6 Asheville cancer surgeons fired amid corporate private equity-backed bankruptcy
ASHEVILLE – The six physicians at GenesisCare Surgical Specialists are known among the local medical community as the bedrock of cancer surgery in Western North Carolina. One physician estimated that they perform 80% of specific oncological surgeries in the region.
Now the surgeons who have practiced out of their South Asheville office since 2021, some of whom have served the community for more than 20 years, are scrambling to find a new partner that allows them to practice in WNC, leaving some sick patients to endure long travels and extended waits to undergo potentially life-saving procedures.
Colin Bird, a colorectal surgeon with the practice, told the Citizen Times he estimates that these doctors see 300 new patients each month.
Doctors at the facility received pink slips in letters dated Aug. 4 from Justin Berry, a market executive director for the Eastern and Western U.S. divisions of GenesisCare, the global management organization that controls the Asheville practice. The letter gave the doctors 180 days of notice. All 15 employees at the practice were terminated. Bird said all employees were offered severance. The six-month window gave the physicians time to find a new place to practice and navigate all the complicated logistics associated with setting up a new arrangement.
But on Aug. 14, they were informed that the practice would close Oct. 13, according to Bird. Recently, the closure date has been extended to Oct. 20.
The shortened timeline will prevent the doctors from operating for at least six weeks, while they rush to set up a new practice. Many patients with life-threatening illnesses will need to travel out of WNC for their surgeries, while referring doctors struggle to schedule timely procedures with large medical institutions like Duke University, where they have not developed strong relationships.
This is another blow for health care in WNC, experts say, a landscape that has been grappling with the intersection of corporate interests and medicine since HCA Healthcare bought Mission Hospital, a Level II trauma center and largest hospital in the area, in 2019.
Bankruptcy filing and complicated corporate structure
GenesisCare Surgical Specialists is managed, but not owned, by GenesisCare Inc., an Australia-based cancer service corporation with locations around the world. The company has been majority owned by KKR, a global private equity group, since 2012, according to a news release announcing the acquisition. GenesisCare Inc. filed for bankruptcy in Texas Southern Bankruptcy Court June 1.
Jim Wall, the attorney for the surgeons, not the corporate entity, told the Citizen Times that the practice is owned by a “friendly physician” – someone who is amenable to the management organization’s objectives. North Carolina state law forbids the corporate practice of medicine and requires practices to be physician owned. The friendly physician model allows corporations to navigate this requirement.
According to a Sept. 15 article in the New England Journal of Medicine, this model allows “lay corporations to assume de facto ownership and control of physician practices.” The rapid corporatization of medicine, including friendly physician models, have rendered corporate medicine prohibitions essentially obsolete, the article argued. It proposed regulation as a solution to the management model.
The letters that surgeons received do not distinguish between the North Carolina-based practice and the management organization, but Wall said he has been dealing with the management organization’s attorneys.
Most, if not all, doctors at the firm did not know the identity of this physician prior to these proceedings. Publicly available documents, dated Jan. 5, 2021, indicate that Timothy D. Shafman is the president of the company.
“It is physician owned but not owned by any of our physicians,” Wall said.
Wall explained that after the management company went bankrupt, they decided to find a buyer. The layoffs in Asheville are a result of the management company attempting to streamline its services ahead of a sale, according to what Wall said he's read and heard. He said that the company has made layoffs at other locations as well.
KKR and GenesisCare did not respond to a Citizen Times request for comment.
Over the past few months, the state attorney general issued a reprimand to Mission Hospital for employing a single medical oncologist. The Citizen Times reported that patients arriving in ambulances at Mission Hospital can wait hours to receive treatment – hospital workers and local emergency service leaders mostly blamed staffing challenges for the bottleneck, which a spokesperson for the hospital denied.
At the same time, 9,000 patients statewide are losing their health insurance each month, waiting for lawmakers in Raleigh to pass a state budget so expanded Medicaid can become available.
The specialty surgeons said they have had to turn patients away, or instruct referring physicians to point their patients elsewhere, at times causing delays in treatment.
A six-week delay
Patients will soon receive letters from GenesisCare dated Sept. 18 informing them that the practice will close Oct. 20. The letter, obtained by the Citizen Times, lists nine options for patients to receive care, stretching as far as Duke Cancer Center in Durham.
“We apologize for any inconvenience that is caused by the practice closure,” the letter reads. Bird said the physicians had no input on the language in the letter.
The North Carolina Medical Board forbids surgeons from operating on patients if they cannot provide follow-up, Paul Ahearne, a surgical oncologist with the practice, told the Citizen Times. According to Ahearne, the surgeons had to stop operating on patients 30 days before the practice’s closure. Bird said he would cease operation Sept. 21. Ahearne’s last day operating was Sept. 19.
