as I hate to see Mike ago, we are glad to have the people he put in place,” said Stovall, a retired army colonel who now works in tax preparation.

Poore assembled a nearly all-new management team for the hospital after he was hired, bringing on board more than a dozen vice presidents and department heads within his first two years.

Poore gives credit to the entire team for the advances that have been made.

“I am so proud of the accomplishments the team has made,” Poore said. “I feel like I am leaving this in good hands on a go-forward basis.”

Haywood County commissioners this week gave their blessing to a $10 million line of credit for the MedWest-Haywood hospital, ending a delicate dance in the finer points of contract law that has spanned the past three months.

The loan was needed to solve a serious but short-term cash flow crunch brought on by a concatenation of unexpected costs. MedWest-Haywood had turned to the powerhouse of Carolinas HealthCare System, a network of 34 hospitals that Haywood is part of, to help bridge the gap.

The status of the loan has been in limbo, however, as county commissioners wrestled with whether to allow MedWest-Haywood to put up the hospital building as collateral. While highly unlikely, if the hospital failed to pay back the loan it could be foreclosed on. The worst-case scenario concerned county commissioners, preventing them from initially signing off on the loan.

Without commissioners’ blessing, the loan was in limbo. The county’s measure of control over the hospital building dates back to its original status as a public hospital — a status county commissioners felt compelled to protect.

Commissioners finally arrived at a series of caveats that would allow the loan to go forward.

“It protects the county’s interest but allows for a way forward for the hospital,” County Commission Chairman Mark Swanger said.

Commissioner Mike Sorrells agreed.

“We wanted to provide the hospital with the means to get over get over this bump in the road, as it is being called, but continue to maintain a viable county hospital,” Sorrells said.

MedWest-Haywood CEO Mike Poore said the hospital is not in dire financial straits, but it is operating under austerity measures and has been forced to lay off some employees as it regains its footing from a series of set-backs.

Poore pointed out that the $10 million loan is the only debt the hospital has — compared to its annual operating revenue of $110 million and a building worth $70 million.

“To have an organization with that little debt ratio in today’s world is really amazing,” Poore said.

Collateral with caveats

Swanger stressed that the process has in no way been adversarial between the county and the hospital.

“I think I can speak for everyone up here when I say we want the hospital to succeed and thrive,” Swanger said at a county meeting this week. “We have an obligation to protect the county’s interest and taxpayers’ interests, but the process of doing that has not been adversarial.”

Poore said he would “echo that.”

“The commissioners have been asking the right questions and doing their fiduciary responsibility, but the whole time the interest is how can we help our hospital along,” Poore said.

Specifically, the county agreed to let the hospital put its building up as collateral if the county is given the first right of refusal, so to speak. Should the hospital default on its loan, Carolinas HealthCare System could not foreclose without coming to the county first.

The county would be given the option of paying off the loan itself. The hospital would then be on the hook with the county to pay back the loan rather than to Carolinas.

“Should there be a default rather than just a normal foreclosure, they first have to give the county notice,” explained Haywood County Attorney Chip Killian. “The county has six months after that notice to kind of figure out what they are going to do — to decide whether they want to purchase the note and in fact be the lender instead of Carolinas.”

If the county indeed decides to bail the hospital out, it would have another 12-month window to put together a financing deal to “satisfy and cure the default.”

The caveats written into the loan drew on the best contract-writing skills Haywood County Attorney Chip Killian could muster.

“There is a lot of legalese in this document, but I had to craft this out of whole cloth because I had never seen anything like this before,” Killian said.

A ‘perfect storm’

Poore said that the need for a loan isn’t a sign of financial insecurity.

“We had several events that were what I would describe as a perfect storm of cash issues,” Poore said. “The clock ran out on us. There were too many things that hit us at the same time.”

MedWest-Haywood had to spend $1 million to replace a broken generator, $1.6 million on a wrongful firing lawsuit by group of emergency doctors and $8 million on a new computer system to handle electronic medical records.

The hospital also spent an undisclosed sum in the past year buying up private doctors’ practices that were being courted by Mission Hospital in Asheville. MedWest-Haywood feared long-term repercussions of a patient drain if it didn’t make a competing offer.

“It is a lot more complicated than ‘the hospital is in some economic trouble,’” said County Commissioner Kirk Kirkpatrick said. “There have been a lot of hurdles we have had to get over. I hope we are at the point we are making that turn.”

Meanwhile, however, the hospital has already spent $7 million of the $10 million loan. Carolinas Health System had already extended the loan to MedWest-Haywood — and Med-West Haywood had begun spending it — before they realized the county’s blessing was needed for the collateral.

Carolinas could have retrenched and frozen the line of credit when the county didn’t promptly sign off. Instead, Carolinas allowed MedWest-Haywood to keep spending against the line of credit, allowing the balance to grow to its $7 million mark.

A $10 million line of County credit intended to bridge short-term cash flow problems at MedWest-Haywood hospital has hit a snag.

A loan taken out by the hospital offers up the hospital building as collateral but legally it needs approval from county commissioners to do so.

The MedWest board failed to seek necessary approval from the county before taking out the loan, however. The hospital had already signed on the dotted line and promptly begun spending some of the loan money before the oversight was realized, prompting the hospital to seek the county’s retroactive blessing.

But, county commissioners apparently have not been willing to rubber stamp the loan. The hospital came to the commissioners six weeks ago for their approval on using the hospital building as collateral.

Since then, county commissioners have held three private meetings, which were closed to the public, citing attorney-client privilege, to discuss the loan conundrum.

