Dogwood Trust Releases Independent Annual Report Shows Progress in Two Areas
Last week, the Dogwood Health Trust released its report from the independent monitors which showed that HCA’s Mission Hospital resolved problems with two areas of potential non-compliance in the 2023 report. The last remaining issue in the report is directly related to complex litigation that is ongoing, so the independent monitors declined to update the findings from 2023.
Background:
In 2019, the Dogwood Health Trust was established to ensure that HCA complied with the promises made during the purchase of Mission hospital Here are the 15 commitments that HCA made in 2019, as you can see a substantial number have been completed and most of them are still in progress.
The Dogwood Trust employs Boston-based Affiliate Monitors to monitor compliance with the agreement.
Most recent report:
The most recent report from Affiliated Monitors shows that HCA has made improvements compared to 2023, with one issue remaining that is tied to ongoing litigation.
Previously, in 2023, the Independent Monitor said HCA was in potential non-compliance with the agreement because Medicare and Medicaid threatened to disenroll the hospital. Mission leadership quickly worked to remedy the handful of issues, and the Center for Medicare Services concluded its investigation. At no time was Mission Hospital unenrolled from Medicare and Medicaid. Mission contends that it did not violate the agreement because it was never not enrolled in the programs. But the Independent Monitor interpreted “good standing” to mean that they must have a good reputation with the federal agencies, not simply be enrolled in the program, so they found them as “potentially non-compliant.
In the 2024 report, the Independent Monitor said Mission was in full compliance with this provision since there were no additional actions taken by the Center for Medicare and Medicaid.
The second issue that was resolved was related to Charity care. In 2023, the Independent Monitor discovered some liens placed on properties prior to HCA’s takeover of Mission Health. But throughout 2024, Mission Health cancelled this policy entirely. Additionally, changes to North Carolina law allowed Mission Health to improve its charity care services.
The last remaining issue involved the level of care for emergency and oncology services. The Attorney General sued HCA over this provision in 2023, and the case remains pending in Buncombe County Superior Court. The Attorney General argued that HCA broke the agreement by changing the staffing levels in the Emergency Room and Oncology Department. HCA maintains that they are in compliance with the agreement and provide quality services in both the emergency and oncology departments. The litigation is still pending, and the independent monitor said that the appropriate venue for determining these claims was the court, not this report.
Bottom Line: These types of reports are overly wonky and technical, but overall, Mission Health remains in compliance with most of the promises
Media Bias?
While the 2024 report overall highlighted compliance with the APA. Asheville media outlets frame this as some sort of scandal for Mission Hospital.
Here are some examples:
Headline from Asheville Watchdog: “HCA was in potential non-compliance with Mission agreement in 3 areas in 2024, independent monitor report states.” But the report paints a different picture of compliance and notes that the remaining issue on potential non-compliance is tied up in litigation.
Same story at the Asheville Citizen Times with the headline of “HCA Healthcare, Mission Health deal: Independent monitor reports potential non-compliance.” The focus is on the one issue that’s still in court, while ignoring that most of the report shows that Mission is in full compliance with the agreement.
Again at the Blue Ridge Public Radio, “Latest HCA Oversight report highlights outstanding Mission ER, oncology care issues.” While this headline is more accurate, the report did not focus on ongoing litigation, but rather on the areas of compliance.
Tim’s Take: Except for the liberal media bias against for-profit healthcare compared to non-profit, this report would receive little attention. There is one area of disagreement between the independent monitors, the courts are resolving that issue. This report is mostly good news, but the media tries to make it a scandal.
