By Lucas Thomae
With four “Immediate Jeopardy” citations in five years, Asheville’s Mission Hospital is on a “merry-go-round” of compliance enforcement by the federal Centers for Medicare & Medicaid Services, one that won’t stop unless either regulators or HCA Healthcare get serious about making meaningful change, according to State Sen. Julie Mayfield.
Mayfield, a Democratic legislator representing Buncombe County, has called on Mission Hospital to address critical issues with staffing and patient care ever since it was purchased in 2019 by Tennessee-based HCA, which owns more than 190 hospitals across the country.
Mission Hospital in particular has faced scrutiny because of numerous noncompliance issues that federal inspectors found over the years. The most severe of these violations can result in an Immediate Jeopardy designation, which is the most serious enforcement finding CMS may issue.
It means that a medical service provider’s noncompliance has placed patients at risk of serious harm or death.
In October, CMS placed Mission Hospital in Immediate Jeopardy after a visit from inspectors revealed preventable patient death, unsafe patient transport, patient misidentification and harmful infection protocol.
That designation was later removed, but inspectors found more deficiencies during a follow-up visit in January and placed Mission in Immediate Jeopardy once more.
CMS has the option to terminate its agreement with medical service providers who fail to shape up, but that’s not a viable option in this case. The resulting loss of Medicare and Medicaid funding would amount to a death blow for Mission, which is the largest hospital in the region and a critical provider of surgical, maternal and trauma care.
Historically, that is what has kept the merry-go-round of enforcement spinning in circles.
But Mayfield told CPP she’s “more hopeful” regarding CMS’ intervention this time around than in past Immediate Jeopardy situations at Mission.
“The main thing that’s different is that CMS is sort of hanging on to this enforcement action in a way that they have not before,” she said.
The agency required Mission to hire an independent consultant to help the hospital implement and track its plan to address deficiencies. Bryant Healthcare Consultants, a New Hampshire-based firm, signed on to fill that role.
Mission must also submit monthly reports to CMS outlining its progress in completing its plan, with a deadline of July 26.
“I do think there is a sense of impatience on the part of CMS,” Mayfield said, “and they’re saying, ‘you’ve got to tell us how you’re progressing with this between now and the end of July.’”
“They’re going to be watching.”
Bipartisan calls for reform grow stronger
The other thing that’s got Mayfield hopeful is what she described as mounting pressure on HCA from a bipartisan coalition of officials who are seeking real change.
On March 5, US Rep. Chuck Edwards, a Republican representing North Carolina’s 11th District, testified to an Appropriations Subcommittee that he was drafting a bill which would expand CMS’ enforcement tools for when hospitals are cited for Immediate Jeopardy.
Although not filed yet, Edwards said this bill, which he dubbed the “Healthcare Accountability Act,” would allow CMS to impose civil monetary penalties, require directed training, appoint temporary management or implement state monitoring for hospitals found in noncompliance.
The agency already has these powers for nursing homes, but not for hospitals.
Right now, Edwards testified, CMS’ only enforcement option for hospitals is to terminate federal funding, which is a nonstarter in most cases.
His bill would also direct CMS to create a public database of hospital Immediate Jeopardy citations.
“If Immediate Jeopardy represents the highest level of patient safety concern, it warrants full transparency,” Edwards said.
Edwards’ communication director Sydney Jones confirmed to CPP that the bill is still in the process of being drafted and hasn’t yet been introduced.
Meanwhile, the Land of Sky Regional Council, which is a coalition of municipal and county governments in Buncombe, Henderson, Madison and Transylvania counties, passed a resolution last week urging HCA Healthcare CEO Sam Hazen to come to Western North Carolina to speak with elected officials about their concerns regarding Mission.
“HCA has failed to provide sufficient resources and support for its staff, has failed to act on recommendations from nurses, and has created a culture in which doctors, nurses and staff are hesitant to raise quality of care concerns with management,” one section of the resolution read.
“HCA and Mission Hospital are not transparent or accountable to our community,” it continued.
What both Edwards’ legislation and the Land of Sky Regional Council resolution signify is that the anger over HCA’s handling of Mission isn’t just coming from one side of the aisle.
“There could be this region-wide call to HCA, across the political spectrum, for them to come talk to us,” Mayfield said.
Upcoming shareholders meeting will address Mission
Despite intense scrutiny over Mission, Tennessee-based HCA is doing very well from a business standpoint.
The company’s revenue rose to $75.6 billion in 2025, a 7% increase compared to the previous year, and its stock price also rose considerably over that time.
At its annual shareholders meeting on April 23, HCA shareholders will consider a proposal made by Mayfield for the company to produce a report examining the impacts of HCA’s hospital acquisitions from the past decade on the communities which those hospitals serve.
Mayfield said she purchased HCA stocks for the express purpose of making the proposal. A similar proposal failed last year after the board of directors urged shareholders to vote “no.”
Mayfield framed HCA’s handling of Mission Hospital since its purchase in 2019 as a legal and financial risk to the company. Although it will almost certainly fail, she wanted to make sure the problems at Mission were top of mind for HCA’s top decisionmakers.
“I am under no illusions that this resolution will pass,” Mayfield said, “but the purpose in doing it is to raise the issues that are happening at Mission with other shareholders and to help them understand the risks.”
HCA spokeswoman Nancy Lindell told CPP that the goal at Mission is to create a “sustainable framework” to enhance patient safety.
“We understand the responsibility that we have for the health and safety of our community, and we remain committed to providing high-quality healthcare to our patients,” she said.
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