In the 4 1/2 months since Nashville-based HCA Healthcare acquired Mission Health on Feb. 1, patient numbers are up across the board, company executives told members of the media on June 20.

“We have experienced an increase in our patient volumes by every metric: in outpatient visits, in inpatient admissions. We’re up substantially in behavioral health admissions,” said Terence van Arkel, chief financial officer of HCA Healthcare’s new North Carolina division.

Some of that growth can be attributed to a rising preference for Mission, added Greg Lowe, chief executive officer of the division. “We definitely have seen increases in our market share, so people are electing to receive care in Mission facilities versus other facilities,” he said.

As Lowe and van Arkel made clear, HCA sees that initial growth as just the beginning.

“Whether it be here in Asheville or with our sister facilities [in other Western North Carolina communities], whether it be inside what we’ve typically looked at as our geographic service area, we’re thinking bigger, because we know we provide great care and, a lot of times, better outcomes than other hospitals. So we want that reach to expand,” Lowe said.

While returning repeatedly to messages of growth and their commitment to long-term investments in the region’s health care infrastructure, the leaders also responded to questions about the company’s business model, staffing and morale.

‘A big threat’

“There’s no way that a small health system can exist whenever the revenue to that system is cut every single year,” former Mission CEO Ron Paulus told a meeting of the Council of Independent Business Owners last May.

Van Arkel said those issues are not unique to WNC. “There’s a lot of people that want to cut our reimbursement,” he said, citing both government and private insurers. “When you think about the Medicare for All movement, that’s a big threat, not just to Asheville but to the whole country.”

HCA has been successful in creating a structure to “weather the uncertainty on the payer front,” van Arkel explained, even though, “We don’t have control on 75% of the business on how we’re going to get paid.” Ensuring that the organization has smart cost structures and efficiencies in place will allow HCA to “really be able to add value to Mission Health going forward,” he said.

Van Arkel pegged HCA’s new investments in Mission at $230 million since Feb. 1. That total includes money to support the new North Tower at Mission, set to open in October; $60 million for the replacement of Angel Medical Center in Franklin; almost $4 million for a new surgical floor at the SECU Cancer Center; and equipment upgrades including MRI scanners, mammogram machines and spinal surgery and robotic equipment, he said.

‘We’re hiring’

Lowe deflected questions about layoffs and “grumbling” among Mission staff, saying, “We’re really focusing on, ‘How do we manage change or perceived change?’ Sometimes a lot of rumors run around.”

“There may be some reassignment of what folks are doing in the hospital,” added van Arkel. “When we go through any kind of staffing changes, it’s based on what we’ve demonstrated to work very well throughout the company. It’s never going to be easy to tell people they’re going to be doing something different in the future.”

The bottom line, though, is “We’ve got a great need for staff right now,” Lowe said. “We have over 700 positions that are open in our facilities in the area. A large number of them are on the clinical front. So we’re hiring.”

Van Arkel agreed, referring back to earlier comments about increases in patient volume. “I get excited about growing volume, because I can create jobs with growing volume.

“If you know any RNs, can you let us know?” van Arkel quipped.

Pressed for specifics on the growth numbers, however, Lowe demurred. “That’s typically something we look at internally, since we’re part of a large organization,” he said.

East of Biltmore Avenue

It’s “a little early on” to predict what changes might be in store for Mission’s St. Joseph’s campus, Lowe told reporters. The hospital opened 20 new behavioral health beds there a couple of months ago, bringing its total to 78. “We filled those beds almost immediately, given the behavioral health need in our community,” he said.

The 34-bed long-term acute care hospital on the St. Joseph’s campus “serves a very vulnerable population” and is a unique and special component of the hospital system, Lowe said.

On the other hand, “That building’s very, very old, and it takes a lot of time and effort to figure out the infrastructure, what exactly needs to be replaced, from plumbing and HVAC, working in a clinical environment — we’ve got to make sure that we fully understand what it’s going to take to rehab that building and if that makes sense for us,” van Arkel said.

“At the end of the day,” van Arkel added, “we’re not looking to cut any services. The services will still be offered, just in a different location.”

The planning and reconfiguration associated with moving many hospital functions into the new North Tower — “a lot of dominoes,” according to Lowe — also needs time to play out before future plans for the St. Joseph’s campus are finalized.

Country roads

Fresh from a visit to one of Mission’s outlying facilities the day before, the two leaders seemed enthused about the potential for the provinces of HCA’s new empire.

“Outside of Angel [Medical Center in Franklin], these are beautiful facilities. They are modern; they’ve got state-of-the-art equipment. We don’t see a massive need for capital investment,” van Arkel said. “People have this preconceived notion of rural health care being older facilities and maybe not offering as great quality of care and services. That’s not the case.”

Land acquisition and design work for the new Franklin hospital have already begun, Lowe said. “The plans look amazing. It’s going to be incredible for that community,” he continued. “We are so excited about placing this new large hospital to serve that community there. It’s greatly needed.”

HCA has been told that attracting doctors and other providers to WNC’s rural facilities is a challenge, Lowe said, but the company’s recruiters are optimistic. “I asked them specifically, ‘Is this the hardest place to recruit to?’ And they’ve said, ‘Absolutely not. We’ve recruited a number of physicians to much harder places to recruit to,’” he said.

The corporation’s national reach provides access to residency programs and other resources that will aid in attracting new physicians, Lowe pointed out.

Rather than looking to the minimum requirements the company promised for Mission’s community facilities as part of N.C. Attorney General Josh Stein’s approval of the transaction, Lowe said, “We’re looking to, ‘How do we go well beyond that?’”

Getting to know you

HOSPITAL HONCHO: Chad Patrick will take the reins as CEO of Mission Hospital in Asheville in mid-July. He comes to the region from Jacksonville, Fla., where he’s served as CEO of HCA’s Orange Park Medical Center for the past six years. Photo courtesy of HCA Healthcare

Lowe and van Arkel oversee HCA Healthcare’s new North Carolina division, which so far consists solely of the Mission portfolio. The division is one of 16 for the company, which operates “186 hospitals and growing,” van Arkel said.

Each of the individual Mission hospital locations has its own chief executive; Chad Patrick will arrive in mid-July to take up that role in Asheville. Patrick comes from HCA’s Orange Park Medical Center in Jacksonville, Fla., where he’s been CEO for the past six years.

Lowe said he and his wife of 20 years, Lee, and their four school-age sons will settle in South Asheville. According to a bio provided by the Mission Health communications team, he’s fluent in Spanish, a skill gained from two years as a missionary in Mexico. Lowe has been with HCA Healthcare for six years.

Van Arkel is a native of Australia who retains only the slightest hint of an Aussie accent. That’s probably because he’s lived in the United States since the age of 11, when his father relocated the family to New York. Van Arkel and his wife, Nora, live in North Asheville. Their 24-year-old son works for HCA Healthcare as an accountant, and their 22-year-old daughter will graduate from Florida Atlantic University this summer.