It’s a cultural tradition in nearly every society, the firm belief that people and institutions become stronger once they’ve been tested. Whether that test comes about due to one’s own shortcomings or to circumstances outside one’s control is important, but in the end it’s the outcome that we remember.

So it is with Haywood Regional Medical Center. When its Medicaid and Medicare status was lost just over a year ago and the hospital went into a financial freefall, people were angry, upset and felt betrayed. They were also very worried that the place they considered their number one healthcare option was in real jeopardy of closing down and that many friends and neighbors would lose their jobs.

In hindsight, that extreme emotional attachment to HRMC might have been its saving grace. County leaders, physicians, hospital staff, and a whole lot of concerned citizens stayed with HRMC when it might have been easier to let it sink. When the number of patients going to the hospital on a daily basis sank to single digits, inspectors still hadn’t given their final OK for re-certification, and the bank account was close to running dry, closing seemed imminent.

No one knows what corporate shape HRMC will finally take — affiliation with another hospital system and with WestCare seems certain, but the structure of that affiliation is still unknown — but now no one believes that Haywood County won’t have a hospital, which seemed a very real possibility in early March of 2008.

So what from this past year at HRMC should residents remember?

First and foremost is the responsibility that lies with the hospital’s board of trustees. These dedicated citizens who volunteer their time must be vigilant to strike a balance between the sometimes competing interests of hospital administrators and the medical staff. They must also be able to look beyond those personal and professional relationships to keep in mind the hospital’s value to the community. No person or group is more important than the institution. It’s a balancing act, but if trustees tip too far one way — as happened with the previous board’s almost blind allegiance to former CEO David Rice — bad things can happen.

Secondly, and probably just as important, is the wisdom and dedication of the long-time members of the medical community. When the medical staff asked some doctors to speak to the board of trustees at a December 2006 meeting, they pointed out very clearly that the relationship between the administration and the medical staff had become dysfunctional. The board, however, ignored those pleas.

Among those to speak at that meeting — where a well-liked ER group was about to be fired — were Dr. Henry Nathan, Dr. John Stringfield and Dr. Benny Sharpton, three of the county’s most respected physicians. HRMC’s medical community, by and large, are practicing medicine for the right reasons and need to be listened to.

Lastly, and like it or not, the CEO of a small hospital carries a lot of power. That can be either beneficial or detrimental, depending on the circumstances. If one went to Raleigh or Charlotte, the CEO of a large metro hospital might get lost among the thousands of employees, hundreds of doctors, and dozens of administrators. Not so at a hospital like HRMC. Former CEO David Rice was very powerful and became very polarizing, yet his strength of personality blinded those who should have seen his shortcomings.

HRMC’s new CEO Michael Poore will also wield a lot of influence. He has become the new face of HRMC, an affable, intelligent guy that has best been described as a “breath of fresh air.” Most believe he will serve the hospital well, and already he is restoring credibility both internally and in the community.

HRMC has survived and, perhaps, become stronger because of this crisis. It might not be so lucky if an event of this magnitude ever occurs again, a truth that should serve as a cautionary reminder to those who might too quickly forget the events of the past year.

One of three hospitals courting Haywood Regional Medical Center and WestCare for a partnership has dropped out of the running.

That leaves Mission Hospital of Asheville and Carolinas HealthCare System, a 23-hospital conglomerate based in Charlotte, still in contention. Both have submitted formal proposals, kicking off the next round in the lengthy affiliation process.

WestCare and Haywood Regional have each appointed blue-ribbon committees to steer the process. They will hold a joint meeting Monday (Feb. 16) to review the proposals and kick off discussions of which one is best. The formal proposals are a follow-up to talks held with the entities last summer.

While there’s only two left at the table, others would likely be interested in a partnership with Haywood Regional and WestCare. But invitations were only extended to the three. A fourth was ruled out following the discussions last summer, and others were ruled out earlier in the process.

It could be another six months before WestCare and Haywood Regional have made their decision. They have to weigh what each brings to the table, from medical expertise to a cash infusion, said Mike Poore, CEO of Haywood Regional.

An affiliation could follow a tier of options: an outright merger, a long-term lease, a year-to-year contract or some sort of loose partnership.

While playing Novant and Carolinas against each other would certainly give the home hospitals leverage in the negotiations, Haywood and WestCare still have plenty of bargaining power. If neither proposal meets the standard they want, they can simply choose none of the above, said Haywood County Commissioner Kirk Kirkpatrick, an integral player on the steering committee.

“If either is not beneficial to both Haywood and WestCare then we have to reconsider,” Kirkpatrick said. “It would be bad business not to.”

If neither of the large entities works out, Haywood and WestCare could still pursue a partnership of their own without hitching up to a larger entity.

“I feel like we have a qualified and competent CEO at Haywood and West Care. If they can put something together for the benefit of the entire community they will,” Kirkpatrick said.

Conservative times

Novant will not say exactly why it pulled out, although the economy is a likely culprit. Novant operates Forsyth Medical Center in Winston-Salem and a host of smaller hospitals across the state.

A spokesperson for Novant said the hospital was honored to be a top contender, but could not over extend itself at the moment.