Formerly known as Haywood Regional Medical Center, the hospital has a clause in its deed that prevents any transfer of the property without county approval. In the unlikely case the hospital defaults on the loan, the lender could not in fact take the building, making the current loan documents partially invalid unless the commissioners give their blessing.

Commissioner Chairman Mark Swanger said commissioners are working with the hospital to come to a suitable arrangement that helps the hospital move forward but still safeguards the building in the event of a default.

“We generally have two goals,” Swanger said. “One is that there be a viable thriving hospital in Haywood County and the second is to protect the county’s interest in the property.”

Meanwhile, the Jackson County medical community has expressed dissatisfaction that their hospital in Sylva, which is part of the MedWest system, ended up on the list of collateral for the loan.

A shorter list, in fact, might be what didn’t get listed as collateral. In all, the loan documents list enough collateral to pay the $10 million many times over. Accounts receivables are at the top of the collateral list — essentially every payment coming into the hospital could be garnished to cover the loan, which in itself would be more than enough to cover the debt. Collateral also includes all the medical equipment in the hospital, as well as the MedWest Health and Fitness Center.

The actual hospital itself, along with the MedWest-Harris and MedWest-Swain hospitals, are far down the list.

So why even list them as collateral? It’s the nature of financing these days, with skittish lenders requiring everything but the kitchen sink, and in some cases even that, to secure a loan, according to Mike Poore, CEO of MedWest-Haywood.

MedWest-Haywood has spent $4 million of its $10 million loan so far. The hospital has no other debt. And that’s why Poore is confident the debate over whether the building is included as collateral is a largely a moot point.

“There are several dominoes,” Poore said, listing all the collateral that would be tapped first in the event of a default before the hospital itself would ever become an issue.

Even then, the loan would merely take the form of a lien against the hospital, as the hospital is worth far more than the $10 million loan.

Indeed, the debate over whether the hospital should have been used as collateral on the loan seems to be playing out more on a matter of principle.

“If we thought there was much chance of default we wouldn’t be doing this. We felt we would be in and out of this moment,” said John Young, vice president for Carolinas HealthCare’s western region.

In an unusual financing arrangement, Carolinas HealthCare System has agreed to act as a bank and put up the money from its own reserves for the loan to MedWest-Haywood. MedWest-Haywood is under a 15-year management contract with Carolinas HealthCare, a network of 32 hospitals under the flagship hospital of Carolinas Medical in Charlotte.

Despite the large number of hospitals under the wing of Carolina’s management, it has never stepped in to provide financial help for an affiliate hospital.

“It has never been done before,” said Young. “I don’t know we will ever do it again, but at the time, it was the right thing to do.”

Young said Carolinas made an exception given the circumstances. For starters, the Haywood hospital desperately needed the money to bridge a short-term cash flow crisis brought on by a perfect storm of financial hits.

MedWest-Haywood had to spend $1 million to replace a broken generator, $1.6 million on a wrongful firing lawsuit by group of emergency doctors and $8 million on a new computer system to handle electronic medical records.

The hospital will actually be paid back for part of the cost of electronic medical records system by the federal government in coming years, Poore said.

“These are what you would consider one-time expenses. We knew we would have to get some kind of financing to help us through,” Poore said.

The hospital also spent an undisclosed sum buying up private doctors’ practices during the past year. It didn’t have the budget to do so, but the practices were being courted by Mission Hospital in Asheville. MedWest-Haywood feared long-term repercussions of a patient drain if it didn’t make a competing offer.

While the hospital was in the black last year, its margin was so slim — around 1 percent — it didn’t have the cash flow to cover the unexpected one-time costs.

“It is not a symptom of the engine being dysfunctional in any way,” Young said. “We realized this liquidity issue would go away, so we decided to lend them the money to get through this moment.”

Smoothing out the wrinkles

Meanwhile, the newly formed MedWest allegiance — a merger of sorts of the hospitals in Haywood, Jackson and Swain under an umbrella organization — need help finding its footing.

“Coming together under MedWest was trying to happen in a very difficult time under a very difficult set of circumstances,” Young said, offering further explanation of why Carolinas stepped up to the plate financially.

The recession was taking its toll on hospitals everywhere, particularly smaller, rural hospitals. And here, the hospitals in Haywood and Jackson were facing tougher competition than ever from Mission Hospital in Asheville.

Meanwhile, the relationship with the Jackson County medical community toward MedWest was strained. A large number of doctors in Jackson County had come forward to express concerns about how their hospital was faring under the new MedWest entity.

Carolinas has been asked for help many times by cash-strapped hospitals operating on razor-thin margins. It’s a frequently asked question by smaller hospitals when weighing whether to join Carolinas’ umbrella.

“One of the things that usually comes up is would you be willing to put capital in. Our answer is always ‘no,’” Young said. “That is not our model. Our business model is to help local hospitals find economies of scale and have the expertise to be successful in a very difficult marketplace. It is hard to do it alone.”

Poore said the financial problem faced by MedWest-Haywood is partly inherited. The hospital couldn’t get a traditional loan from a lender.

The once deep-reserves of MedWest-Haywood were spent up during a faltering time four years ago when the hospital failed federal inspection, largely on technicalities, but the resulting decertification by Medicare, Medicaid and several major insurance carriers forced the hospital to essentially shut its doors for five months. Its reserves were depleted as a result.

“I wish it could have happened a different way,” Poore said of the need for the loan from Carolinas. “I wish we had all the credit in the world and everyone was knocking down our doors to give us credit.”

Poore sees the loan more like a line of credit, a very common financial tool used by corporations both large and small.

“The line of credit is helping us pay for a lot of one time expenditures we’ve incurred this year,” Poore said.

