Dogwood Health Trust chose Boston-based Affiliated Monitors as the new independent monitor to oversee HCA Healthcare’s compliance with its purchase agreement of the Asheville-based Mission Health system, the private foundation announced April 2.
The monitoring firm’s engagement began April 1, according to Dogwood. HCA and the state Attorney General’s Office each consented to the pick.
The independent monitor’s job is to make sure HCA Healthcare complies with stipulations the company agreed to when the state approved its acquisition of the Mission Health System in 2019.
Dogwood Health Trust is a nonprofit grant-making foundation established to receive the proceeds from the sale of formerly nonprofit Mission Health to for-profit HCA.
As the “seller representative,” Dogwood chooses the monitor to advise them in making sure HCA complies with the purchase agreement, according to an emailed response from Dr. Susan Mims , CEO of Dogwood.
The agreement covers conditions that must be met over 10 years, “and a number have already been satisfied during the first five years of the agreement,” Mims told Carolina Public Press in an email..
N.C. Attorney General Josh Stein sued HCA Healthcare in late 2023 over allegations the hospital company is not providing the agreed-upon levels of emergency and cancer care for Western North Carolina residents.
According to Stein, HCA agreed to continue providing emergency and trauma services and oncology services at Asheville’s Mission Hospital until at least 2029.
In an emailed statement about the new monitoring firm, Stein said, “A strong, independent, and transparent monitor will go a long way in ensuring that HCA upholds its commitments.”
The new independent monitor team includes Gerald Coyne , a former deputy attorney general for Rhode Island, Denise Moran , director of health care monitoring services at the firm and Jeff Brickman , a former hospital administrator, the press release said .
Their work will focus on “HCA’s annual report evaluation, community engagement and education, engagement with the AGO, and continuous compliance evaluation and other activities,” according to the press release.
Coyne said Affiliated Monitors is one of the only firms in the country that specializes in compliance monitoring.
The team is currently focused on learning all they can about the situation, Coyne said, and expects to begin visiting the hospitals and holding community meetings in late May or June.
He also plans to visit each site physically, as the Mission Health system includes several rural communities in Western N.C. and each one is different, Coyne said.
Reactions to Affiliated Monitors
Sen. Julie Mayfield , D-Buncombe, said while it’s good to see the firm’s specialty, it’s important to remember the new monitor doesn’t have new powers. It’s still up to Dogwood Health Trust to ultimately say whether HCA breached the agreement, not the monitor, she said.
Micheal Messino , a retired physician who founded Messino Cancer Centers, is part of a coalition of advocates and elected officials following developments at Mission Hospital. While it’s good to see the monitors’ backgrounds in health care, he said, “there’s not a whole lot of excitement” around the development.
With the previous monitor, Messino said it was difficult for advocates to make clear the importance of overseeing quality when the agreement was solely considered as a legal document. Quality in medicine matters, he said.
Gibbins Advisers was the previous independent monitor.
Coyne said the monitoring team is “very sensitive” to quality. He said he also read the public reports from the Centers for Medicare and Medicaid Services about findings at the hospital.
The monitors will not work directly with CMS, but the agency’s reports are an important “data point” as the two entities are looking at similar topics through different perspectives, Coyne said.
Part of Dogwood Health Trust’s role is to ensure all residents of Western North Carolina have access to health care, Mims said over email, and that means carefully monitoring HCA’s continued participation with CMS.
Dogwood will also discuss how to approach quality of care issues with Affiliated Monitors in the upcoming evaluation cycle, Mims said. The monitor will help people share concerns around quality of care with appropriate oversight bodies, including the Attorney General’s Office, she said over email.
Aimee Bovara , a nurse at Mission Hospital, said she’s “excited and hopeful” for the new monitor. Nurses are the monitor’s allies to hold HCA accountable, she said.
In past audits, Bovara said she’s noticed extra criteria for patient care in place while auditors are in the hospital, but that “falls by the wayside” once they leave. She said she’s hopeful the new monitor will do things differently, as well as focus on staffing.
In response to hearing both skepticism and optimism about the new monitor, Affiliated Monitors president Vin DiCianni said the cynical views will “always be there” to an extent, but it’s good to hear of hope.
“Doing things in a transparent way and getting all of the parties involved – the AG’s office, Dogwood, HCA Mission and the hospitals – moving in the same direction, that’s our goal,” he said.
Asking for public feedback
Affiliated Monitors will hold in-person information sessions throughout the region in the coming months, the press release said , and publish “feedback tools and resources” for the community soon.
If members of the public have concerns, the monitor team wants to hear about them, Coyne said.
“If we are not aware of something, then it’s almost impossible for us to respond to it,” he said.
The monitor team is working on updating the website so community members can submit concerns there, he said. Community meetings are another way to hear from the public, but not the only way, Coyne said, as the team needs to figure out how effective past town halls were at getting information.
Three board members and three staff members of Dogwood Health Trust reviewed proposals and conducted in-person interviews with final candidates for the new monitor. The foundation also ran background and reference checks on Affiliated Monitors, according to Dogwood.In an emailed statement, HCA spokesperson Nancy Lindell said, “We look forward to working with the new independent monitor, and we are confident that we have been and will remain in compliance with the Asset Purchase Agreement.”
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