Jason Sandford
Jason Sandford is a reporter, writer, blogger and photographer interested in all things Asheville.
Here’s another enlightening comment about the ongoing Mission Hospitals dispute with area doctors:
Today’s “leaked document trail” is an appalling attempt for non-employed physicians to gain buy-out negotiation power over hospital administration. The coverage is about as close to sensationalism that Asheville has ever seen.
“Mission’s conduct in dealing with physicians is unacceptable in any environment, let alone one in which other large health systems are encroaching on the region.” -John Silver, MD – Mountain Neurology -Pete Mangone, MD – Blue Ridge Bone and Joint -Kenny Simpkins, MD – Victoria Urological Associates -Frank Moretz, MD – Asheville Anesthesiology Associates
Shame on them for making such a overtly threatening statement. You will note that there are no employed physicians who have signed this document, nor any co-owned practices on the list. Each of these practices stands to gain if acquired by the hospital in the coming year.
This example is just one in a long line of how physicians continue to leverage their only threat (to take away patient referrals) in order to negotiate better buy-out deals with the hospital. They believe making the argument public will further their cause because they’ll be seen as the “little guy.”
In fact, it’s just another example of the top 2% screwing over the rest of us while convincing the general public they’re doing them a favor. The real truth is that this year hospital employees have taken benefits cuts and been passed up for salary increases while administration saves money to buy growingly expensive practices (in order to control costs).
Despite the shelter from the economic woes that a buy-out would offer many practices, they still ask for more! Most of us “regular employees” are happy to have stable jobs, and it makes this poorly planned negotiation move appalling.
Play ball or get off the field, physicians. Your entitled attitudes already make us sick and your transparent negotiation techniques are clearly against the best interest of the people of our region.
To sit back and take a look at where we have come and how we got here is disturbing to say the least. The constant finger pointing has morphed into a huge snowball rolling downhill and the momentum comes from the same tired, boring place it always does…It appears in every workplace, school, church and sometimes at family gatherings… belief that somehow, someone else is responsible for my unhappiness.
Oh how people love to complain about their pitiful lives and are resolute in their commitment to not do a thing about their situation. Have we not progressed enough to understand that our happiness is not determined by Joe Damore or the physicians or anyone else for that matter? If you don’t like working at Mission then why are you putting yourselves through the anguish you describe? Quit! If you are convinced that Mission is a ship destined to run aground because of its crazy captain – then abandon ship before it hits the reef! Do everyone else a favor, save yourself!
Moral at Mission is not low. It is only low in the people it is always low in. The same 4% of overall hospital staff that fill out 90% of the employee satisfaction surveys completed. Everyone knows these people. They would not be happy winning the lottery because they had to pay taxes on the winnings…Their moral is low. Who cares?
It is amazing to me that the mountains surrounding this tiny town have so blinded us to what is going on in the world today that we actually think that removing the present administration at Mission Hospitals is going to make everything all better. Why? Why would that make it all better? Don’t you remember when there were problems with the past administration…and the one before that? I have an idea – why not start with yourself as a place to initiate change? Take some responsibility for it instead of expending so much creative energy trying to drill someone else to the wall.
Mission Hospitals is this lumbering behemoth of an organization and like most healthcare organizations it has been a very sloppily run business and a lot of misdirected expectations and bad habits have formed as a result. I’ve watched for years as the hospital has continued to hemorrhage money…Now it is being forced into an agile state so it can be competitive – not in a local market but in a national market. The nurse to patient ratio at Mission Hospitals is smaller than one would find with many of our competitors – including Carolinas. You want to tell me there will be better patient care when we are having to take care of 6+ patients a piece? C’mon, do your homework! Healthcare is just being forced to catch up with what corporate America has been doing for decades. Talk about shoddy leadership!
I believe the present administration understands what it is going to take to obtain the flexibility to maintain our viability in the immediate future. I think they do have our interests at heart despite our "eat your young" mentality. Do you not remember how it felt last year when we found out about the state Medicaid reimbursement cuts? Do you remember that not a single person lost their job to make up for the millions needed to balance the budget? How about this year when businesses all around us are shutting down and laying off because of the present economic crisis…and we haven’t experienced one layoff? Who do you think is responsible for this? Now think about what would probably have happened to you if you worked in banking, the auto industry, pharmaceuticals, etc?
