ASHEVILLE, N.C. (828newsNOW) — When HCA Healthcare acquired Mission Health in 2019, many bells and whistles were put into place — think Dogwood Health Trust and an independent monitor.

But what does that mean for the hospital system and community? What can HCA be forced to do or not do?

Dogwood Health Trust, created from proceeds of the Mission sale, is to monitor and enforce HCA’s compliance with the asset purchase agreement through an independent monitor. The independent monitor ensures HCA complies with the APA terms and informs Dogwood Health Trust of any issues.

According to the Affiliated Monitors website, HCA committed in the APA to obligations that included the following:

  • Keeping major Mission Health facilities open
  • Continuing to provide certain key services
  • Continuing policies for uninsured and charity care
  • Making significant capital investments in promised projects and programs.

Affiliated Monitors Inc. began its work with Dogwood Health on April 1. Representatives with Affiliated Monitors have been reviewing documents, visiting hospital sites, interviewing staff and getting community feedback.

On Tuesday, Dogwood Health Trust said it had notified the N.C. Attorney General’s Office of plans to charge HCA Healthcare with potential purchase agreement violations based on the monitor’s findings and HCA’s annual report.

Does that mean penalties for HCA? Not really.

If the independent monitor, the applicable advisory board and HCA cannot come to an agreement about a change in HCA’s obligations, then Dogwood Health will attempt to resolve the dispute. Dogwood Health may pursue the matter through the courts if the dispute cannot be resolved.

“You can use the court to enforce the APA but only up to the terms of the APA. There are no penalty provisions,” Affiliated Monitors representative Gerald Coyne said. “It’s also obviously not a criminal matter. It’s a civil enforcement action. It would look like going to court and making the party to the agreement actually adhere to the agreement.”

HCA POTENTIALLY VIOLATED MISSION PURCHASE DEAL, REPORT SAYS

Dogwood Health Trust CEO Dr. Susan Mims said the nonprofit would work with HCA on resolving the issues.

Here’s the timeline, according to the Affiliated Monitors website:

  • July 29: Dogwood must provide notice to the Attorney General’s Office 90 days after the receipt of the HCA’s Annual Report as to whether Dogwood intends to notify HCA of any potential non-compliance.
  • Aug 28: 30 days after receipt of Dogwood’s letter, the attorney general must provide notice to Dogwood if the attorney general decides that Dogwood has failed to adequately exercise its right to enforce certain obligations of HCA.
  • Oct 27: 180 days after receipt of HCA’s Annual Report, Dogwood or the attorney general is required to provide notice to HCA of any potential noncompliance.
  • Dec 26: During the 60-day period following delivery of notice to HCA, all parties can attempt to resolve any issues regarding noncompliance. If the parties are unable to come to resolution, Dogwood may seek resolution through the courts after 60 days. If conversations with HCA are productive, the parties can continue discussions to resolve the matter past Dec. 26.

Although it is early in the process, Mims said Dogwood Health chose to make the Affiliated Monitors report and the subsequent letter to the attorney general public in an effort to be more transparent.

“We have been doing a lot of listening from the community,” Mims said. “Folks would like more education and transparency in this process to really understand Dogwood’s compliance oversight of HCA. So, we heard you, and we are making this information available so that everyone can understand what’s in the letter and then the reasoning that with the information from the independent monitor informed those conclusions.”

CLICK HERE TO SEE THE LETTER

Affiliated Monitors representatives plan to return to Western North Carolina for more community engagement sessions.

“We are right now tentatively planning on returning for a week in September to continue what we refer to as community engagement by meeting with other groups that we have not yet heard from,” Coyne said. “Just to kind of continue with the dialogue that we have begun. It’s been wonderful to meet as much of the community as we have, but we all recognize that during the two weeks that we spent on the ground, we really only scratched the surface.”

Mims said Dogwood Health had expanded the scope of the independent monitor’s work to include more community engagement and education.

“That is something that we heard and more communication with the AG’s office, as well. We recognize that it, you know, it’s a different environment now, and we needed the independent monitor to broaden the scope of how they engage with the community and collect information in terms of how they conducted it,” Mims said.

CLICK HERE TO SEE THE COMPLIANCE REPORT

Coyne said one common thread in community meetings was that quality of care was not mentioned in the asset purchase agreement.

“We made the point at the community meetings that although quality is not specifically mentioned as a benchmark that has to be maintained,” he said. “It is mentioned in terms of the requirement under the APA that the hospitals maintain participation in Medicare and Medicaid and that Medicare and Medicaid programs have very specific quality metrics that they have to meet. So, quality does come into the provision of the Medicare and Medicaid requirement, even though it’s not independently mentioned in the agreement itself.”