It's been two years since the Hospital Corporation of America (HCA) took over Mission Health in Western North Carolina.
For the first time, News 13 is hearing from several doctors about how they've been treated and how your health care could be affected.
News 13 has also confirmed that at least 55 doctors have left or plan to leave Mission Health.
"DRASTIC, FUNDAMENTAL CHANGE"
Dr. Kate Rasche worked at Mission Health for five years. She was a regional clinic lead for primary care at Mission's office in Haywood County.
She tells us she loved her job but saw things change drastically when HCA Healthcare took over.
"Before HCA came in, I feel like Mission recognized that it's very difficult to be in the black running a primary care office, but also take care of all insurance types and all payers," Dr. Rasche said. "And HCA was more focused on seeing financial data from the clinics rather than seeing it as part of the big picture of keeping the region healthy."
She talked to News 13 because she says it's time to share the truth about what's happened at Mission.
Unfortunately, the change in ownership has shifted this system's priority away from the health of Western North Carolina to the health of the stockholders.
Dr. Rasche says over the last two years, she watched as positions meant to support doctors, like mental health experts, were cut.
She says at the same time pressure was added to increase patient load.
So about four months ago, she made the decision to leave - right as HCA started sending out new contracts for all primary care doctors.
"It was a shock to see that it would be a pay cut for so many," said Dr. Rasche.
Dr. Rasche tells us the contracts were clear - see more patients or get less pay.
"Restructuring physician contracts to where it's fully based on how many patients you see and how high of a level you bill them versus focusing some on quality outcomes and some on productivity." She goes on to say, "my understanding is that the portion of pay that was for quality metrics and things like that was significantly decreased and the focus on how many patients you were seeing was increased."
She says doctors weren't happy, some even hired lawyers.
"The marching orders they are being given right now are very different from what we're used to being given, and that may result in changes in the patient experience or changes in how fulfilled the providers are in their jobs," said Dr. Rasche.
The very same week, Dr. Rasche says HCA announced that it was shutting down two primary care clinics - one in Biltmore Park and the other in Candler.
Dr. Tim Plaut was a doctor at the office in Candler. He says at the time he was shocked to learn that the clinic he loved and his job would be gone in just 45 days.
"I'm sad that our clinic was closed in Candler," Dr. Plaut said. "It created a lot of hardship for our patients." He estimates that more than 7,000 patients total, many without insurance, were treated at the two clinics.
At the time, Mission Health told us the patients were being contacted about transitioning their care to other nearby providers.
But Dr. Plaut worries that some fell through the cracks.
He says when doctors offices close, often times it means patients have a hard time finding transportation to travel farther to another clinic.
Our practice in Candler was one of the original safety nets through Mission and we took care of a lot of Medicaid and Medicare; we had homeless folks and severe mental illness.
Dr. Plaut was offered another position within Mission Health but instead chose a job at Appalachian Mountain Community Health Centers. He now sees patients at the Leicester Community Health Center and believes in the work he's doing.
"I feel good about where I am now. I realize HCA made a business decision and although I may not agree with the way they went about it, it's up to us the providers, and the organizations that provide care to step up and continue to provide care for the people in this area," said Dr. Plaut.
CHANGE IN PRIMARY CARE FOCUS
Dr. Ben Aiken also parted ways with HCA recently.
In 2018, he helped Mission Health create a new, innovative clinic, a direct primary care model, where patients pay a monthly fee instead of insurance and are given much more access to their doctor.
But about a year ago, HCA decided against the project, and Dr. Aiken bought it to run himself.
"Ultimately, at the end of the day I felt like it wasn't an area that they wanted to focus," said Dr. Aiken. "So when that became clear, we shifted the conversation because our core team here felt very passionate about continuing what we had started."
He tells us that Mission Health had become a regional leader in primary care as the foundation of a strong healthcare system. But he believes HCA is moving in a different direction.
I don't sense anybody wants HCA not to succeed, we want an incredibly high functioning hospital in our community. But if in fact they aren't going to be focused on the primary care piece, because we all know that foundation is critical, everyone is putting their heads together and saying we want this to exist, how do we make this happen? If you look at the large footprint of HCA nationally they don't do a lot of primary care, they're not operating a lot of primary care practices so in the acquisition here it was kind of a new territory for them.
We asked Dr. Aiken if he's surprised by how many doctors are leaving Mission Health.
"Not really, you know frankly, at this point, as with any transition, transitions are difficult," said Dr. Aiken.
DOZENS OF DOCTORS LEAVING
Over the last few months, News 13 has had conversations with several former and current Mission Health doctors who want to remain anonymous.
Those doctors have confirmed that 29 hospitalists have left since the HCA takeover was announced.
In addition, at least 16 out of 21 doctors at Transylvania Regional Hospital plan to leave after being offered contracts with 10-25 percent pay cuts.
When you include the primary care doctors we've learned about, it totals 55. Those are just the doctors we've confirmed.
We wanted to sit down with Mission Health to discuss the doctor turnover and new contracts, but they refused an interview. Mission Health also wouldn't provide the workforce data we requested two months ago.
A spokesperson for Mission Health did give us the following statement:
As with any organization, employee contracts are confidential. Through our contracts with our employed physicians, Mission Health seeks to support our focus on patient care while compensating our physicians at Fair Market Value. While most Mission Health physicians were offered new employment contracts, some have chosen to pursue other options. We are actively recruiting to fill any vacancies that we anticipate, for instance, just this week we signed contracts with three new providers. All of our primary care locations continue to be available to the community for their care needs.
"I WAS IN PANIC MODE"
When doctors leave, patients are impacted.
"I was shocked and totally upset because he has been my doctor since May of 2004 when I moved here," said Mike Martinelli.
Martinelli recently got a letter from his doctor at Mission. It said all six of the physicians at Vista Family Health were leaving to start a new practice, Pardee Primary Care.
He knows my history; I have to see him every two or three months for medical issues and I don't want to start with another doctor. One of the reasons I've never actually moved out of Asheville, he's too valuable to me.
"Some doctors have already left our community and there is a loss there for sure," said Dr. Aiken.
But despite all the changes and uncertainty, those meant to protect us are still trying to do just that.
"The HCA takeover has been spun in a lot of different ways, positive and negative, but it's up to us to make it what it's going to be and we are choosing to make it as good as it can possibly be for our patients," said Dr. Tim Plaut.
This is one of three segments investigating what's changed with Mission Health since HCA took over.
CLICK HERE for the second report.