Tough times require tough decisions and sometimes those decisions "trim the fat" in a much needed way. For someone to assume that experienced staff were fired for no reason or because they were being paid more is ludicrous. Do you think that person’s privacy should be breached so everyone knows that they were fired because they had 18 absences? Do you really believe that the hospital was getting rid of experienced professionals and replacing them with inexperienced people who could be paid less? C’mon…it would cost a heck of a lot more money to pay for the lawsuits the hospital would have lost due to that inexperience. Think about it…!
The present leadership at Mission hospitals is far from perfect and continued work needs to be done to regain the trust needed between physicians and the hospital administration. Please remember all of us little people that are caught in the middle….we are the ones that have to listen to our neighbors, friends and families discussing this. It is embarrassing to witness because, to them, I am Mission Hospitals. Whether the players like it or not it is a symbiotic relationship. While everyone is busy peeing on trees as the fire grows larger, please don’t lose sight of how this is effecting the community you have all sworn to serve…the community all of you are a part of.
Oh…4 US troops died in Afghanistan yesterday. How many of you thought about their families today?
Re: Fightingthegoodfight
It is fairly clear who you are. Griping that you are only paid $4000K per year, and don’t get to "sell back" your vacation for another $100K more won’t win you any supporters!!!
As another employed physician, I am appalled.
Personally, I support the changes and am fairly content as a Mission employed physician.
A bit of further enlightenment/advice: Don’t just guess wildly at what you think physicians make. You are off by up to 6 figures in some of the posts. Many pediatricians and family practitioners are lucky to make $150K in a year. Yes, that’s alot of money, but not for the years of educ/training, hrs worked, threats of lawsuits, and stress of caring for patients (often in life and death situations). Do your homework before spouting off. One resource is MGMA.com. Be sure when you search this you do so by region as the NE, FL, and west coast physicians have higher incomes (Medicare reimburses relatively more for the higher cost of living.)
Please don’t begrudge a physician their time off. Actually, in residency training there is now mandatory time off to try to decrease the risk of overstressed/tired docs making poor decisions. All work and no play makes Jack a dangerous physician.
And as to comments about monopolies: they do exist. Yet, what community just got recognized for providing high quality care at low cost?? Do you really think a bunch of greedy docs who only care about stuffing their pockets could get this recognition. Nothing in medicine is more powerful than the doctor’s pen. But does it appear these local pens are driving up health care costs?
And finally I have to give credit to the Mission staff who are standing up for the doctors. The staff lives paycheck to paycheck and an unhappy work environment doesn’t improve their situation. The docs and staff know the other cares deeply about them. Each hates to see the other getting screwed when they all just want to come to work every day and do their best for the people of WNC. This added stress is not needed and the demoralization could ultimately result in care deterioration through despondency. What a shame that would be when the system in prior years has been built up to a top hospital in the nation. And don’t let the current administration take any credit for those accolades. That all started under prior leadership with the fruits seen about the time the present CEO arrived, but not by his team’s efforts. Mission wasn’t recognized as a top 100 hospital this year…
"Entitled"!! Well, I have to admit, you have a point. After 1)14 years of post-high school education, 2)massive education debts, 3)very long work hours, 4)night and weekend call, 5)spending decades taking financial risks to build a patient oriented practice, 6) building trust and strong relationships with patients, colleagues, and community, and 7)doing all I can to help my patients, I do feel entitled. I feel entitled to make less than 20% of the salary of the Mission CEO, who can claim 1) maybe 7 years of post-high school education, 2) nominal school loans, if any, 3) banker’s hours, 4) no night or weekend call, 5) no financial risks, 6) destroying in a short time the once idyllic and unique Asheville health care community – for patients, hospital employees, and dedicated physicians, and 7) doing all he can for the almighty dollar and number one. Oh, also 8) he’s happy to tell me that he can easily replace me with a perfectly good doctor from Timbuktu. But hey, to his credit, he’s a big fat guy who has the audacity to write health tips for the Mission house organ Scope (Sorry, that’s rude and beside the point, but hilarious nonetheless.).
