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As physicians quit Mission Health facilities in western North Carolina following the system's purchase by HCA Healthcare, an independent monitoring team said they were paying attention to the issue.

The outside monitor -- Nashville-based consulting firm Gibbins Advisors -- was put in place as a result of stipulations the North Carolina attorney general made in greenlighting Mission Health's $1.5-billion sale to HCA in 2019. Team leaders held a 2-hour virtual meeting on Wednesday to address the issue for members of the public.

Recently, many of the questions submitted to the independent monitor by members of the communities that Mission Health serves relate to physicians leaving local facilities, leaders at Gibbins said during the online webinar.

Though the team from the consulting firm said it's likely many of the physician departures don't fall within the independent monitor's purview, they assured meeting attendees that they are still taking a look and raising the issue to HCA.

Ronald Winters, principal at Gibbins Advisors, said during the webinar that he would break questions about physician departures into two groups -- those regarding primary care physicians, and those regarding surgeons.

Generally, a set of 15 commitments from HCA that the independent monitor is tasked with examining do not include physician employment or primary care, Winters noted. However, one of the commitments states that Mission Health's local hospitals -- which serve 18 largely rural counties -- must provide emergency, acute medicine, and surgical services.

"To the extent those departures impact services at hospitals, that's certainly something we're going to look at and inquire about," Winters said. Surgeons leaving facilities is going to have an impact on the ability to provide services, he added.

Also during Wednesday's webinar, Thomas Urban, managing director at Gibbins Advisors, said that the team would take a look at service levels relative to emergency, acute medicine, and surgical areas in particular, and see if there are any trends or patterns that relate back to physician retention.

Many of the physicians departing Mission Health facilities have landed at other health systems in the region, 口袋女优 previously reported.

Other concerns fielded by the monitoring team involved confusion around charity care, as well as long emergency department wait times, inadequate nurse and housekeeping staff levels, and diminished cleanliness of facilities.

One concern raised with the independent monitor was that HCA's charity care policy was confusing for patients. In some cases, patients may have been required to pay for care up front before the policy kicked in, the Gibbins team noted at the meeting.

However, the monitoring team's role is only to check compliance with policies, not evaluate them -- and the team's review found HCA had followed the charity care policy, Winters said.

Winters noted that some of the other concerns fall under regulatory requirements monitored by government agencies. Having said that, there may be issues that indirectly affect compliance, or give rise to not providing services as specified in HCA's commitments, he added.

Each year, the independent monitor's role is to advise a foundation called Dogwood Health Trust on HCA's compliance with a list of agreed-upon commitments, as well as the attorney general's office. The foundation was formed with proceeds from Mission Health's sale for the purpose of ensuring that HCA meets its obligations and serves local communities properly.

Dogwood Health Trust hasn't notified HCA of any issues of noncompliance to date. But the recent or impending losses of handfuls of physicians has caught the attention of the North Carolina attorney general's office, as well as Gibbins Advisors, 口袋女优 previously noted.

J.C. Luckey Sadler, a spokesperson for HCA Healthcare's North Carolina division, said in a statement provided to 口袋女优 that the team joined the independent monitor's webinar: "Our commitment to our patients across Western North Carolina remains steadfast and at the forefront of all we do. The Mission Health team understands the enormous trust placed in us to serve this community."

Leaders from Gibbins Advisors said that some 200 people registered for the webinar.

Gibbins expects to receive an annual report and capital expenditure report from HCA later this month or early next month, its team said during the meeting. It plans to complete its annual evaluation and submit its own report to Dogwood Health Trust over the summer.

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