Poore said it wasn’t altogether clear initially whether they actually needed county commissioners to sign on the dotted line.

“At one point, we had 11 attorneys on the phone trying to put this deal together,” Young said. “It is unusual for one hospital to loan another hospital money.”

Poore pointed to the proactive steps MedWest-Haywood has taken during the past two years that will start paying off. It has employed doctors practices, has an outpatient surgery center under construction on its campus, has a new urgent care slated to open in Canton in the spring, and has recruited several new doctors, including a new urologist, cardiologist and neurologist just recently.

These days, it is all about fighting for market share against Mission, and that’s what Poore has been positioning Haywood to do.

“There is a demand, and if we can meet that demand, we can keep those patients here,” Poore said.

Steve Heatherly made sure there were plenty of Diet Cokes queued up in the office mini-fridge before work Monday morning — he would need at least a dozen, probably more, to get through the next 24 hours.

Heatherly faced hundreds of nurses, doctors, lab techs, billing clerks, cafeteria workers  — anyone and everyone who works at MedWest-Harris hospital in Sylva — for a full day and night this week. Every hour on the hour, he repeated a short spiel laying bare the challenges and issues facing the hospital before turning the floor over to questions from a steady stream of hospital workers rotating through for the interactive marathon.

“In our current environment we felt like as quickly as possible I have the opportunity to interact with as many of our employees as possible in a very rapid succession,” said Heatherly, the newly promoted CEO of the two WestCare hospitals, MedWest-Harris and MedWest-Swain.

Heatherly likely touched on the challenge of competing for market share against Mission Hospital in Asheville. He allayed concerns that the hospital was struggling financially — at least not hopelessly so — but also charted a course for a better bottom-line.

Billed as a “frank and open dialogue,” Heatherly was bound to get questions about why he was suddenly put at the helm two weeks ago — giving Harris its own leader rather than sharing a single CEO with MedWest-Haywood as it has for the past two years.

The move signaled a retrenching of sorts following a pseudo-merger of the neighboring hospitals two years ago after they both signed a management agreement with Carolinas HealthCare System out of Charlotte. It is also a reflection of discomfort among some in the Jackson medical community about whether their hospital was getting the attention it deserved from a CEO based in neighboring Haywood County.

“Any time those type of administration changes come about, obviously people have lots of questions,” Heatherly said. “They are interested not only in the present but also the future.”

The epic, uber-long format was an effort to hit all hospital employees on every shift, bringing the whole staff up to speed at once but in the comfort of small group sessions — all the while keeping the round-the-clock operations of the hospital humming.

“He is a straight shooter,” Bunny Johns, the chair of the WestCare board, said of Heatherly. “What you see is what you get, and he will lay it on the line for you. I think it is a real talent to do that in a way people can hear it.”

For the record, Heatherly isn’t a big coffee drinker — thus the arsenal of Diet Cokes.

More ‘boots on the ground’

Meanwhile, Mike Poore has returned to being the CEO of MedWest-Haywood only. When the MedWest partnership was formed two years ago, Poore went from being the CEO at Haywood to being CEO of all three hospitals. But, that changed somewhat suddenly two weeks ago.

The stated reason: to give each hospital their own in-house leader that could singularly focus on the issues each location face.

“It makes sense for both of us to put more time into our individual organizations,” Johns said.

Things haven’t exactly been rosy for the Jackson medical community since the affiliation. Patients have been lost to Asheville. Revenues are down. The downward trend was already in play before the merger, an unfortunate combination of a doctor shortage in Jackson and the economy. But some doctors wonder whether the merger with Haywood has helped matters.

“It hasn’t gone down any more, but it hasn’t come back up,” said John Young, vice president for Carolinas HealthCare’s western region.

Several doctors apparently came to the WestCare board of directors with their concerns, thus the CEO shuffle that Young calls “more leadership boots on the ground.”

“I wanted to make sure the folks on the WestCare side of the system knew that Steve (Heatherly) had the authority to work with them to solve issues and win back market share,” Young said.

Working well with doctors

Heatherly isn’t a stranger to the staff at Harris. He has held various top positions at WestCare during the past 15 years. He spent a good part of his childhood in Sylva, went to UNC-Asheville, then got his MBA at Western Carolina University and a second masters in health administration from UNC-Chapel Hill.

He started out at WestCare in 1997 over a subsidiary company that handled physician management and billing and spent nearly a decade on the frontline of doctor-hospital relations.

Heatherly had worked his way up to second in command at Harris, serving as both the chief financial officer and chief operation office, when the merger happened. He was given a new title of chief strategy officer.

Meanwhile, however, the ranks of doctors employed directly by the hospital was swelling. MedWest now has more than 80 doctors on its payroll, a major change from the days not too long ago when doctors all worked in their own private practices.

Heatherly’s skills working with the physician community were tapped for a new position of CEO of MedWest’s physician network. He is continuing to serve in that role as well as his new role of CEO of the MedWest-Harris and Swain.

Heatherly has learned a thing or two about working with doctors over the years, and has occasionally been asked to share his insight.

The relationship between any hospital and its doctors — whether in private practice or employed by the hospital — can take many forms. Some are outright adversarial, and even the rosiest relationships have their share of tension.

“I think the pitfall for a lot of hospitals is if you aren’t fully engaged,” Heatherly said. “You really don’t even have to have active discord, but if a hospital and medical staff aren’t fully engaged then you run the risk of not walking in lockstep. Through no ill will, not being actively engaged can lead to a disconnect. You don’t always have to be in agreement, but the process of going through the dialogue is very, very important.”

That attitude could make Heatherly just the man to iron out concerns of Jackson County’s medical community.