"Regular employee"!! Whoever wrote the above is no doubt an employee of someone, but certainly not regular. Virtually everyone involved in health care at the hospital holds the current administration in high disregard. This is not just about physicians, but the non-physicians feel powerless and at risk.
As a long time worker and student of the healthcare system ( 30 years)I am stunned by the recent developments at Mission.There is a dynamic at work here that has profound implications for the people of WNC, now and into the future.At play are the community of MDs,the hospital system ,the administrative drivers,board,mission staff,and last but not least the patients.The physcians in Asheville generally have a sweet deal and they know it. What they wont tell you is that many groups have no local or regional competition. The hospital subsidizes many of their expenses. Could you imagine starting a buisness where all your overhead is paid for up front and you have exclusive rights to all the buisness? The mds are a hetergenous group, many are hardworking caring professionals, others are driven by ego, money, and prestige.It seems the younger physicians ( we were promised riches for our efforts) have dilusions of grandeur. The staff and administration put up with their incessant demands for " control" and support at any cost to staff or the system.There are many that provide excellent service,are dedicated,and forego a personal life to pursue their profession. They are rewarded handsomely for their efforts. Others work 4 day weeks, have 6-8- weeks vacation per year and are rewarded well over 500k.It is fairly obvious many mds are simply trying to protect their freedom and compensation.
The administration is another story. They have an agenda that philosophically may seem reasonable,survial depends on a cooperative effort between mds and the hospital because of a shrinking reimbursement…Unfortunately the means used by the current administration dont justify the ends. Transparency is an issue. The results are a huge gap in trust between Administration and the physicians. Another issue is the apparent strategy of squeezing the staff of needed resources, staffing etc. to increase the bottom line. Many directors and managers have been given untenable metrics as goals and as BA states "conditions of employment"The expectations is the directors and managers implement cuts to achieve these goals. This alienates front line managers from the staff they are trying to manage and lets the VPS off the hook . The claim of senior management is that we have not laid anyone off -how many have fired or forced out of positions. BA has demeaned ,demoralized, and disrespected many to achieve his goals and has encouraged other vps to do the same.I think administration and the board has severely underestimated the results of this behavior. The comments I hear from staff are scary and quite personal. Of coarse all this could not be possible without the cooperation of the vp and director of HR. The most objectionable part of this is that resources ,personnel etc. that would go to direct patient care have gone wanting to achieve the financial goals-there are many examples. The future, this is a mess, a Carolinas buyout would nutralize some of the dynamic. The worst thing that could happen to Mission would be an improvement in the housing and job market,then you would see an exodus of quality health workers divesting the system of its strongest asset.
As a Mission employee for a number of years and an RN for over 30 years in various hospital settings, I have never seen anything like what is going on in the Mission system recently…we are dedicated, hard working employees trying to live by the Mission MERIT values of Mercy, Excellence, Respect, Integrity and Trust…but we do not see these values in our leadership. There is no transparency or honesty…nurses with the most experience are being "let go" with no real explanation, so that less costly new nurses can take their place. Or no one is hired and the rest of us just work harder. We are not told what the true agenda is, as there is no communication that we can trust..if we speak up about any of the treatment we are currently receiving, our jobs are definately on the line..we do not feel valued or respected by "the system." Fortunately, we take great pride in our profession and taking care of our patients, but many of us are truly fed up with the feeling that we work for an uncaring machine..and since Mission is the Big Dog in town and Asheville’s major employer, we feel stuck with no place else to go. The physicians are correct. Something is definately very rotten at the top of the management food chain. Employee morale is rock bottom.
You have done a great job investigating this story. I have no idea how you got a copy of this letter, but its impact is huge – the signees include many of the most respected and influential physicians in the community (not to mention the biggest moneymakers for the hospital system). Asheville medicine is acknowledged far and wide for its excellence. This is largely due to the quality and efforts of the medical staff (easy to attract top docs to this area!), along with the benign cooperation of previous administrators, resulting in a patient-oriented, efficient, kind, and friendly medical environment. The new sheriff (medical administration) in town takes a purely business (not patient!)-oriented approach, finding reasons to let valued, capable, and even beloved hospital empoyees go (they are higher paid due to seniority), and threatening long term excellent but recalcitrant physicians with replacement by warm bodies from foreign lands. It will be interesting to see how the hospital board handles this (and where they seek their own medical care in the future).