“After careful evaluation, we concluded that we needed to focus on our current commitments to capital projects,” said Freda Springs, media spokesperson for Novant.

Novant is building brand-new hospitals in Kernersville and Brunswick County, both in the ballpark of $100 million. Springs said the hospital would not comment further.

Neither Poore nor Mark Leonard, WestCare’s CEO, had additional insight as to why Novant dropped out.

“That is for them to explain if they choose to explain it,” Leonard said.

The letter from Novant announcing its withdrawal was only two paragraphs. Poore speculated, however, that is was likely the economy.

“They are like everybody else, trying to look at the economy and trying to decide what the future is going to be and none of us really know that,” Poore said.

If hospitals are reining in their resources, the deals on the table today might not be as good as they would have been two years ago, or two years from now. But Poore said there is no way of knowing that.

Poore’s bottom line: “This hospital is going to survive and thrive no matter what the affiliation is.”

Secret for now

For now, the public is largely in the dark about the nature of the proposals, or even what type of affiliation WestCare and Haywood are willing to entertain. WestCare and Haywood won’t release the letters sent to Mission, Carolinas and Novant inviting them to make a pitch — which would likely shed light on exactly what the home hospitals hope to get out of the deal.

They also won’t make public the proposals that came back from Mission and Carolinas. Carolinas and Mission don’t want their private business information shared, and might not have sent proposals if they thought they would be made public, Poore and Leonard said.

“Although we are bound by confidentiality agreements to not give out details of the proposals, we will continue to let the community know about the evaluation process and where we are in it,” Leonard said.

The process is fraught with complexity, with each entity forced to share inside details of their operations to accurately size each other up, but wishing they didn’t have to. While Haywood and WestCare shared information with Carolinas and Mission so they could craft their pitches, it’s not being swapped with each other. For now, the two are still technically competitors.

Another factor in play is anti-trust laws. If Haywood and WestCare joined, especially with Mission, they could be subject to anti-trust regulations.

“We are trying to deal with a pretty complicated situation. There are a lot of moving parts,” Poore said. “We have been very forthright — as much as we can — during the whole process.”

Many in the medical community have expressed concern over an affiliation with Mission, fearing it would steal local specialists and siphon the most profitable operations away to the flagship in Asheville. Mission has insisted it wouldn’t do that, and they are still considered in the running.

“It will be premature to say one organization has a lead over the other at this point,” Leonard said. Besides, the decision rests in the hands of WestCare’s and Haywood’s hospital boards, he said. They likely have a long way to go before reaching a final decision.

Depending on the arrangement, Haywood Regional Medical Center could face an added layer of scrutiny, and a significant one at that. If the arrangement takes the form of merger or long-term lease, final approval rests with county commissioners.

Haywood Regional is a public hospital, and state statute gives final authority to the county’s elected leaders rather than the appointed hospital board. The statute also requires all proposals for an affiliation — not just the one the hospital says it wants — to be made public so county residents can see for themselves the options on the table. It also requires two formal public hearings to provide for public input.

Poore said once the hospital gets further along with its own decision, it will begin following the state statute requiring public involvement.

Why affiliate?

Health care conglomerates, often organized under one flagship hospital, are increasingly common. On the other hand, rural hospitals flying solo are increasingly rare.

“The growing demands of providing healthcare have jeopardized the mission of small rural hospitals,” said WestCare CEO Mark Leonard.

Smaller hospitals are struggling to stay relevant in the rapidly changing world of health care. Doctors are more specialized, while equipment is more sophisticated and expensive. Theoretically, a larger patient base — achieved by pooling patients from more than one county — can justify the cost of providing the service. Those who don’t band together but opt to compete can end up unable to provide an advanced level of health care.

The economy has exacerbated the challenges, as more patients fail to pay their medical bills or turn to the emergency room for basic treatment, Leonard said.

The first stop for sick people in Haywood County should still be their local doctor.

Over-worked and underpaid. It’s a complaint most in America could wage against their boss. But at Haywood Regional Medical Center, it was just the tip of workplace complaints.

By Julia Merchant

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Anyone following the saga of Haywood Regional Medical Center has to feel like their head is spinning. So much has happened so fast that keeping it all straight is likely proving difficult, even for those with the most nimble minds.

By Julia Merchant • Staff Writer

Donning purple ribbons of support, members of the community came together Monday in a show of encouragement for the embattled Haywood Regional Medical Center, which is facing a financial crisis after losing its Medicare and Medicaid funding.

By David Rice • Guest Columnist

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By Jennifer Garlesky • Staff Writer

Imagine having the flu and sitting in a folding chair in a crowded waiting room for five hours just to see a doctor. For those with no health insurance this is probably the best option when seeking care for minor illnesses. An office visit to a family physician could cost at least $100, and that’s not including prescription costs.

Our story last week about a fund that helps women pay for breast cancer testing and treatment pointed out cracks in the health care system. It’s not surprising that this situation exists, and while we hope the funding issues for this cancer program are solved, we hope — more importantly — that the health care debate that takes place every presidential election cycle will gain some traction this time.