Immediate Jeopardy at Mission Hospital: Implications and Action Plan

2024-02-06 09:30:00

By Andrew R. Jones

Mission Hospital has been officially informed by the U.S. Centers for Medicare & Medicaid Services that it is in “immediate jeopardy” related to deficiencies in care, according to an internal email obtained by Asheville Watchdog.

The finding is the most severe sanction possible for a hospital and starts a 23-day clock for Mission to produce a plan for fixing the problems or risk losing its Medicare and Medicaid funding.

The notification comes 44 days after inspectors from the North Carolina Department of Health and Human Services, on behalf of CMS, recommended the hospital be put in immediate jeopardy, citing nine deficiencies related to incidents occurring over 19 months. The Watchdog was first to report the recommendation on Jan. 11.

If Mission fails to correct the deficiencies to the satisfaction of regulators by the deadline, it could threaten the financial viability of the hospital, which receives a majority of its funding from Medicare and Medicaid.

State Sen. Julie Mayfield (D-Buncombe)

State Sen. Julie Mayfield (D-Buncombe), speaking last week at an Asheville Watchdog public forum on the fifth anniversary of for-profit HCA Healthcare’s purchase of nonprofit Mission Health, described Mission Hospital’s potential loss of CMS funding as “catastrophic.”

“As bad as things are in the hospital, closing this hospital would be 10 times worse,” Mayfield said.

When the hospital submits a plan of corrective action around the immediate jeopardy findings, Mayfield said, she and other leaders will review it “with a fine-toothed comb.”

CMS informed Mission and the North Carolina Department of Health and Human Services of its findings Thursday, according to an email from HCA North Carolina Division President Greg Lowe obtained by The Watchdog.

“As you may have heard or soon will, Mission Hospital’s recent comprehensive survey by the Department of Health and Human Services has resulted in an Immediate Jeopardy finding by the Centers for Medicare and Medicaid Services (CMS),” Lowe said, noting Mission received the CMS report Feb. 1.

“As the initial findings of the survey were shared last month, steps were taken immediately to address them,” Lowe wrote in the email. “Significant HCA Healthcare resources were deployed to assist with our response. We brought in additional staff who are working in our emergency department and, on our busiest days, we have repurposed space on the Memorial Campus to accommodate additional patients.”

HCA and Mission executives, including HCA North Carolina Division CEO Greg Lowe, and Mission CEO Chad Patrick, are shown visiting the hospital on Dec. 19. // Obtained by The Watchdog Credit: Asheville Watchdog

Lowe said in the email, “now that we have the report from CMS, we will submit our corrective action plan by their deadline.”

“Further, we will continue to reeducate our teams and refine our processes in these areas to strive to always do better for our patients,” Lowe wrote in the email. “We continue to work toward resolutions on any identified issues and are confident that we will be in compliance when surveyors return to Mission Hospital.”

CMS regulations define immediate jeopardy as noncompliance that “has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death…[It] is the most serious deficiency type, and carries the most serious sanctions … An immediate jeopardy situation is one that is clearly identifiable due to the severity of its harm or likelihood for serious harm and the immediate need for it to be corrected to avoid further or future serious harm.”

The Watchdog’s Jan 11 report showed that NCDHHS’s inspections had led to two immediate jeopardy identifications, one on Dec. 1 and another on Dec. 9.

Those two identifications of immediate jeopardy were based on nine incidents that happened over 19 months between April 2022 and November 2023.

Lowe wrote in the email that “(i)mprovement is already being acknowledged by our patients and EMS partners in multiple counties as they experience decreasing wait times.”

“I am immensely proud of our team and the quality care that is provided across Mission Health. Yet, as I’ve stated previously, we take these findings very seriously, and there are no excuses for our patients receiving anything other than exceptional care,” Lowe wrote.

On a page Mission Health FactsHCA’s corporate website cites Mission Hospital’s current “A” grade for safety from the independent rating company Leapfrog, and a “50 Best Hospitals” ranking by Healthgrades, which “evaluates hospital performance using objective quality measures including clinical outcomes and patient safety, as well as patient experience.”

On its website, HCA attributes persistent complaints about HCA’s management and a litany of other issues at Mission Hospital to “vocal critics” who have “minimized or ignored our positive impact and achievements.”

Mission Health spokesperson Nancy Lindell issued a statement Friday afternoon.

“There are no excuses for our patients receiving anything other than exceptional care, and Mission Health has already taken action based on the preliminary findings shared last month,” Lindell said. “We are pleased to hear from our EMS partners and patients that those actions are yielding positive results, including decreased wait times for care. We respect the process of these surveys and will submit our corrective action plan to CMS by their deadline. Again, these findings are not the standard of care we expect, nor that our patients deserve, and we are working diligently to improve.”

Immediate jeopardy is rare, according to a 2021 study from the National Library of Medicine, which reviewed 30,808 hospital deficiencies between 2007-2017. Only 2.4 percent or 730 of those resulted in immediate jeopardy, according to the study.

In addition to the CMS finding, HCA and Mission face a lawsuit filed in December by North Carolina Attorney General Josh Stein. Stein, a Democratic gubernatorial candidate, contends that they have violated the asset purchase agreement regarding cancer care and emergency services.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email [email protected]. To show your support for this vital public service go to avlwatchdog.org/donate.

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