As Haywood Regional Medical Center ponders the best way out of its crisis, other hospitals are already making overtures.
The motives are mixed. Some are circling like sharks. Others are more charitable, genuinely concerned that the hospital remain viable.
Attitudes among doctors are equally mixed. On one hand, doctors fear the loss of specialized medical fields. A larger hospital might siphon off those high-dollar specialties and send the business to its flagship, leaving Haywood with more run-of-the-mill medical care. Another fear is the loss of autonomy, followed by an outflow of dollars.
But a merger or partnership might be the hospital’s only way out of its current bind. For starters, it might need the cash infusion a buyout or merger could offer.
The loss of Haywood Regional’s Medicare and Medicaid status — followed by an exodus of private health insurance companies — has left the hospital with less than 75 percent of its normal patient load. Meanwhile, the hospital is bleeding more than $100,000 a day in payroll, not to mention the free medical care being doled out to patients who show up in the ER and can’t immediately be transferred to a neighboring hospital.
If the hospital runs out of money, or bumps into cash flow problems, merging could be the only way to stay viable. A merger or partnership might provide a quick route to a new reputation. A partnership with a larger hospital could also let Haywood doctors tap experts they otherwise wouldn’t have access to.
A committee of 26 doctors will begin exploring the pros and cons of the myriad merger options this week. At the same time, the hospital board and hospital administration will research the options as they see them — including the proposals to date.
The county commissioners instructed hospital leaders to get started immediately. To make sure it’s being done, Commissioner Kirk Kirkpatrick told hospital leaders he wanted a report within the week.
“I know there are some hospitals out there that are interested in some role,” Kirkpatrick told hospital leaders at a meeting last Friday. “That role has not yet been determined, or they might not be needed, but those options need to be looked at.”
Commissioner Skeeter Curtis summed up the county’s fear.
“If we run out of money what are we going to do?” asked Curtis. “That is one of the worst scenarios, but I think we need to look at that and be ready for it if it does happen.”
“We need a plan A and plan B and plan C,” agreed Commissioner Bill Upton. “We can’t wait until down the road when we find out we didn’t make it.”
“We did specify there should be a parallel path,” Commissioner Mary Ann Enloe added. “Every option has to be addressed.”
Commissioners will hear the report Friday at 1:45 p.m. in the commissioners meeting room in the justice center.
Options on the table
As a stand-alone hospital, Haywood Regional Medical Center is in the minority. Roughly 70 percent of hospitals in North and South Carolina are part of a larger hospital system.
A merger could take several forms. The most extreme is a buyout. The hospital would simply be sold, losing all semblance of local control forever. Or it could also be leased — turning over control and management for a limited period of time.
At the other end of the spectrum is a management agreement. The hospital board contracts with a larger hospital to run Haywood Regional for a fee. The local hospital board makes final decisions, however. Under that scenario, the hospital retains local control but won’t get a cash infusion. The more Haywood needs bailing out financially, the more control it will lose.
“If one organization makes a financial investment in another organization, the degree of involvement and control by the organization that made the investment is going to be greater — the greater the investment, the greater the control,” said Bill Moore, vice president of development for Carolinas Medical System, which operates 22 hospitals.
Yet another option is a merger, such as joining forces with WestCare, which operates the hospitals in Sylva and Bryson City. A merger would make Haywood more of a partner, rather than being absorbed in a buyout.
Yet another option is an affiliation or cooperative agreement, as two small hospitals in the region have done with Mission. They got cash and management help from Mission, but retained controlling interest through the local hospital board.
Fear of an outside regime
Partnering with Mission Hospital in Asheville is the first thought for most when contemplating a merger. But it’s the option that elicits the most fear among doctors.
“I am afraid if we were bought out or merged with a nearby hospital like Mission, we would be stripped to the bare bones due to a desire not to duplicate any services,” said Dr. Daniel Fox, an internist with Mountain Medical Associates. “It’s not that I am anti-Mission. It is a fine hospital. I am just worried they would put pressure on us to send our patients to Asheville.”
Some fear that would happen if absorbed by any larger hospital.
“I think lots of rural hospitals that get bought out or absorbed into bigger systems end up getting the short end of the stick,” said Dr. Stephen Wall with Haywood Pediatrics. “They get a lot of services drained away to their flagship — but not always. It might be a good thing.”
Wall said the committee will weigh the benefits against the drawbacks before forming an opinion, but until then, his first choice is staying independent. Dr. John Stringfield with Waynesville Family Practice has similar reservations.
“My first take is I would be really hesitant about having the county or local community giving up ownership of the hospital,” Stringfield said. “You just have a sense or fear if you have an outside authority coming in, they might gut the hospital of those more high revenue services lines like orthopedic surgery.”
No, within a year it will be Mission Haywood Regional Medical Center, or something similar.
dear Lord don’t let Mission have anything to do with this. they already have a monopoly in Asheville and are terrible, greedy employers.