A new firm will monitor Mission Hospital compliance with HCA purchase agreement

ASHEVILLE – A new contractor will be responsible for reviewing HCA Healthcare’s compliance with the 2019 agreement to buy the Mission Health system. This firm is known as the “Independent Monitor,” a designation defined by the contract.

Gibbins Advisors, a Nashville-based firm, was first appointed as the monitor to the purchase agreement in October 2019. Ronald Winters, the firm’s founder, told the Citizen Times Feb. 9 that Gibbins did not reapply for the role. The Asheville Watchdog first reported that Gibbins did not reapply.

"While we were encouraged by Dogwood's board and management to participate in the RFP process, after careful consideration we decided it is a good time to pass the baton to someone new," Winters said in a Feb. 9 statement. "We love this community and hope to continue the many good friendships with community members and leaders we made during our time as Independent Monitor."

The Independent Monitor is paid by Dogwood Health Trust, a nonprofit grantmaking organization that received the proceeds of the $1.5 billion purchase. Dogwood is responsible for enforcing compliance issues with HCA’s commitments to the agreement. The nonprofit was unable to provide information by press time.

HCA agreed to 15 commitments as part of the acquisition of the Mission Health system, including retaining hospital services, investing in facilities, community health and wellbeing.

Dogwood becomes officially aware of violations to those commitments through an annual reporting process coordinated between HCA, Dogwood, the North Carolina Attorney General’s Office and the Independent Monitor.

Dogwood last enforced the compliance agreement for violations in 2021 and 2020. The violations were for a four-month closure of endoscopic surgical services at Highlands Cashiers Hospital from October 2020 to January 2021, and for discontinuing a program for preventing injuries to children. Both service stoppages required HCA to notify Dogwood, which Dogwood said did not happen, according to a May 2022 Dogwood statement.

During the 2021 and 2022 reporting periods, Dogwood found that HCA was in compliance with the purchase agreement, according to statements from the nonprofit.

While the findings from the 2023 reporting period are still pending, state and federal regulators filed enforcement actions against HCA.

Attorney General Josh Stein filed a lawsuit against HCA in December 2023 alleging that it did not provide the level of emergency and cancer care it agreed to when it bought the system, violating the 2019 contract. Stein’s office asked the court to demand HCA restore the emergency and oncology services to its pre-sale conditions.

In February, the federal Centers for Medicare and Medicaid services found that conditions at Mission Hospital created an “Immediate Jeopardy” situation, the most serious deficiency regulators can assign. Mission Hospital met the federal deadline for submitting a Plan of Correction, which details how the hospital will remediate the specific deficiencies cited by the federal government. According to state and federal spokespeople, details about what created the immediate jeopardy situation will not be available until March 3 or when the federal government receives an acceptable plan of corrections, whatever comes first.

"We are closely watching Mission's required implementation of an approved Plan of Correction addressing the recent CMS survey," Winters said.

HCA will deliver its annual report to Dogwood and the Independent Monitor at the end of April, according to a statement of work linked to Dogwood’s application. Dogwood must notify Stein’s office whether it will notify HCA of potential noncompliance by the end of July.

In June 2023, Stein’s office sent a letter to Winters, criticizing Gibbins’ role in overseeing the terms of the compliance agreement. Winters responded in a July 2023 letter, saying that the firm was “surprised and disappointed” to receive the critical correspondence from the Attorney General’s Office.

Stein later complimented the Independent Monitor in a December news conference unveiling the lawsuit against HCA, saying that Gibbins uncovered some of the information to help bring the case.

More: Mission Hospital meets federal deadline for submitting plan to correct immediate jeopardy

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Dogwood announced a request for proposal to fill the Independent Monitor’s role Jan. 2, saying that the nonprofit wanted to expand the scope of the firm. Beyond analyzing the annual report, the firm will be expected to engage with the community, the Attorney General’s Office and participating in continuous compliance evaluation.

"Through the expanded scope of work, the IM will increase its engagement with and listening to the community beyond what is outlined in the Asset Purchase Agreement," Dogwood CEO Dr. Susan Mims said in a Jan. 4 statement to the Citizen Times.

"This change in the scope of work will allow the IM to evaluate any issues of potential non-compliance and work with the AG’s office to help people share their concerns that are not addressed in the APA, such as quality of care, with the appropriate bodies with oversight for those issues."

According to the RFP, the deadline to apply for the position was Feb. 6. Dogwood will review proposals until Feb. 20. The new firm is expected to be announced April 1.

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: Dogwood to pick new firm to check Mission Hospital contract compliance