Highlands-Cashiers hospital to jump on Mission affiliation train

fr highcashHighlands-Cashiers Hospital will soon join the growing number of small hospitals in Western North Carolina to come under the management of Mission Hospital in Asheville.


The move will help Highlands-Cashiers Hospital improve its financial position, bring new medical services to the community and tap expertise needed to navigate the changing health care landscape, according to Craig James, the CEO of Highlands-Cashiers Hospital.

The hospital has contemplated a partnership with a larger hospital system or institution for more than a year but began in earnest vetting the various entities this summer, James said.

The board overseeing Highlands-Cashiers Hospital voted last week to formally negotiate a business arrangement with Mission, known as a “management agreement.”

“The goals of Mission Health and Highlands-Cashiers Hospital are truly one in the same — to provide the western North Carolina community with better access to world-class care and to improve the health of our communities,” said Ron Paulus, president and CEO of Mission Health.

One factor in going with Mission was the sheer number of other hospitals in the region already under Mission’s wing.

Highlands-Cashiers Hospital could marshal its resources with other small hospitals also under Mission — from Angel Medical Center in nearby Franklin to Transylvania Regional Hospital in Brevard — to land medical specialties it currently doesn’t offer.

If Highlands-Cashiers doesn’t have enough business to support a full-time doctor in a specialized field, it could share one with another nearby hospital also under Mission. 

“Between the two of us we may be able to do that on a shared basis,” James said.

Mission’s network includes the hospitals in Macon, Transylvania, Mitchell, McDowell and Rutherford counties. Its dominance in the region is so pervasive critics have accused it of being a predatory monopoly.

James said he is not concerned Mission will try to usurp any of the services Highlands-Cashiers currently provides or siphon business to the flagship in Asheville.

To the contrary, a Mission partnership could also make it easier for patients currently traveling to Asheville for surgery to get more of their care in the Highlands area — such as pre-surgery consultation and screenings, post-op recovery and rehab.

Mission doctors could hold occasional office hours in Highlands to consult with patients, even though the surgery itself may be done in Asheville. The doctor could also coordinate for recovery to happen locally. 

“We may not have the equipment they would need for the medical procedure, however, if we can provide local access so the initial consulting can be conducted locally and also the follow-up visits being done here that is just great for the patient,” James said.

Partnering with Mission also makes sense because Mission is where patients ultimately end up when they need a higher level of care or subspecialties not available locally.

“Other options were certainly considered by the board, but what makes most sense for us, I go back to those existing relationships we’ve had for all those services we don’t offer,” James said.

To make the transfer of patients to Mission more seamless, Highlands-Cashiers follows Mission’s protocols for patients with chest pains or a possible stroke. Physicians and nurses also uses the same templates as Mission for documenting patients’ symptoms and clinical treatments.

“That collaborative relationship has been going on back through the existence of the hospital and this is taking it to the next step,” James said.


How it would work

Under a management agreement, Highlands-Cashiers Hospital would hire Mission to manage the hospital. Mission would get a fee for its management services, and in return, Highlands-Cashiers Hospital would benefit from a larger institution running it.

Once part of Mission’s network, the hospital can get better deals on everything from medical supplies to health insurance reimbursement rates, thanks to economies of scale and a better negotiating position.

The CEO of Highlands-Cashiers Hospital would be an employee of Mission under the management contract. The local hospital board would hold the ultimate trump card, however, ensuring its autonomy. If the Highlands-Cashiers board didn’t like the way Mission was running the hospital, it could end the management contract.

While the setup puts Mission in charge of daily operations, steering long-term direction remains under leadership of the local hospital board — and ultimate ownership of the hospital remains unchanged.

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