“He is highly motivated. He is highly intelligent. He is well versed in medical systems,” Johns said. “He will bring a level of energy that is impossible to put down on paper.”

Some within the Jackson County medical community are wondering whether their hospital has gotten a fair shake in the partnership forged with neighbor Haywood County under the MedWest umbrella two years ago.

When the hospitals in Haywood, Jackson and Swain counties partnered, they were careful to avoid the word “merger.” Technically, it was an affiliation, according to hospital leaders.

But at the end of the day, it looks an awful lot like what most people would call a merger. The hospitals share each others’ financial gain — or pain — as it may be.

“At the end of the year, we take the bottom line and split it 50-50,” said Mike Poore, the CEO of MedWest-Haywood.

The hospitals keep their own books from day to day, but come year’s end, the profits and losses of each are averaged out.

Steve Heatherly, the CEO of MedWest-Harris, calls it “financially integrated.” In slightly more layman’s terms, Bunny Johns, chairman of the WestCare board, likened it to a “financial truing up.”

That’s likely why some in Jackson’s medical community may be resentful of big bucks seeming to fly out the door of MedWest-Haywood during the past year.

MedWest-Haywood has seemingly been on a building and spending spree during the past year — from the very necessary replacement of a broken down generator to the very optional construction of a new surgery center. Meanwhile, however, the medical community in Jackson has watched as its plans for a new emergency room and major hospital renovation has been sidelined.

“Any individual who is prone to analyze that very critically, sure someone could be upset by that,” Heatherly said of the spending disparities between Haywood and Harris.

But a partnership like this one can’t be sized up from a one-year snapshot, he said.

“When you put together in essence a capital plan with multiple facilities, in any one year it might be perceived that one of those facilities benefits more,” Heatherly said. “But over the long haul, the goal is to make sure the needs of all facilities are met.”

One day, the tables may be turned and likely will. Harris has jumpstarted plans once more for a new emergency room, which will likely carry a $7 million price tag.

Poore said the spending in Haywood has been necessary. In many cases, the hospital’s hand was forced. A generator broke down. A lawsuit was settled. Computer systems needed updating.

But, what about the surgery center, new hospice center or urgent care in Canton?

Johns said the picture isn’t as skewed as it may seem on the surface.

“Most of those were in place and moving before the merger,” Johns said.

But more so, what appears to be spending by the hospital was in fact paid for by outside sources. Doctors put up most of the money to build a new surgery center in Haywood, while the nonprofit MedWest-Haywood Foundation raised money for the hospice center. The hospital, for its part, contributed $2 million combined to those projects.

A new urgent care center coming on line in Canton is costing $150,000. But one was built in Sylva as well, evening the scales on that particular expense. Besides, an urgent care center is a case of spending money to make money. It helps capture patients.

Here’s the spending at Haywood in a nutshell:

• A hospice center, a new surgery center and a new urgent care are in various stages of construction, a total of $2.35 million.

• The back-up generator broke and a new one cost $1.3 million.

• Money has been put on the table to buy physician practices, bringing more than two dozen doctors on the hospital’s payroll in Haywood County.

• The biggest ticket item is an $8 million medical records system. While the biggest need for the new system stemmed from Haywood, the cost also includes upgrades for the hospitals in Jackson and Swain, as well as computer systems to tie in to the burgeoning number of in-house doctors practices across all three counties with the hospital system.

• Hardly the stuff of bragging rights — but expenses nonetheless — are payouts in two old lawsuits, roughly $1.75 million in all.

Bringing docs on the payroll

One expense weighted toward Haywood since the merger is the buyout of doctor practices.

Doctors nationally are cashing in the hassles of private practice for the steady paycheck of being a hospital employee. They no longer have the freedom of an entrepreneur, but they are free to simply practice medicine without worrying about the business side.

The transition has proven costly for hospitals, however.

“It is not an inexpensive proposition to employ physician practices,” Johns said.

The hospitals nor doctors will reveal exactly what it cost to buy the practice. But, the expense doesn’t stop there. The hospital has to assume payroll and overhead immediately, but there is a several month lag before billing catches up, putting a dent in the hospital’s cash flow.

Both WestCare and Haywood had fallen behind in the arena of employing doctors compared to the national trend, however. As doctors retired or moved away, the hospitals were struggling to attract new ones without being able to offer in-house employment.

“The traditional model of recruiting physicians into private practices was no longer working,” Heatherly said.

So starting five years ago, Heatherly led a campaign to bring doctor’s practices under employment of Harris.

“The potential loss of additional market share far outweighed the investment we needed to make,” Heatherly said. “The good news is we have been able to stabilize market share and now our focus has been to demonstrate to the community we are here and have an engaged group of physicians and employees who are very interested in meeting the health care needs in our community.”

Haywood, however, didn’t have that luxury.

While WestCare was on its aggressive campaign to employ doctors, Haywood was struggling to rebuild its image after failing federal inspections. The hospital was decertified and essentially closed its doors for five months in 2007.

It wasn’t exactly in a position to bring doctors onto its payroll. And doctors most likely weren’t going to sell their practices and go to work until they were sure the hospital was on solid ground.

And thus, it was catch up time.

“The pace of question activity certainly picked up over there,” Heatherly said of Haywood during the past 18 months.

Despite his WestCare roots, Heatherly is the first to admit it was worth the money to buy the doctors practices in Haywood County. The doctors were being courted by Mission Hospital, who was making forays to buy doctors practices in Haywood as part of a fight for market share. Heatherly said Haywood had to step in to protect its turf.

John Young, vice president for Carolinas HealthCare’s western region, also agrees with the move.

