By Grace Vitaglione
HCA Healthcare, which owns Mission Hospital in Asheville, had to submit an amended plan of correction to regulators March 13, which the federal Centers for Medicare and Medicaid Services approved in a notice to Mission Hospital CEO Chad Patrick. That plan was made public March 20.
HCA’s amended plan of correction includes an addendum on the hospital’s staffing strategic plan.
But while the plan has some positive changes, Mission Hospital nurse Kerri Wilson said management isn’t following all of it.
“Most of it is actually not new,” she said. “It’s just different ways that the hospital actually can get away with short staffing.”
Wilson works in medical cardiology. While HCA’s plan includes staffing to patient acuity, she said, that’s not the reality. Management has continually staffed less than what staff agreed to in their contracts, she said, and is instead putting the onus on staff to go through learning modules.
There were better staffing numbers when surveyors were present at the hospital, but that hasn’t been sustained, Wilson said. It’s also frustrating that management didn’t ask nurses for their input or share the plan of correction with them, she said.
HCA spokesperson Nancy Lindell said in an emailed statement, “We respect the CMS process and are confident that by accepting our plan of correction, the surveyors are satisfied with our improvements.”
The plan made public on March 20 is just one in a series of plans that HCA has produced or is under a mandate to produce to address issues at the Asheville hospital.
Mission Hospital management earlier submitted to CMS a plan of correction, made public Feb. 15, detailing how it would fix violations at the hospital. That plan was also approved, despite advocates saying it failed to address staffing shortages.
Regulators determined that conditions of immediate jeopardy at the hospital were removed after surveyors went back to the hospital Feb. 23. But they said the hospital continued to be noncompliant in some areas.
Those include patient rights, quality assessment and performance improvement, nursing services and emergency services. If the hospital doesn’t come into full compliance by June 5, 2024, it may lose federal funding, according to CMS.
Surveyors will be back on or before that date to see whether the hospital is compliant, according to the federal agency.
The hospital also violated requirements of the federal Emergency Medical Treatment & Labor Act, according to CMS, and management must submit another plan of correction for those violations to CMS by March 24.
Staffing strategic plan
Some of the management’s staffing plan includes evaluating staffing levels each shift through adjusting assignments based on patient acuity, which is how serious each patient’s medical condition is. Under this system, the plan has charge nurses provide direct care if needed. The hospital reviews staffing at minimum every four hours to see whether changes are needed.
But that four-hour revaluation may mean that one already understaffed unit can lose a member to another unit that’s in “shambles,” Wilson said, which doesn’t really help.
Management can also offer incentive pay when supplemental staffing is needed, as well as utilize travel nurses and support staff, according to the plan. The addendum also listed competitive pay practices for nurses and nursing assistants, salary adjustments based on industry trends and bonuses for staff who work overtime.
But some of those strategies “trap people into doing dangerous amounts of overtime,” Wilson said.
The incentive pay is only offered to staffers who are already full-time, when it should also be available to part-timers, she said. Critical shift bonuses are also offered to staff who will work four to 12 extra shifts over four to 12 weeks, but if they miss one shift, they lose the bonus, she said.
The addendum also addressed retention and recruitment strategies, listing efforts such as opening a location of the HCA’s Galen College of Nursing in Asheville and financially supporting local nursing schools, sign on bonuses for nurses, new hire training programs and the HCA student loan repayment program and tuition reimbursement.
Recruitment efforts focused on the emergency room resulted in a 60% reduction in RN vacancies since December 2023, according to the hospital’s plan, and retention tactics reduced nursing turnover to rates “well below the national average.”
In response to staffing shortages industry-wide, Wilson said there used to be enough staffers before HCA bought the hospital, but they left because of the poor working conditions.
Wilson said overall, the amended plan and addendum just put more work on the staff, who she said already know what needs to be done but just don’t have enough people.
“No amount of administrators trying to micromanage and sending reminders and auditing charts is gonna fix that,” she said. “The only thing that’s gonna fix that is actually having the people to give the care.”
New hospital in Buncombe?
Meanwhile, AdventHealth announced it will build a new hospital in Weaverville, Buncombe County, just north of Asheville, according to the Town of Weaverville’s press release posted on Facebook March 19.
AdventHealth received approval through the state’s certificate of need process in 2022, but HCA appealed the decision which led to a trial in fall 2023, the press release said.
That means this announcement comes as AdventHealth waits to hear the decision on the appeal, which the administrative judge is expected to make in the next few weeks, according to the press release.
The location would serve Buncombe and nearby counties with in-patient, surgical, labor and delivery and emergency care, AdventHealth said in a press release.
That would include 42 Medical/Surgical Beds, 12 Intensive Care Beds and an Emergency Department with 12 beds, according to AdventHealth.
AdventHealth currently operates a hospital in Hendersonville, just south of Asheville. If cleared by the judge, the new hospital would give AdventHealth, a faith-based nonprofit headquartered in Florida, a presence both north and south of Asheville.
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HCA’s purchase of Mission St. Joe was a mistake from the very beginning. There is a fund HCA was required to establish to help serve the community of Asheville and the surrounding communities. Maybe that money needs to go back to the Mission St.’Joe to hire nurses. Of course, they could start by firing top management and also returning the hospital to not for profit status. Of course that won’t happen because HCA needs to make its stockholders happy.
Everything I read about this “deal” suggests that the fix was in, and that Western NC citizens were poorly served by the board managing their community hospital. The “fund” established by HCA was the money they paid for the health system. There is no way it should go back to HCA, unless it is to buy back our hospital or fund some high-quality competition.