Tuesday, April 23, 2024

HCA’ s top N.C. executive defends Tar Heel expansion

Greg Lowe was one of two HCA Healthcare employees who started working at Mission Health on Feb. 1, 2019, when the biggest U.S. hospital company completed its $1.5 billion acquisition of the Asheville-based hospital system. Four years later, he is president of HCA’s North Carolina division, the state’s sixth-largest health system. The graduate of the University of Utah had previously been CEO at HCA’s Richmond, Virginia, and Fort Pierce, Florida, hospitals and, earlier in his career, led Lake Norman Regional Medical Center in Iredell County. 

It’s been a tumultuous four years for HCA in Asheville, with continued criticism from community leaders and employees and a barrage of media reports contending that the quality of care has diminished under the publicly traded company’s ownership. The frustration was evident when Mission’s nurses voted to join a union in 2020, resulting in a three-year contract through 2024.

In an interview, Lowe discusses the controversies and HCA’s experience.

What are examples of HCA’s commitment to its large N.C. region?

We’ve made what I consider amazing capital investments in our region since 2019. We’ve approved more than $660 million in projects. We’ve not spent all of that, but we’ve committed those dollars. We’re finishing a new 120-bed behavioral-health hospital in Asheville that will cost $140 million. We’ve opened a new hospital in Franklin that is incredibly positive with much better access for people of that region.

We’re also expanding McDowell Hospital in Marion by adding 11 beds. That’s a $20 million project.

At many of our facilities, we’re also going floor by floor and completely renovating each room and nursing stations. That’s costing $2 million to $5 million for each floor.

We’ve also added a helicopter, which is very important in a mountainous  area where folks might have heart attacks in some inaccessible areas and need to be picked up quickly. A helicopter costs more than $8 million.

Another example is that four years ago, we had one robot to do surgeries. Since then, we have purchased six da Vinci [Surgical System] robots to provide super high-end surgical care that didn’t exist until HCA came here. We are adopters of technology that helps our physicians deliver care that leads to better outcomes and shorter lengths of stay.

What was your view when regulators allocated new hospital service in Asheville to Advent Health?

We went through a process that showed there was a need for 67 more beds. We believed the need is for high-acuity beds. We don’t need more low-acuity beds in this region.

But the state decided to give those beds to a hospital system from outside of our region. (Advent is a faith-based nonprofit headquartered in Florida that operates a hospital in Hendersonville.) 

We are in a conundrum because the state is not allowing us to expand the beds that we justified a need for. It’s a disservice to the patients in North Carolina.

We are the only provider in our region that can provide the depth of those services including ICU, cardiac, neurosciences and trauma. On a daily basis, we have patients waiting to be admitted because our beds are full. But we view other hospitals as our partners, not our competitors because they send us patients every day. We take that responsibility very seriously.

Why has Mission received so much criticism over its staffing?

It’s an industrywide challenge and a national issue. I’ve been involved at the state level and every hospital is struggling with this. But I’m pleased with our ability to partner with four nursing schools in Western North Carolina that haven’t had the funding for additional faculty members, which are needed to expand the number of nursing students. 

One advantage of HCA is our partnership with our own nursing school, which has a wonderful track record. We’ve opened a college of nursing in south Asheville and had great success in hiring two cohorts of their students. Enrollment has exceeded expectations.

We always could do better and we don’t want to use the excuse of so many retirements and the fact that more nurses are taking traveling jobs. We have a lot of open positions.

But we’re doing incredibly well with our recruiting and we’re seeing a positive trend that we’d like to see accelerate. It’s very competitive for nurses, LPNs, techs and every position. We can always do better.

Did you raise pay to attract workers?

We did a massive compensation adjustment that involved more than $20 million of extra cost, both for existing and new employees. We’ve hired more than 700 people into areas where we were struggling with vacancies.

Mission has always used contract labor, though it has increased in recent years. We aren’t at the highest level right now, but that can change month over month.

What about a series of reports citing inadequate care?

It’s hard to respond to anecdotal commentary. The factual evidence doesn’t show the anecdotes to be true. We have staffing grids that provide an hourly assessment of our needs. We know that is very much of an art in addition to being a science and we do the best that we can.

Things can happen on a daily basis such as someone having a crash before work and not being able to fill a shift. We do everything we can to fill that spot when we are able to do so, and we adjust within the hospital based on the needs of our patients.

We are also the only trauma center hospital in Western North Carolina, so the sickest patients come to us. They often have different levels of nursing experiences because as patients get better, they may move to another area with a different continuum of care. It requires sophisticated, complex management on a shift-by-shift, hourly basis.

We also receive hundreds of emails and texts about the great care that patients have received. And when the media writes a negative story, we ask the staff to talk about why we are here and what we are doing. 

How have unionized nurses affected Mission?

We work closely with all of our employees and the union adds another variable. We know a good portion of our nurses are in the union, but I can’t tell you who is or who isn’t. They are still team members. We don’t ignore them. We engage with them and need them to be part of this great team effort. 

The union has an agenda and their talking points, which we’ll work through with them. The facts don’t support the narrative that is often out there in the community. Regardless of the noise, we are an A-rated, Top 50 Leapfrog hospital based on outcomes. (Leapfrog is a national hospital-rating service.) Union or not, we have people who are providing dedicated service to patients. 

What are some of your priorities in 2023?

A big priority is Medicaid expansion, which would help us address many more patients. It would mean a great deal for many hospitals across the state. But a really neat thing about HCA coming to Western North Carolina is that we have an extremely generous charity care policy that has allowed us to provide more care to individuals who make as much as 400% of the poverty rate. I know we have the most generous policies in our region and maybe in the entire state.

At the same time, we’re also the largest taxpaying entity in our region, which has helped the city and county with a massive increase in revenue. (As a not-for-profit, Mission Health didn’t pay property tax.) We could be the largest supporter of local schools and infrastructure here. We are pleased about that. 

What would you tell State Treasurer Dale Folwell, who has urged HCA to sell Mission Health?

We are focused on quality outcomes and patient satisfaction. We care for a lot of state employees and if I was one who needed to go to a hospital ranked in the top 50 nationally, I’d feel very comfortable. 

We’ve positioned ourselves with investments in people and a focus on quality outcomes. It’s been a tough journey because of workforce issues, but we are positioning ourselves to move through this and have great quality outcomes for those that we serve.    

David Mildenberg
David Mildenberg
David Mildenberg is editor of Business North Carolina. Reach him at

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