“If they hadn’t done it somebody else would have,” said Young, who works for the Charlotte-based hospital system that has a management contract over MedWest.

Perfect storm

Other things on the expense list simply couldn’t be helped — namely the lawsuits and blown generator.

“You have to have back-up generation for your hospital,” Young said.

The biggest financial hit by far was an $8 million system for electronic medical records. The expense was once again seen as spending on Haywood’s side of the ledger sheet, but it’s more complicated than that, Poore said.

When the hospitals partnered, each had a different computer system for electronic medical records.

WestCare’s was seen as the best system of the two, so Haywood had to ditch its system and start over. The cost includes some upgrades for WestCare’s portion of electronic medical records. The cost also includes bringing all the doctors employed by MedWest onto the system as well.

From Poore’s perspective, the expense was for all three hospitals.

Haywood also took a hit from two old lawsuits. Both date to the former hospital administration. One quite literally: the suit was filed by the former hospital administrator to pay out accrued vacation. The hospital settled for $150,000 in back pay.

The other was a $1.6 million judgment against the hospital in a suit filed by ER doctors wrongfully ousted at the hands of the former administration.

“It was before us, but in the end, you have to pay what you have to pay,” Young said.

But neither lawsuit was factored into the profits or losses split at year’s end. Those were backed out and kept on Haywood’s side, meaning Haywood took the whole hit of those rather than factoring them into the shared profits and losses.

Harris next in line

Harris’ turn is indeed next, hospital leaders promise.

Five years ago, Harris was in the throes of designing an ambitious $18 million expansion and renovation. Plans called for a new emergency room four times bigger than the current one, as well as major renovations and additions to various parts of the hospital.

But, the recession sidelined the plans.

“We found that health care is not recession proof,” Johns said.

Unfortunately, the project at Harris had to wait.

“We have been juggling a lot of priorities,” Johns said.

With those now out of the way, however, a new emergency room for Harris is now back on the table as the “top priority,” Johns said.

“The ED is at the very top of the list,” Heatherly agreed.

It won’t be as big as once hoped for — likely only doubling the size of the emergency room and minus the related hospital renovations, for a much smaller price tag of only $6 to $7 million.

Still, that’s a lot of money. It will take borrowing, and that can’t happen until Harris is able to improve its financial bottom line.

Heatherly said MedWest-Harris needs to show “some good, sustained financial results” before the project gets the final green light, so it is hard to say exactly when it will happen.

WestCare is already carrying $14 million in debt on its books dating to various expansions on both its Sylva and Swain a decade ago.

MedWest-Haywood, on the other hand, has only about $4 million in debt, recently assumed as a line of credit from Carolinas Health Systems, which has a management contract over MedWest.

The MedWest system had a profit margin of 0.8 percent last year. It is aiming for 1.1 percent this year.

While slim, it is only slightly below what most small or mid-sized hospitals are pulling in these days. The margins also include depreciation, which artificially deflate what the hospital actually made in hard cash at the end of the day.

Concerns among Jackson County doctors that Harris Regional Hospital is not thriving as it should under a partnership with Haywood Regional Medical Center has prompted a change in top leadership.

Harris once more has its own CEO, and Haywood will be under its own CEO. This marks a step back from the shared management structure the hospitals were moving toward.

“Right now, it is clear that we need to have two very strong managers focusing on their specific campuses,” said Fred Alexander, chair of the MedWest Board of Directors, the umbrella partnership for the Haywood, Jackson and Swain county hospitals.

Until last week, Mike Poore served as the CEO of all three hospitals as well as the umbrella partnership of MedWest. Poore has now been pulled back to his former role of being over Haywood’s hospital only. WestCare, which includes both Harris and Swain County Hospital, will have its own CEO in Steve Heatherly, who was second in command at WestCare prior to the partnership and since then has served the head of the MedWest Physician Network, which employs more than 80 doctors.

Poore said he wants whatever is in the best interest of all three hospitals, even if that means a change in his job title.

“We have to be laser focused on giving the absolute best care at each of our hospitals,” Poore said.

When Harris and Haywood hospitals formed a partnership two years ago, the CEOs of both applied for the top job over the new MedWest entity. While Haywood was seen as pulling for Poore, Jackson was seen as pulling for its own CEO at the time, Mark Leonard. When Leonard did not get the top spot, he left rather than staying on in some other capacity.

Now, Heatherly may be the next best thing. He has been at Harris since 1997, working his way up to CFO, chief operating officer and executive vice-president. Heatherly got his MBA from Western Carolina University.

Alexander said several physicians recently brought their concerns about the direction of Harris to the hospital’s board and management team.

“I think their sincere motivation is to try to see the hospital operating more smoothly,” Alexander said. “As a result we felt both hospitals needed to have direct hands-on management. Our whole desire is to resolve any issue that is present.”

And the clock may be ticking. If Jackson’s medical community isn’t satisfied, they could lobby to pull out of the MedWest partnership in 2013.

While dissolving the partnership may not be particularly easy, there was a clause in the contract forming MedWest that allowed for an out after three years — which is coming up next year. But it would take a super majority of MedWest’s board of directors to terminate the partnership. The board has 14 members — with Haywood and WestCare evenly represented with seven members each — and 75 percent would have to vote to dissolve. Barring that, legal arbitration could be an option.

Not uncommon hiccup

In addition to partnering under the MedWest umbrella, the entity also signed a management contract with Carolinas Health System, a network of 30 hospitals under the flagship Carolinas Medical in Charlotte.

