AdventHealth appeals HCA's application for West Asheville freestanding emergency room

ASHEVILLE – HCA Healthcare’s latest attempt to expand its footprint in Western North Carolina met a roadblock at the hands of a familiar foe: AdventHealth.

AdventHealth Hendersonville and AdventHealth Asheville appealed HCA’s Certificate of Need application for a $29 million freestanding emergency department in West Asheville. The Florida based nonprofit filed an appeal Oct. 25, according to spokesperson Victoria Dunkle. HCA, the Nashville-based for-profit giant, bought the Mission Health system in 2019.

CON applications are required for North Carolina health care providers that wish to expand their facilities, equipment or medical services.

“We understand the need for more convenient access to care for the families in our community,” Dunkle told the Citizen Times in an Oct. 25 statement. “Not only are we ready to provide that increased access, but we are ready to do so by expanding health care choice.”

This is HCA’s second application for a freestanding emergency department in West Asheville. AdventHealth appealed the first application, which was reversed by an administrative law judge in a March 17 decision because the North Carolina Department of Health and Human Services failed to hold a public hearing about the pending new facility. The judge also reversed an HCA application for an Arden freestanding emergency department, which NCDHHS appealed to the state court of appeals. NCDHHS approved Mission's most recent application Sept. 25.

HCA spokesperson Nancy Lindell told the Citizen Times in an Oct. 25 statement that Mission’s application for the facility was an attempted solution to the increase in demand for emergency departments nationwide. She criticized AdventHealth for appealing the application.

“Advent Health has chosen to appeal the State’s decision each time despite not having a near-term solution of their own for improving ER access in Buncombe County,” Lindell said. “It is disappointing other hospitals that regularly send their patients to Mission for a higher level of care would actively work to stop better access to emergent care for our communities.”

Dunkle said the appeal is based in part on a perception that the community wants more health care options.

"We believe this comes down to understanding what the community is requesting," Dunkle said in an email. "They have clearly and consistently said what they want, directly telling AdventHealth and their elected leaders that they want choice and competition. We saw the evidence of that desire in the more than 4,000 letters sent to the state and from the patients, community leaders, elected officials and others who shared their wishes during the public hearing for the 67-bed acute care hospital CON. We saw that in the State’s decision to award that certificate of need for the hospital to AdventHealth Asheville."

The Citizen Times previously reported that patients arriving at Mission Hospital in ambulances can wait hours to receive care. Mission Hospital workers and local emergency service leaders blamed an overtaxed emergency department and understaffed hospital for the delays, saying that the hospital struggles to quickly treat, admit and discharge patients.

Some emergency service leaders and Buncombe County officials believe that the freestanding emergency departments could help fix the problem, allowing patients with less severe cases to receive treatment without taxing the main emergency room. Others question whether HCA can adequately staff the freestanding facilities given the challenges at Mission Hospital and wonder if the satellite emergency departments would stress an already-strained ambulance system.

Government officials don't formally weigh in on Mission freestanding Emergency Department applications

North Carolina Attorney General and gubernatorial candidate Josh Stein opined on HCA CON applications before, but his office has not have officially weighed in on the freestanding emergency department process. Stein's office sent a letter in July 2022 to NCDHHS about HCA's application for the 67-bed acute care hospital in Buncombe County, asking the agency to deny Mission's application. It was ultimately awarded to AdventHealth, which Mission appealed.

“Our office generally does not weigh in on such decisions that fall under DHHS’ oversight,” Nazneen Ahmed, a spokesperson for Stein, told the Citizen Times in an Oct. 26 statement. “We shared our thoughts with DHHS in the regarding the CON for the 67-bed acute care facility in Buncombe County issue to address specific concerns regarding hospital competitiveness and consolidation. Broadly, we believe these decisions should be governed by public feedback.”

Stein, who ultimately allowed the sale of Mission Hospital to go through in 2019, touted his role in brokering 15 stipulations that HCA had to adhere to as part of the acquisition of the hospital at a recent Asheville campaign event. He also noted that he had limited power to influence the terms of the sale. A recent public meeting in Asheville with the firm tasked with reviewing whether HCA has adhered to those commitments showed how little power those promises have at requiring HCA to improve quality of care.

Stein’s office has sent a series of letters to HCA North Carolina President Greg Lowe, decrying the state of cancer care at Mission Hospital, threatening that it may violate the terms of the sale agreement. At the campaign event, Stein told the Citizen Times that the letters could preclude a civil investigative demand, which would require HCA to respond to requests from the attorney general. The last time the compliance agreement was enforced was 2021.

Stein also had an opportunity to take Mission on earlier this year. Current and former Mission emergency department doctors filed a False Claims Act suit against the hospital. Neither his office nor the U.S. Department of Justice decided to take on the case. It was dismissed following a motion from the doctors.

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Buncombe County Board of Commissioners Chair Brownie Newman sent a letter in June 2022 on behalf of the entire commission to an NCDHHS official, supporting a provider other than Mission Hospital to own the 67-bed acute care hospital. While Newman and other commissioners have expressed concerns about HCA’s expanding footprint, the commission has not formally weighed in on the freestanding emergency department discussion.

County Manager Avril Pinder sent a letter to NCDHHS June 2021 in support of Mission’s applications for freestanding emergency departments. She clarified to the Citizen Times earlier this year that she believes adding a department, irrespective of the provider, would be good for the community.

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: AdventHealth appeals HCA's attempt at West Asheville freestanding ER