Mission Health System dominates the healthcare field in Western North Carolina, owning or partnering with six hospitals and controlling more than 40 percent of hospital beds in Western North Carolina. The nonprofit company began its expansion in the 1990s. It absorbed small rural hospitals struggling to foot the bill for an aging, low-income and underinsured population in Western North Carolina.
Now because of the Affordable Care Act, Mission Health is making big changes. Asheville Citizen-Times reporter Jon Ostendorff and photographer William Woody gained unprecedented access to Mission, from the floor of the emergency room to the office of Mission's CEO Ron Paulus. Ostendorff told Frank Stasio of WUNC's The State of Things that changes at Mission mean the company will grow even larger than it already is by absorbing doctors and private practices into its outpatient services.
"Mission has expanded into outpatient care dramatically in the last 18 months," Ostendorff said. "That's a place where it sees it can get a better reimbursement under the Affordable Care Act."
Finding more lucrative sources for Medicaid and Medicare reimbursements is crucial for Mission Health's financial sustainability, Ostendorff said. Three-quarters of Mission's patients are Medicaid or Medicare patients. Moving them to less expensive outpatient services rather than treating them in the hospital will help Mission save hundreds of millions of dollars. The Centers for Medicaid and Medicare Services asked Mission to cut $350 million over the next decade.
To make these cuts, Mission cut back on expensive fee-for-service agreements. Now many doctors who used to have these agreements with Mission actually work for the company. Mission's outpatient doctor group has increased 50 percent since 2012, Ostendorff said. Those doctors can join Mission's Accountable Care Organization (ACO), a group of providers that share data on their patients to find ways to cut spending while keeping up with quality standards.
Some doctors welcomed the chance to align with Mission.
"That's really beneficial for doctors because they really get to get out of the business of medicine and focus more on providing care," Ostendorff said. By aligning with Mission, many doctors have access to infrastructure they struggled to provide their patients as part of a private practice. Still, Ostendorff said many doctors have concerns about becoming a part of Mission.
"They [the doctors] had a lot of angst about aligning with the healthcare company," he said. "When they partner with Mission, or with any company, they have to play by the company's rules."
Ostendorff said some doctors worry about their ability to advocate for patients in a rapidly expanding healthcare system. It's possible, he said, that one day Mission will be not only hospital and doctor's office, but also a health insurance provider.
Mission's CEO Ron Paulus told Ostendorff he believes his company's growth is justified because without it, Mission wouldn't be able to offer "big-city medicine" in rural Western North Carolina.
"In a lot of ways it's maybe kept those hospitals open and helped them offer the services they offer in rural counties," Ostendorff said. Ostendorff said Paulus also points to the fact that even as Mission has grown its outpatient services, it has succeeded in keeping costs down while also reducing hospital deaths by 500 a year.