So where excatly are doctors supposed to be threatening to take their patients? Exactly. There is NO where for them to go. No other tertiary care hospitals in the area. Damore and his state sponsored monolopy….oh I mean COPA ….are the ones being anti-competitive, not the physicians. I can guarantee few, if any, are making the salary Damore is making. Threatening doctors when you have a monopoly and are essentially forcing them out of business and/or into your control? Perhaps the Board would like to discuss this with the Department of Justice? Is anyone out there listening?????
The damage has been done to Damore and Company. I can assure you the majority of what has been posted on this blog about them is true. It is time for big Joe to turn in his resignation along with the "toxic team" of Aston, Roloff and Ford. They are the heart of the problem. This rift with the physicians cannot and will not heal until these four are gone from Mission. Face the music and save the community a bloodbath by turning in your resignations and negotiating a comfortable serverance package. We will be glad to pay it.
My take ,from an employee of over 15 years…This is a pitiful administration. From the 17 or so vice presidents to our publicity hound CEO, to our little coup planner Brian and entourage that he brought with him from South Carolina. I just want our mealy mouthed Board of Directors to stand up and take back our hospital. If this is an example of leadership then this area is sorely lacking. I have never heard of so many vice -presidents at one institution. Maybe, they make a convienent smoke screen for ineptitude. Shame on all of you.
For the last six weeks, Ive spent every day, between work and sleep, at Mission-StJoe. Ive experienced ER, ICU (both sides), Step Down, Heart Wing, Adult Floor…. Its been surreal to watch the talking heads on CNN in the cafeteria talk nonsense, protesters carrying guns while I watch doctor after doctor, nurse after nurse rotate in and out of my family’s life; it floats around me.
Normally Im first to debate, first to phonebank… I cant even imagine being strong enough to not cry, feeling defeated, at those who think we dont need a complete overhaul of our healthcare system. Yes, we need public option becaue insurance companies arent enough. Apparently, we’ve learned.. we need Medicare and Blue Cross. Out of at home care benefits for the year….
The nurses are worked to the bone on the regular floors and are furious they have to rebid for their jobs, apparently with the reshifting of the wings. The doctors have been heros, except for a few duds. But not bad odds for hanging around so long. I wish there was a resident doctor.. is there?.. we feel lost sometimes…
Its hard to hear that egos at the top might be affecting the quality of care by killing the morale. Everyone treated there, old and young, tired, poor or rich need the people keeping them alive treated with respect and kindness.
Doctors aren’t allowed to own other businesses like labs or imaging facilities because it is a conflict of interest. But facilities can own doctors? Mission should do a little research on this failed experiment before they invest in too many practices.
No one has the information needed to defend Mission’s CEO, COO, and CFO – and to bash the physician community – until such person has been present in a meeting where these administrators have lied, bullied, and tried to manipulate him/her. Then – and only then – can a person understand the level of evil at work in the hospital’s administration. Again, unless a person has witnessed first hand how the board turns a deaf ear to this evil – that person cannot possible understand what is happening at the hands of Mission’s board and its current administration.
Joe Damore and his minions are single-handedly destroying years of collaboration and relationship-building throughout WNC.
Remain Anonymous or Suffer
As someone who lives in WNC and has an avid interest in health care (who doesn’t, really?), I beg journalists to dig and explore this story. I also implore them to look to independent hospital and health care delivery "grading" sources that can perhaps give some independent insight. I think it is important, too, to see what if any national trends are playing out here with our major health care provider.
I am encouraged by the revelations appearing on this site. Regrettably, it seems members of the medical community in Lansing (who eventually developed similar impressions of Mr. Damore’s tenure and tactics) must not have been consulted. A significant function of any senior manager involves managing risk. In my opinion, Mr. Damore has distinguished himself by his spectacular failures in this regard. Beyond the failure to integrate with Haywood at such a crucial time, the methods he employed need to be investigated. There have been occasions when Mr. Damore (and his administrators) gave assurances to the medical staff that they were not actively seeking to purchase physician practices while simultaneously conducting active negotiations to complete such purchases. The Mission systems dealings with Radiation Oncology services and other clinical services appear to have been anti-competitive in nature (something expressly forbidden under the COPA agreement that governed the merger of St. Joseph’s and Mission).
