ASHEVILLE – An independent monitor tasked with helping ensure HCA Healthcare complies with the terms of its 2019 purchase of Mission Health met with community members May 13 to answer questions and provide updates on its work.
More than 60 people attended the meeting held by Boston-based Affiliated Monitors, Inc. on the campus of Asheville-Buncombe Technical Community College. AMI was named independent monitor in 2024, replacing Gibbins Advisers of Nashville, which had been appointed monitor in October 2019. The independent monitor is paid for by Dogwood Health Trust, a nonprofit grantmaking organization responsible for ensuring HCA follows 15 commitments outlined as part of its $1.5 billion acquisition of Mission Health.
“As monitors Dogwood Health Trust made it clear to us that they want us to engage with the community as well — to hear from the community what your concerns are, to hear how the merger is affecting you in your daily lives,” Gerald Coyne, AMI’s managing director, told those in attendance.
So far, HCA has completed five of the 15 commitments, including spending $232 million in general capital expenditure, building a replacement hospital for Angel Medical Center in Franklin and building a new 120-bed behavioral health facility in Asheville, all within the first five years after the sale.
Other commitments, such as keeping material facilities open for at least 10 years and not discontinuing specific services for at least 10 years are still in progress. Questions around the latter are currently being litigated in state court after then-Attorney General Josh Stein filed suit in 2023, alleging the for-profit health system is failing to provide the level of emergency and cancer care it agreed to when it purchased Mission Health.
Coyne said one of the commitments AMI is following closely is HCA’s charity care policy. It’s also following whether HCA remains in good standing with Medicare and Medicaid programs. In 2024 Mission Hospital was put into “immediate jeopardy” status by regulators, threatening its reimbursements under the two programs. The hospital soon filed a “Plan of Correction” to fix the deficiencies and was later found to be back in compliance.
Later that year, AMI recommended that Dogwood find HCA out of compliance with the terms of the sale, citing issues involving emergency and oncology services, Medicare and Medicaid compliance and charity care, the Citizen Times previously reported.
Coyne and others from AMI also answered several questions submitted by community members, ranging from what information the independent monitor had access to from HCA, to why the asset purchase agreement didn’t list “quality of care” as a component HCA must maintain.
“Even though there are no specific metrics that are listed in the agreement, our position as monitor is that quality is inherent in the delivery of medicine,” Coyne said. “It’s inherent in the delivery of medicine if you look no further than the requirement that HCA maintain not just enrollment in the Medicaid and Medicare programs but remain in good standing.”
“If the quality is not there, if action is taken against an entity because of a lack of quality then that would be, in our view, a problem under the APA,” Coyne added.
The final question of the evening asked what HCA is required to do after the asset purchase agreement expires in 2029. The question drew an audible groan from several people in attendance.
“I would like to say, ‘Run the best healthcare system that they’re capable of running,’” Coyne said, adding that HCA will be regulated by the same agencies that every other health system in the country is regulated by.
