Doctors in Haywood County will soon be asked to weigh in on whether they think Haywood Regional Medical Center should merge or affiliate with another hospital.

The hospital board decided at its meeting last week to distribute a simple survey to every doctor. The idea came from board member Pam Kearney, and was supported by Dr. Henry Nathan.

Kearney said it is clear to her that the medical community wants to partner with another hospital, but her feeling is based only on anecdotal information. Kearny said a survey would give the entire medical community a voice.

“I think the board needs to poll all the medical staff to confirm their feelings on affiliation,” Kearney said. Nathan seconded the idea.

Meanwhile, however, the pace of merger talks has frustrated doctors who are growing nervous about the hospital’s dwindling financial reserves. The hospital lost its Medicare certification in late February, setting off a financial and public relations crisis.

Many in the community began talking immediately of the need to partner with another hospital as a way to shore up the hospital’s finances and restore its reputation. But nearly five months passed before the hospital held its first formal talks with another hospital.

HRMC had several suitors knocking on its door, but chose four to make formal pitches. Two were heard last week, with two more to come next week.

Discussion of whether to merge and if so, with who, is being carried out by a small committee of four hospital board members, four doctors and a county commissioner — known collectively as the Future Directions Committee. The rest of the hospital board and the medical community are in the dark about the status of the process, as is the public.

The void of information is driving anxiety among the medical community and public, Kearney said. A remedy would be for the hospital board to adopt a timeline to carry out the merger talks and make a decision, Kearney believes.

“We just can’t leave these folks guessing about our timeline. Some folks need to make personal decisions based on the timelines,” Kearney said, referring to doctors whose livelihoods are at stake. “This would be a timeline that would kind of guide us and give the stakeholders an idea when we are going to get to the end game.”

Kearney said the timeline should identify “high level” tasks, like when the first round, second round and third round of talks should be completed, and what information needs to be brought to the table from a due diligence perspective.

“Otherwise we may not be approaching the exploratory interviews and follow-on interviews in the most efficient manner possible,” Kearney said.

Kearney said developing a timeline is the basic starting point of any project, one she employed often in her job as a financial, business and systems analyst overseeing major multi-million dollar projects.

“I think it would provide some structure. We will know if we are off task,” Kearney said.

The rest of the board had objections to the idea, however.

“A timeline is a great idea, but it might just be a little premature,” said Cliff Stovall, a board member who is on the Future Directions Committee. Stovall suggested waiting until the suitors were narrowed down after the first round of pitches.

Roy Patton, an attorney, said he didn’t like the idea of timeline for fear it would pigeonhole the board into a partnership

“You are starting out with the presumption that this hospital is going to affiliate. Have we made that decision yet? I’m not sure that has been made,” Patton said. “What if we don’t like any of these people? What if they don’t come up with something we like? Then our timeline is gone.”

Patton said he wants the board to do what it can to reassure physicians, but first wants to see financial projections for the next two months.

“If we are going to go down the tubes without (a merger) the timeline got written,” Patton said. “On the other hand, if it shows we are going to make it though that quarter, at least we have a little pressure off us. I don’t think it is cast in stone yet what we have to do. Show me first we shouldn’t try to make it on our own.”

Kearney countered that the Future Directions Committee seems to have made up its mind already, however.

“There seems to be a consensus that the hospital needs to affiliate. The next step is the who,” Kearney said.

Patton said if that was the case, the committee should formally present their stance to the full hospital board.

Glenn White, chairman of the hospital board and member of the Future Directions Committee, said the committee isn’t there yet.

“The committee is leaning toward that and is probably thinking an affiliation is important,” White said. But there is no conclusion, White said. When there is, the committee will share that with the full hospital board, White said.

For now, the committee is “going through their work process to arrive at these things,” White said.

Kearney said again that it was her understanding the committee had already reached the conclusion that an affiliation was inevitable.

Dr. Richard Lang, a radiologist and member of the Future Directions Committee, spoke up from the audience.

“I would like to say very simply anybody who does not think we need to affiliate in some manner is living in a complete dream world,” Lang said.

County Commissioner Kirk Kirkpatrick, another member of the future directions committee, said in an interview two weeks ago that a partnership of some sort was likely, adding that it was the general consensus of the committee.

Dr. Henry Nathan, a hospital board member who is also on the Future Directions Committee, was once a supporter of the hospital remaining independent. But after seeing how Haywood Regional could benefit from a partnership, it seems he changed his mind.

“I had no idea what these entities were going to come and tell us,” Nathan said. “We are finding out that this could be a very good thing for Haywood County and Haywood Regional Medical Center. We are getting energized and excited about his process.”

Nathan said the entities are “extremely high quality” and are very interested in partnering with Haywood Regional.

“Their philosophies coincide with our philosophies — what we think is important and what they think is important,” Nathan said.

But that didn’t seem to settle the issue of whether a general timeline would be beneficial to the process. Kearney continued to push for one, offering to spend the next two weeks doing a mock-up of one herself.

White said a formal timeline to guide the process is unnecessary.

“There already is a plan in place. You talk to these entities, find out what is going on, eliminate some of them, have a couple left and then decide whether you want to do a management agreement, a merger or an affiliation,” White said, referring to three different levels of a partnership.

Nathan didn’t think it was that simple, however.

“There is a lot of work to get the best deal for our community,” Nathan said. Nathan asked Kearney if she thought the board needed a more precise plan than the general outline White gave. Kearny said yes, and again offered to do it. Nathan settled the matter by suggesting she do a rough draft for the board to see, with no promise that it would be adopted.

“I would be happy if you would take the time to do that. This is not gastroenterology so I don’t know how to do it. If you would just do a simple mock-up of what you are talking about, that would help,” Nathan said.

But the issue wasn’t over there. Kearney next expressed reservations that the majority of the hospital board is in the dark about the pros and cons of a partnership. Only four of the 10 board members are on the Future Directions Committee, leaving the rest clueless on how a merger or affiliation could be beneficial and what the best structure may be.

“You are light years ahead of some of the board members,” Kearney said.

Kearney said she would not be willing to “rubber stamp” the committee’s recommendation, adding that it was her responsibility as a board member to take the decision seriously. Kearney said it was her intention to come to the Future Directions Committee meetings — not the interviews with other hospitals but simply the committee meetings — so she could make an informed decision.

A woman in the audience then stood up and voiced support for Kearney.

“I do not know this lady’s name, but I have carefully listened to what she has said. If she is not on this Future Directions Committee, I recommend that you ask her to be on it. It seems to me she has already done a tremendous amount of work. I think that could be a valuable help to the committee,” Joy Eppes said, prompting applause from others in the audience.

The process

The four entities invited to make formal pitches to Haywood Regional are Mission Hospital, Carolinas HealthCare System based in Charlotte, Novant based in Charlotte, and Adventist Health System, according to those familiar with the talks.

At the first round of talks the committee primarily listened to the pitches and asked questions. At the next round of talks, the committee will focus on what HRMC wants out of the deal.

White said the committee is not losing sight of its top goal, which is an arrangement that will mean better care not only for people in Haywood County, but the whole region.

“I personally see a lot of good things that are going to happen,” White said. “It’s not that far away I don’t think, but nevertheless it’s a process we have to go through.”

White said follow-up talks are already being scheduled.