Davin Eldridge – Staff Writer

Ever since Mission Health announced it would be discontinuing labor and delivery services at Angel Medical Center last year, things have been touch-and-go in Macon County.  The healthcare conglomerate’s move proved to be an unpopular decision by many in the community, despite its Chief Nursing Officer Karen Gorby contending it was a difficult yet unavoidable one. So it’s no surprise many county residents have been wary of Mission Health’s next move. But things are now picking up, as Mission released a Letter of Intent at the last county commissioner’s meeting, indicating a potential merger between it and Hospital Corporation of America (HCA),  Franklin’s Town Council got a visit from Angel Medical Center’s Karen Gorby at its last regular meeting on Monday. While it’s clear it was an effort to walk local leaders through the process of Mission Health and HCA’s recent partnership, it was also a chance for Gorby to extend some level of transparency on the part of the merger, acknowledging “what some missteps are and expectations for the community.” “So, going through this process is sort of like dating,” she said. “We announced our Letter of Intent, and then next we started doing what is due diligence.” At this stage, Gorby said Mission Health provided their new partner with more than 25,000 administrative documents, and in turn HCA has toured all of Mission’s community facilities.  “That, really, to me was very engaging because we gave them a lot of information,” she said. “They actually read it and wanted to come and see what we had given them in the documentation.” Nearly complete, Gorby said the two healthcare companies will move from the due diligence portion of the merger and into its next phase – coming up with a definitive agreement between both parties. “We hope to have that agreement done by the middle of August,” she said, adding from that point the agreement will be submitted to the N.C. Attorney General. “We hope that by the end of the year there will be a ruling, as far as if we can proceed to be a partner with HCA or not.” With that, Gorby then pitched the board on the benefits of the Mission Health-HCA merger. She described the state of healthcare as an “unstable” market drawing on the level of uncertainty with regard to government funding which increases the availability of medications to rural providers. “That funding is decreasing beginning in 2019 and although we’re not in financial distress right now we wanted to be sure that we could sustain healthcare in WNC now and in the future.” In their search for prospective partnerships, Gorby explained that Mission’s Board of Directors chose HCA because of its platform for quality care and because they deemed HCA’s philosophy toward healthcare as compatible with theirs. “It’s about ‘patient first’,” she said. “So, we looked to add the innovation they do matches our care.” According to Gorby, what Mission Health wanted most in a partner was a real sense of security, as well as someone they felt they could count on to help them deliver better healthcare to the region. She cited HCA’s funding as a major plus to both of these factors, stating from Mission’s own experience that improving healthcare is difficult without healthy and maintainable finances and an efficient billing department. “There was enough things that, when we looked through that initial ‘why HCA?’, we felt that was a good partnership,” she said. If good quality medical care, compatibility, an innovative culture and good profit margins weren’t enough, in the end what proved to be the cherry on top for Mission was HCA’s robust pool of practicing medical residents from nearby Enka. This would ensure Angel Medical Center can avoid the burden of having to recruit and replace its staff. “Mission has already talked to HCA about providing additional residents here that are really linked to rural health,” she said. “The way that you can keep and recruit residents here is to have them in your area so that they get used to the community… We’re looking forward to having more residents here at Angel.” There was also HCA’s apparent buying power, having shown Mission officials a proven track record of purchasing medical equipment at the lowest rates in the industry, which Gorby said helped it court Mission. “If you can buy your supplies – your bandaids, your syringes, your parts cheaper – then you’ll actually be able to have a margin,” she said. “That’s really difficult in today’s environment. As healthcare costs increase, at least five to seven percent a year, we need to keep looking at how we’re going to maintain that margin.” Gorby also said a partnership with HCA would also give Mission access to one of the country’s leading cancer institutions which holds some 75 percent of the country’s research grants. Among other things, she said the partnership would give Angel access to all of today’s state-of-the-art cancer research protocols. Finally, Gorby appealed to the board on grounds of economic development. Noting that HCA is a private healthcare company, she said the revenues that the community would collect through the provider’s taxes would greatly benefit the local economy. But not all people are created equal in the eyes of the free market. While Gorby said the added tax base from a merger would go a long way to improve the quality of life, it would only go so far. For the many others in the community unable to afford things like travelling to doctor’s appointments, finding housing, enrolling in medication programs or getting opioid addiction treatment–Gorby said a merger between Mission and HCA would benefit them as well. “The best benefit is the proceeds from the sale of Mission Health will form what’s called the Dogwood Trust,” she said. “It’ll be a similar foundation to the Duke Foundation, although this foundation will have the highest per capita dollar than any foundation across the country.” Once the project is about 75 percent of the way complete, she said Mission would then apply for a special use permit through the town. “Our plan now is to move into the facility in the winter of 2022,” she said. “That seems like a long time, but you know how time flies. This year’s halfway over.” Mission is currently in the process of validating its space plan to come up with its bridging document, which Gorby said opens the door for soliciting design plans from architects and contracts from builders. Despite the avalanche of benefits and plans that Gorby brought before the board, council members had all remained rather skeptical of the partnership in the wake of her pitch. With the taste of a raw deal still fresh for many Franklin residents, the only council members with any questions or comments for Gorby were recalcitrant, if not reserved, to say the least. “Can you be objective and tell us what any potential downsides of the merger are going to be to this community?” asked Town Councilman David Culpepper, allowing more than enough room to be candid. ” “To the community? No,” she said. “When we looked at the opportunity and sustainability of the medical center–there really aren’t any downsides to the community.” Mayor Bob Scott expressed concern that HCA sent no delegates before the board, and recalled the only time he was offered any access to its officials since their Letter of Intent. “I did get the opportunity, but it had to be 30 minutes in the hospital and it was a day when I could not get to them one time,” he said. “Where is HCA? This is going to have a huge impact on this community.” Gorby proceeded to give Scott explanations regarding their last visit to Angel, telling him how brief their director was on site and how many already had engagements with him, yet the Mayor pressed her. “I think we would like to speak to somebody in the executive position with HCA,” he said. “This has a huge impact on this town.” Gorby remained vague, saying it was still too early to tell, however she then indicated that Mission was “keeping that open.” Asked by councilman Joe Collins whether Mission might bring back its old labor and delivery services, Gorby gave the same reply, but added that much of it depends on planning and local population–factors which led to Mission discontinuing the services to begin with.