HCA Healthcare has less than 40 days to comply with service continuity requirements in a four-year-old hospital purchase agreement in North Carolina.
Otherwise, the massive for-profit operator could be slammed by a lawsuit from the state’s attorney general.
In 2019, HCA acquired Asheville, North Carolina-based Mission Health for $1.5 billion. As part of the purchase, HCA agreed not to shutter service lines at Mission facilities, including oncology units and emergency department services, for at least ten years following the deal’s completion.
North Carolina’s attorney general could sue HCA as soon as Dec. 10 over alleged noncompliance, according to a recent notice reviewed by Healthcare Dive.
AG Josh Stein’s office sent the letter in late October to Dogwood Health Trust, the nonprofit formed to oversee proceeds of the sale and ensure HCA complies with the purchase agreement. The notice triggers a 40-day clock, during which Dogwood can work directly with HCA to remedy the complaints of reduced access to medical services.
North Carolina has been investigating HCA’s handling of the Mission deal since February, sending letters to HCA and its advisors seeking information and warning that HCA and Mission could face potential litigation, according to the Asheville Watchdog.
Most recently, the AG released a notice in September demanding answers about the reduction of oncology services at Mission’s Asheville flagship facility.
The AG said that HCA reduced cancer services at the hospital due to an inability to adequately staff units. The Messino Cancer Group, which formerly provided inpatient hematology treatment to adults with leukemia and lymphoma, severed relations with the operator in September.
Mission lost more oncologists when GenesisCare, a private oncology practice which had previously provided staffing, declared bankruptcy in June. The final Mission oncologist plans to depart the hospital this month, according to the Asheville Watchdog.
As a result, patients are forced to travel hours to reach Charlotte, Raleigh, Durham, Chapel Hill or out-of-state facilities for care, Stein said.
“People in western North Carolina are worried and scared and frustrated because they can’t get the care they need at Mission,” said Stein in a September statement. “HCA agreed to provide cancer care in western North Carolina ... We need answers from HCA — now.”
Dogwood plans to meet with Stein soon to address “any issues of potential noncompliance,” Dogwood CEO Susan Mims told Healthcare Dive via email.
Mission Health denies any wrongdoing.
"We are confident that we have and will continue to meet our commitments" under the purchase agreement, Mission Health spokesperson Nancy Lindell said in an email to Healthcare Dive on Thursday.
Since HCA first announced its intention to acquire Mission in 2018, the deal faced concerns from doctors and community members wary of the influence of HCA — the largest U.S. for-profit operator by revenue — on a formerly community health practice.
Soon after the buyout, Mission raised prices by 10% and began charging unexpected fees. Dramatic staffing shortages also occurred “only a few months” into HCA’s ownership, according to previous reporting from Healthcare Dive.
Last month, a coalition of 50 Mission doctors penned an open letter saying HCA had “gutted the heart and soul of our community healthcare system.”
Along with service closures, hospital consolidation has been associated with increased inpatient prices and rising readmittance rates. Across the country, local regulators are fighting similar battles to preserve access following acquisitions from health systems and private equity firms.
In October, private equity firm Prospect Medical Holdings announced it had nine months to find a buyer for its struggling four-hospital health system, Crozer Health, after the Pennsylvania attorney general alleged the firm was reneging on its purchase agreement by trying to close locations within the 10-year purchase window.