Carolinas Health System has been an astute observer in recent years of mergers and partnerships playing out with smaller hospitals across the state. Hiccups like this are not uncommon, according to John Young, vice president for Carolinas HealthCare’s western region.

“We need someone living and breathing and spending all their time on each side,” Young said. “When you have people going back and forth you feel like nobody is getting the full attention of anybody. We decided it was time to make sure we had enough boots on the ground in terms of leadership.”

Neither hospital has a particularly easy row to hoe these days — whether together or alone. Hospitals and doctors have all been impacted by the recession, as consumers cut back on health care spending and insurance companies and Medicare lower their reimbursement rates.

But the financial challenges in Haywood and Jackson have been exacerbated by competition from Mission Hospital, which has been chipping away at market share of the local hospitals in recent years.

“We have lost too many patients out of our marketplace and that is putting financial stress on the entire organization,” Young said. “If we get grow bigger and get better a lot of this stuff will just fall away.”

The MedWest partnership is still relatively new, and there is naturally going to be an adjustment period as hospitals and doctors who used to be independent begin thinking collectively, Young said.

“We probably are moving it back a little bit form the direction we were going, but if that helps both sides be more successful, then it will help MedWest be successful,” Young said.

As the CEO of all three hospitals and MedWest at large, Poore brought a more collective approach that perhaps the hospitals and medical communities weren’t ready for yet.

“We haven’t been meticulous about accounting this widget went to that campus and that widget went to that campus, but we are going to start doing that,” Poore said.

Several administration functions have been consolidated by the partnership. MedWest shares a nutrition department, marketing department and purchasing department, for example.

But medical care and health specialties have not been consolidated, and there are no plans to make patients trek to either-or hospital depending on the type of treatment they need.

“The end game of everything we are trying to do through MedWest and the individual hospitals is to provide local services for local people,” Alexander said.

Alexander pointed out that if the business side of a hospital — namely how good or bad the hospital is faring — always seems to capture headlines, that’s because it is directly related to its mission.

“Most succinctly, if a hospital wants to do good for its community it must do well financially,” Alexander said.

Alexander said the hospitals may return to a single CEO model at some point.

“We don’t see this as a permanent set up, but for the foreseeable future,” Alexander said. “Change is your middle name if you are a hospital these days. In the life cycle for any organization the form has to follow the functions that are at hand.”

By Kate Queen • Guest Columnist

At the beginning of December, Mountain Medical Associates, an established, multi-specialty internal medicine practice in Clyde, joined the MedWest Physician Network. Our new affiliation with MedWest is a continuation of Mountain Medical Associates’ longstanding commitment to provide high-quality healthcare in this community.

Mountain Medical Associates grew out of a practice founded in 1964 by Dr. Ralph Feichter, a Haywood County native whose medical training included work at the Mayo Clinic. That experience inspired him to develop a clinic here where physicians could collaborate to meet the needs of patients with complex medical problems, a model we believe has enhanced care as well as physician satisfaction.

Over the past nearly 50 years, Mountain Medical Associates has supported community healthcare initiatives throughout Haywood County. Dr. Feichter led the effort to relocate the hospital to its current central location in Clyde. The members of Mountain Medical Associates also played key roles in the development of the hospital Health and Fitness Center and the Osteoporosis Center, and continue to strive to build innovative programs on the hospital campus.

Mountain Medical Associates has 12 providers who specialize in internal medicine, pulmonary medicine, gastroenterology, rheumatology and neurology. The current environment for recruiting new physicians with the level of knowledge and training we believe our patients deserve is challenging. Most recently trained physicians want the benefits of a formal affiliation with a health care system.

Becoming part of the MedWest Physician Network will help to attract high-quality health practitioners to serve this region and secure the presence of a multispecialty practice like ours in this community.

One of the other benefits to becoming part of the MedWest Physician Network will be the opportunity to use a unified electronic medical record system which will enhance our ability to offer seamless care and avoid the fragmented transfer of information and at times unnecessary duplication of testing that unfortunately has been part of usual care in this country

We want to assure our patients that our commitment to them will not change and that we will all continue to provide care in our current long-term location. We are welcoming patients seeking internal medicine providers and will continue to embrace our commitment to securing excellent health care for all of Haywood County.

(Dr. Kate T. Queen, M.D. has practiced rheumatology at Mountain Medical Associates for 25 years. She  received her M.D. from the University of North Carolina in Chapel Hill where she also did her residency in the Department of Medicine. Call 828.452.0331 or visit www.mountainmedicalassociates.com for more about the practice.)

The medical community in Western North Carolina is embroiled in a debate over Mission Hospital — should its influence and reach be reined in or given the freedom it needs to serves as the region’s health care leader?

A state committee is examining whether Mission needs more checks on its health care monopoly, and will hold a public hearing on the issue at 6 p.m. Thursday, Oct. 20, at the WNC Agricultural Center in Asheville.

Physicians in surrounding counties fear encroachment by Mission could siphon patients away from their local hospitals to Asheville, despite the same quality of care and caliber of physicians serving in their community closer to home.

“You have to have a certain volume of business to be viable,” said David Markoff, an ophthalmologist in Haywood County. “At some point, you reach this tipping point where you can’t keep quality health care locally because the physicians aren’t busy enough.”

Mission has made overtures to buy physician practices in Haywood County and has set up an outpatient clinic for doctors from Asheville to hold office hours in Haywood on select days. If successful, this could result in patients being sent to Mission for procedures and take business away from MedWest-Haywood.

Janet Moore, vice president of communications for Mission, said Mission is trying to fill in gaps of medical specialties that aren’t accessible now, citing a doctor shortage in America that could grow more acute for the region.