Bird and Ahearne told the Citizen Times they hope all the surgeons can begin accepting new patients through a new practice by Nov. 1, but Bird conceded the timeline was ambitious. Most of the employees who will lose their jobs will have a position at the new practice, Bird said.
“There are three things going on,” Bird said. “I’m trying to do my job and take care of my patients. I’ve got a corporate manager making things very difficult for us. And at the same time, I’m trying to negotiate a contract for my employees, myself, my partners and my staff.”
Bird explained that the doctors have tried to work with GenesisCare to adjust their timeline so they could continue caring for patients, but GenesisCare has not budged. The doctors have moved up their surgeries so they could operate on scheduled patients before they needed to stop, but they will not be able to accept referrals, Bird said.
“As surgeons who care deeply about providing quality care, we’re just devastated that we can’t do that right now,” Ahearne said.
The Citizen Times was not able to reach any current patients.
A temporary loss with potentially dire consequences
Doctors in Asheville rely on this group of surgeons to perform highly specialized procedures for their patients that other physicians in the area are not capable of conducting.
“These guys have been the bedrock of cancer surgery in the region,” said Martin Palmeri, an oncologist at Messino Cancer Centers in Asheville and president of the North Carolina Oncology Association.
“My impression was that they perform 80% of the oncologic surgeries in the region when it comes to skin, rectal and thyroid sarcomas.”
Clay Ballantine, an internal medicine physician with Asheville-based Blue Ridge Premier Medicine, told the Citizen Times there are also limited options in Asheville for liver, bile and adrenal cancers.
“If you’ve got abdominal cancer, chances are you’re seeing one of their doctors,” Ballantine added.
Physicians in the region have developed a relationship with the surgeons at the practice that have made coordinating referrals relatively easy. Surgeons at GenesisCare have developed such strong relationships with some doctors in the region that they communicate through cell phones.
“I think that for surgeons to make themselves available to physicians in our practice in such an accessible fashion is very valuable,” David Spivey, a doctor with Asheville-based Carolina Internal Medicine Associates, told the Citizen Times. “I think it demonstrates the degree to which they're willing to collaborate with us in primary care to enhance patient care.”
Is Mission Hospital an option?
Until the surgeons at GenesisCare can practice again, doctors looking to find highly specialized surgeons to treat their patients are looking to cities hours away, which poses problems beyond the long distance.
Referring doctors say that there are other surgeons in the region, including a few at Mission Hospital, who can perform some of the general procedures conducted by the GenesisCare doctors, like gall bladder removals. Some doctors even have overlapping subspecialties with the GenesisCare physicians, but the temporary loss of these highly trained surgeons will have an immediate and potentially devastating impact on cancer and surgical care in the region, local physicians say.
“These cancer patients are having to have their care delayed because it is much harder to send somebody to Duke, Chapel Hill, Wake Forest or Charlotte, than it has been to send patients to Genesis here,” Ballantine said.
Ballantine explained that the process takes longer because he needs to identify a surgeon, see if surgeon will accept the patient, make calls on the patient’s behalf and navigate the complexities of ensuring the medical records are received by the correct entities for review. He said that the academic medical centers that he often relies on take longer times to schedule patients for surgeries.
“Cancer is a ticking time bomb,” he said. “When you have to delay cancer surgeries because we need to refer people out to places that aren’t used to dealing with our patients, like the academic centers scattered around the state, then it further delays care and increases everybody’s chances of having metastatic disease by the time they get treated.”
Palmeri said Mission Hospital has tried to build up its surgical oncology program over the past few years, but many of his patients are hesitant to get their treatments at Mission.
“A lot of my patients enjoyed having the option of having surgery with non-Mission facilities and with doctors who have affiliations at hospitals other than Mission,” Palmeri said. Palmeri has sent patients requesting to have their procedures at other hospitals to Duke, Charlotte and University of Tennessee, he added.
More: Patients arrive at Mission Hospital in ambulances, then the waiting begins
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Prior to joining GenesisCare, the doctors were employed by HCA, which bought Mission Hospital in 2019. Ahearne said that the doctors left HCA to join GenesisCare April 2021 so there could be a choice for physicians who didn’t want to be employed by the for-profit giant. Bird said that concerns with how HCA operated Mission as well as the flexibility to operate at other locations were among the main reasons for the change.
Bird also told the Citizen Times in a message that he is unsure what will happen to patients who require follow-up appointments from Oct. 20 until the new practice opens. He is resolute, however, that the surgeons will continue to care for the community, after the pause.
“We’re not abandoning our patients,” Bird said. “We’ve been forced to reorganize. We’re going to take care of our community. Period.”
Mitchell Black covers Buncombe County and health care for the Citizen Times. Email him at mblack@citizentimes.com or follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.
This article originally appeared on Asheville Citizen Times: Asheville specialty cancer surgery center closes after bankruptcy
