‘Failed’ to prove a need: Pardee calls foul on Mission, AdventHealth, Novant 67-bed bids

A fourth hospital has joined an increasingly complex bid to bring 67 acute care beds to Buncombe, claiming each of them failed to prove the county needed those beds in the first place.

UNC Health Care-managed Pardee Hospital, which has a location in Henderson County with 222 acute care beds, claims in a document filed with North Carolina Department of Health and Human Services that HCA Health Care-owned Mission Health, AdventHealth and Novant Health’s applications for a certificate of need to provide the new beds is built on a false premise: namely, that the area needs them at all.

More: Buncombe hospital expansion bid gets 4K support letters. Which got the most?

The 30-page document, filed Aug. 1, essentially argued the need for 67 more acute care beds was artificially manufactured by increases in care during the COVID-19 pandemic.

This need was originally reported in the 2022 North Carolina State Medical Facilities Plan of SMFP by Mission Hospital in Asheville. In June the three hospital systems filed with the DHSR to compete for the certificate of need, which is meant to serve patients in Buncombe, Yancey, Graham and Madison counties.

Though a decision as to which system will get the certificate may come before the end of 2022, the Pardee document could complicate that timeline.

According to data Mission reported, it had 733 licensed acute care beds and had 207,208 inpatient days logged in 2021. An inpatient day is the number of days a patient stays at a hospital.

Mission also projected increases in the numbers of days the hospital would serve patients at its Buncombe location and used those projections to estimate how many patient beds it would need by 2024.

More:Plenty of input at Buncombe hospital expansion public hearing. Who got the most support?

That’s where the 67 number originated.

But Pardee took issue with this data-based claim, first noting in the document that there was no precedent for such a need.

“Prior to the 2022 SMFP, no bed need had been generated in the SMFP-defined service area of Buncombe/Graham/Madison/Yancey counties in over 10 years,” Pardee’s document stated in a section titled “Background Comments Applicable To All Three Applications.”

It continued: “No need has existed even though Mission Health, the only acute care provider in the SMFP-defined service area, operates as the area’s only tertiary facility drawing patients from surrounding counties and even other states. Not coincidentally, bed need has been generated only in the two years since COVID-19 began impacting patient days.”

Pardee spokesperson Erica Allison responded to the Citizen Times when asked about the document but did not immediately ssay why the hospital was challenging the CON.

Buncombe Acute Care Beds Comments by Pardee UNC Health Care by Andrew Jones on Scribd

Readers can download the document using this link.

WNC's 17-hospital Mountain Area Healthcare Preparedness Coalition, which includes all Mission Health hospitals, reported significant spikes in COVID hospitalization in 2021, including near the end of the year when hundreds each week were occupying beds at Mission in Asheville, according to previous reporting from the Citizen Times.

More:Buncombe COVID cases up 50% in a week, omicron and holiday could see 'many more' infected

“The ultimate need determination for 67 beds was generated exclusively by the COVID-19 adjustments to the methodology,” the Pardee document states. “In other words, actual patient days did not generate the need for additional beds in the Buncombe/Graham/ Madison/Yancey service area.”

The Pardee document alleges COVID pandemic impacted the 2022 State Medical Facilities Plan adjusted bed need calculation in two ways.

First, it reasoned that 2020 patient days, used as the baseline for 2024 projections, were adjusted to be higher than actual patient days.

More:‘Stupid and dangerous’: Forum scrutinizes 3 hospitals’ competition for more Buncombe beds

Second, it said growth rates used to project 2024 patient days — the total number of days patients would stay in Mission Hospital in 2024 — which included the 2020 growth that was based on adjusted patient days, were also higher than they should have been.

“Using the actual data from 2020 would have resulted (in) no bed need in the 2022 SMFP, compared with a bed need of 67, driven exclusively by the upward adjustments for COVID-19,” the document concludes in a preamble to 27 pages of information attempting to debunk Mission Health, AdventHealth and Novant Health’s certificates of need.

“Pardee recognizes that the need determination in the 2022 SMFP was finalized by the (North Carolina State Health Coordinating Council) and approved by the Governor,” the document states. “Nonetheless, Pardee believes it is important for the Agency to consider these unique facts and circumstances in the context of this review, particularly with regard to each of the applicants’ conformity with Criterion 3.”

That criterion is part of N.C. law regarding NCDHHS review of applications.

Criterion number three No. 3 reads:

“The applicant shall identify the population to be served by the proposed project, and shall demonstrate the need that this population has for the services proposed, and the extent to which all residents of the area, and, in particular, low income persons, racial and ethnic minorities, women, handicapped persons, the elderly, and other underserved groups are likely to have access to the services proposed.”

This is not the first time an entity has evoked state law to oppose hospital expansion.

N.C. Attorney General Josh Stein used language from the same law to say in a July 25 letter his office was against Mission's bid to expand.

Stein did not cite patient days or COVID-19 as justification for this, however, rather choosing to focus on the lack of health care competition in Western North Carolina.

"Mission has almost no competition for acute care in Buncombe County," Stein said in the letter. "The lack of competition is the result of Mission’s unique history. Mission effectively operated as a legislatively authorized monopoly for over twenty years, and no new hospitals have opened even after Mission’s arrangement with the State ended in 2016."

Mission is facing two class-action, antitrust lawsuits, one from Buncombe and Madison counties and the cities of Asheville and Brevard and one from six Buncombe-area residents. Both claim the hospital holds a monopoly in WNC, is involved in anti-competitive practices and changes unreasonable prices for service.

Andrew Jones is an investigative reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or arjones@citizentimes.com. Please help support this type of journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: Pardee claims hospitals competing for 67 beds used inflated numbers