Yet that doesn’t explain why Mission is courting local doctors to join its payroll, nor accounts for all the doctors, including general orthopedists, coming over the county line to set up shop in Haywood.

Graham Fields, a spokesperson for Park Ridge Hospital, said Mission’s maneuvers could ultimately undermine patient choice by squelching the free market.

“Missions’ success is inversely proportional to small hospital’s success. As Haywood gets better at keeping patients at home, Mission loses business and has to get more aggressive,” said Fields.

Mission currently attracts about 32 percent of Haywood County’s impatient market share.

Mission sees itself unfairly placed in the crosshairs, however.

“Rather than stepping back with the patient at the center saying what’s right for the region, we have a lot of politicking, frankly,” Moore said.

Mission, however, isn’t the only one playing offense. Carolina’s HealthCare System has brought four hospitals in the region — including Haywood, Jackson and Swain — under its management umbrella. It is based out of Charlotte and dwarfs Mission.

“Carolinas has a footprint that reaches from Murphy to Manteo,” Moore said.

Mission seems to be concerned that Carolinas could funnel specialty care away from it. It is a troubling prospect as Mission’s thin margins grow even thinner. More patients lack insurance and are being written off as charity cases, while Medicaid and Medicare continue to reduce their level of reimbursements to hospitals.

“What you have is a pie that isn’t getting any bigger,” Moore said. “Nobody can afford to lose market share. Everybody wants to stay where they are or get better.”

Markoff said Asheville has attracted lots of doctors since it is such a desirable place to live.

“Asheville has too many physicians for the patients in Buncombe County. They have to pull patients in from surrounding counties to keep their physicians happy,” Markoff said.

Mission is governed by anti-trust regulations dating back to its merger with St. Joseph’s 15 years ago.

“We are the most regulated hospital in the state of North Carolina and in the United States. We live under a microscope and have for 15 years,” Moore said.

Mission sent out a mass email to employees and community members encouraging them to come out and voice support for Mission.

“If you are an employee who is planning on attending and would like a boxed dinner, please click below,” the email read.

A new $9.3 million surgery center in Haywood County is being financed with equity put up by 20 doctors in the community who invested capital in exchange for a real estate interest in the project.

The hospital will lease the space, outfit it with equipment and manage its operation, but won’t pay for any of the construction costs.

MedWest CEO Mike Poore said the hospital could have afforded to build the surgery center on its own if it had to, but prefers the business structure.

“We could have taken on the debt, but what’s more important is it has our physicians invested even more in the health care of our community,” Poore said.

Poore said the hospital-physician partnership makes the outpatient surgery center all the more unique.

The business arrangement marries the hospital and physician community. Now more than ever, their success is contingent on the other.

The doctors will profit from the lease paid by the hospital. The hospital profits from the patients the doctors will rake in.

Also involved in the project is Meadows and Ohly, a development company out of Charlotte that builds medical offices and outpatient centers. The firm will act as the general partner and orchestrate the construction.

The 20 physicians who bought shares in the project as limited partners fronted nearly one third of the building’s cost, accounting for all the equity.

At first blush, the number of doctors who bought in to the outpatient center is impressive — more than 20 percent of the doctors practicing in Haywood.

But it is a fairly fool-proof and risk-free venture. As long as the hospital keeps leasing the space, they’ll get a return on their investment.

Dr. Luis Munoz, a pathologist, said for some doctors who put up money, it may have seemed like an attractive real estate investment. But for most it was out of their conviction to support health care in the community they serve.

The project didn’t exactly hinge on the financial backing of physicians.

“I could always do it with my own equity,” said Jay Bowling, vice president of Meadows and Ohly.

And the firm could have kept all the profits for itself.

“Are we leaving money on the table? Probably,” Ohly said.

But, the project is much stronger thanks to doctors’ involvement, Bowling said. And certainly less risky.

Its success is nearly guaranteed since the doctors are doubly vested: not only in their own practices but also as a real estate investor. The more business they bring in, the better surgery center does, and the more they get back on their lease.

Storied history

An outpatient surgery center has been in the works for more than a decade, but at one time was a controversial undertaking, one that looked much different than the end result today.

Five years ago, the hospital was poised to break ground on a $16.5 million expansion, financed and funded solely by the hospital. In late 2007, hospital leadership held a reception to unveil the blueprints, and even showed off upholstery samples for new waiting room sofas.

But the entire project came crashing down a few months later when the hospital lost its Medicare and Medicaid status after failing federal inspections in early 2008. Savings squirreled away to pay for the $16.5 million surgery wing were spent instead to keep the hospital afloat until it rebounded from the crisis. The leadership in place at the time has been replaced.

More than $400,000 spent on architects and plans went down the drain.

The project today looks much different than the one pursued by the older hospital leadership — both in scope and cost.

While the old project was billed as a “surgery center,” in reality it was a new wing of the hospital. The old plans simply called for a makeover of existing surgery rooms, while the majority of the project was ancillary: a new lobby and main entrance, new administrative offices and two floors of “shell” space for future expansion, for example.

While that project was shelved, the idea for an outpatient center was not.

Starting over from scratch — and without a nest egg to work with — the hospital administration and more than a dozen doctors split the cost of a $40,000 feasibility study in 2009 to reassess the project.

The result is a far different project: a standalone building on the hospital’s campus with the entire footprint dedicated to outpatient services.

New era of physician involvement

Other than its physical differences, the most marked evolution in the project is the business arrangement, namely the partnership with the doctors.

Under the old leadership, that type of investment and partnership wasn’t welcomed or allowed, Poore said.

Doctors had previously sought a seat at the table, offering to partner with the hospital and help finance the surgery center.