At the same time as these management decisions contributed to the deteriorating relationships between the medical staff and the hospital administration, Mr. Damore’s administration seems to have damaged employee morale. Through a series of cost cutting measures that were not communicated effectively, many employees have seen their benefits cut without feeling enfranchised in these decisions. These sort of strains are not easily revealed since employees would risk retaliation if they became too vocal. If it were possible to investigate the way Mr. Damore (and his HR staff) managed EEOC related risks this might further attest to the damage (and potential damage) his management has produced.
Finally, risk associated with competition has been managed ineffectively and sometimes through dubious practices. Perhaps the results of Haywood is emblematic of a failure to manage the risk of competition. Time will reveal whether the arrival of a strong competitor will benefit our region, but from the perspective of the Mission system, this was a failure to manage competitive risk.
Taken together, the current administration has displayed poor skills with regard to managing community relations, medical staff relations, Board of Director relations, employee relations, and relations with regional providers (competitors). As the Board contemplates its response to the current crisis perhaps it will examine whether or not Mr. Damore and his administration managed the risks facing Mission in an effective manner that demonstrated integrity. If this results in a change in administration, that may be a good first step in ushering in the changes our community desperately needs.
"Your entitled attitudes already make us sick"
First off, nice spin. Good deflection techniques, you must have learned from the foot of the master. Let me tell you about "entitlement". "Entitlement" took 17 years to train. Hundreds of thousands of dollars in student loans. 100 hour work weeks. One week of vacation a year, combined with C.M.E. Two days off to bury my beloved Mother. Entitlement, meant Never being there for my wife or kids. Entitlement took enormous loans out to build a practice up, employ people, educate them, insure them. " Entitlement" gave me my life bloods work, and I will not give it up, without a say in how I practice the art and gift of medicine. I will not practice under dubious contracts, unethical principles, and draconian tactics. That is just my opinion, and I am "entitled" to it.
This statement does not ring true. Did it come from the PR department or directly from Damone’s office?
A few specifics:
"Shame on them for making such a overtly threatening statement."
What has shame got to do with it. This sounds like the strict father trying to keep the flock in tow. When you get highly educated, professional, grown-ups rising up in such numbers against a widely condemned administration there’s a problem. Are you going to be able to shame them into submission? There’s something rotten at the core at Mission and scolding and ‘shaming’ rebellious children is not the way to restore harmony.
"Most of us "regular employees" are happy to have stable jobs,"
That’s not the impression we have from what we’ve seen here. And by ‘us’ to whom do you refer? Damone, at $700,000 a year may be happy. (Are you happy Mr. Damone? Have you taken a pay cut to help cover costs?) From what we’ve read here an overwhelming majority of employees at Mission are disgruntled, dissatisfied and unhappy. And, it does not seem to be about money.
I think the whole above statement is an attempt to distract attention, to blame someone else, to find fault with the accuser. As the story unfolds, I guess we’ll get to judge who to blame. Greedy doctors –boo, hiss, or toxic management.
OK let’s get real. This did NOT start with complaints by or about the physicians. That just upped the ante! The concern is the administrative team and their lack of leadership, vision, integrity, and ethics. They are hypocritical bigots and need to be removed from Mission immediately. The facts are overwhelming and if the board does not act then, as one commenter stated earlier, they can/will be held liable. Another commenter even gave you the names of the senior leaders and VPs whose teams should be interviewed concerning these threatening and intimidating tactics. Just so you don’t have to trouble yourself with too much work I looked back in the posts and found them for you. They are Joe Damore, Brain Aston, Maria Roloff, Kristi Sink, and Frank Ford.
Focus people Focus!
It never ceases to amaze me the different prospectives people have from looking up or looking down the corporate food chain. The from the low end, they are pretty tired of the "The Jack-Booted gestapo techniques used to imitate the employees."
Dave, anonymous.
Who made this comment? I don’t see any attribution.