But the former hospital CEO wanted “complete and total control” and shut the doctors out, said Dr. Luis Munoz, a pathologist and a partner in the project.

Munoz, one of the physician investors, is pleased with the new approach under today’s hospital leaders.

“I think this is a preferable scenario, when both parties are involved,” said Munoz. “This is another example of this administration being transparent.”

“This is a really good example of how collaboration should work,” agreed Dr. Al Mina, a general surgeon in Haywood.

Better for the bottom line

The new outpatient center should help Haywood capture more market share, namely those patients who now bypass Haywood and go to doctors in Asheville affiliated with Mission Hospital.

Currently, outpatient services accounts for two-thirds of the hospital’s revenue. Not all of those services and procedures will be relocated to the new center, but it provides a snapshot of just how important outpatient revenue is for a hospital’s bottom line.

The hospital hopes to attract more outpatient services — and thus bring in more revenue — to pay for the new building.

While the hospital won’t bear the upfront construction costs, it still has sizeable expenses to deal with: the annual lease on the space, the overhead, the nurses and other support staff to run it. The cost of the equipment, from waiting room chairs to operating tables, will fall to the hospital as well.

But some of the cost to run the new surgery center will be a wash. Nurses and technicians who currently work in the surgery wing, mammography services, and other departments of the main hospital will simply move to the new outpatient center.

Some services will be duplicated in both the hospital and outpatient center, such as MRIs or blood work, and will require doubling up of staff.

In other areas, the outpatient center will operate more efficiently thanks to a better layout. The hospital will no longer need such an extensive transport crew, a by-product of the cumbersome design of outpatient services inside the hospital.

“It will save on this whole group of people who spend all day transporting people up and down from the sixth floor to the basement,” Markoff said.

Patients using the new building also will be able to stay on the same stretcher during their pre-surgery prep, the actual surgery and the recovery. Again more efficient, and cost cutting since there’s not all the sheets to wash or staff to constantly strip stretchers.

In many urban areas, new outpatient centers aren’t being built alongside hospitals, but instead are free-standing medical office buildings across town, sometimes not even run by the hospital. But it is advantageous to have the surgery center on the same campus as the hospital, Poore said. If there’s an emergency, the full resources of the hospital right next door can be brought to bear.

“If you are a free-standing surgery center and something goes wrong, they call 911. Here, we are the 911,” Poore said.

The project should be completed by spring.

“This project has been in the planning stages for many, many years so it is a great thing to see it come to fruition,” said Mark Clasby, member of the hospital board and Haywood County economic development director.

Patients seeking simple, routine procedures from mammograms to cataracts will no longer have to ride the elevators and trek up the halls of the hospital in Haywood County.

Construction of a new $9.3 million outpatient center has been launched on the campus of MedWest Haywood, making health care more convenient and accessible.

“It is going to have such a positive impact for out patients and the region,” said Dr. Al Mina, a general surgeon in Haywood County and one of 20 doctors who invested in the surgery center.

The patient experience will be a better one psychologically as well. Some people have anxiety about entering the hospital, said Mike Poore, CEO of Med-West Health System. A routine colonoscopy has a far more solemn and serious air about it at the hospital, while the outpatient setting will make people more comfortable and at ease.

“It will be less institutional,” Poore said. “If you are having a simple, same-day surgery, you don’t have to go into the hospital.”

Dr. Luis Munoz, a pathologist, said patients needing simple blood work can easily get in and out without traipsing through the hospital to the lab like they do now.

“You avoid going through the halls where potentially people are ill,” said Munos, also a capital partner for the facility.

Patients who now bypass Haywood and travel to Asheville for outpatient surgery could stay closer to home thanks to the convenience of the new center.

“If I need a couple of items at the store, I don’t go to Super Wal-Mart where I have to walk a quarter mile,” said Dr. David Markoff with Mountain Eye Associates. Instead, he goes where he can park near the door and quickly skirt to the aisle he needs.

Markoff is pleased he will be able to pop down the hall to tell waiting family how a patient is doing, something he can’t do now given the disjointed layout of outpatient services in the hospital, where the family waiting room is several floors away from where the surgeries and procedures are performed.

The Haywood hospital currently has six surgery beds. Four will remain in the hospital. Major surgeries — those requiring a stay at the hospital for recovery like a hip replacement or spine surgery — will still be done in the hospital’s surgery rooms.

The new outpatient center will have two surgery rooms, two minor procedure rooms and one endoscopy room, along with other outpatient services like MRIs, CT scans, lab and blood work, wound care and physical therapy.

Separating major surgeries from minor, outpatient ones will make for a smoother workflow, Poore said.

When elective or routine procedures share the same suite of operating rooms as emergency surgeries, as is the case now, patients getting an eyelid lift, for example, get bumped from the schedule to make way for a woman in labor needing an emergency C-section.

Balancing the flow of rooms can be difficult, Poore said.

“If you were an air traffic controller, it’s like having the space shuttle landing at the same time as a prop plane,” Poore said.

Phyllis Prevost, a Waynesville philanthropist who has made several sizeable contributions to the hospital, said the hospital has been running out of room and a dedicated outpatient center is desperately needed.

“The citizens of Haywood County are growing older every year,” Prevost said.

Prevost is particularly excited about the Women’s Center.

The Women’s Center will have its own entrance and will serve as a central location for mammograms, breast imaging and breast MRIs. It will also house the nurse navigator program, which works with women when an abnormality is detected in their mammogram.

“They hold that patient’s hand through the process and coordinate that patient’s care,” said Teresa Reynolds, chief operating officer of MedWest-Haywood.