In western North Carolina, frustrations remain after HCA Healthcare acquired nonprofit Mission Health in 2019. Now, the city of Brevard has filed an antitrust lawsuit against HCA, the second of its kind in less than a year. year, alleging that the expansion, the Nashville, Tennessee-based system, has harmed competition in local markets and artificially inflated health care prices.
Brevard operates a self-funded health insurance plan for its city employees and their families, and said in its complaint that it continues to be harmed by HCA’s anti-competitive conduct. He is trying to represent a similarly situated class of North Carolina health plans, including commercial and self-funded insurers.
“This action comes at a time when providing affordable health insurance plans for working families and government employees, such as firefighters, police officers and teachers, and controlling health care costs have been top priorities for plaintiff and members of the the proposed class, the business communities they serve, and state and local governments in western North Carolina,” the city wrote in its complaint. “Defendants’ conduct has impeded these objectives by impairing competition in markets for health care … and substantially and artificially inflating the health care prices paid by Plaintiff and the proposed health plans for Class Members.”
Specifically, the City of Brevard alleged that HCA has unlawfully maintained and enhanced monopoly power in the general acute care inpatient hospital and outpatient market, and continues to dominate those markets in the Asheville region and its peripheral region. HCA controls more than 85% of the overall acute care market in the Asheville region and more than 70% in each of the outlying region counties.
HCA’s anticompetitive conduct has included “all or nothing” arrangements that require health plans to contract for all of HCA’s outpatient and general acute care services as a package; exclusive treatment requirements that prevent insurance companies from directing policyholders towards less expensive and/or higher quality options; “gag” clauses that deliberately prevent price transparency and prevent employers from knowing the prices they pay for health care; and other conduct related to negotiating prices for general acute care services, according to the complaint.
The plan “has allowed defendants to raise prices substantially above competitive levels, reduce health care options, reduce quality through dramatically worsening facility conditions and patient service, and reduce patient access to [general acute care] and outpatient services in relevant markets,” the city said in its lawsuit.
HCA has also refused to comply with CMS’s federal price transparency rule that was implemented early last year.
“Ensuring our community has affordable, easily accessible, high-quality health care is a top priority of city leadership,” said Brevard Mayor Maureen Copelof. medpage today in an email. “We filed this lawsuit because HCA’s demonstrated monopoly and predatory practices result in higher prices and fewer options. I want our community to have choice where to get medical services and want costs controlled and quality maintained through the competition. This is not the case right now. Any kind of monopoly is a concern, but when it comes to health care, it becomes a critical concern that demands action.”
He called the lawsuit “the culmination of the problems of the last two and a half years” and said the community has expressed concern and frustration with HCA since the first town hall on the issue was held in early 2020.
“Since then, there have been ongoing issues that have affected our community’s ability to receive high-quality, accessible and affordable health care,” Copelof added. “Some of these include the departure of physicians from the HCA system, the lack of a permanent general surgeon in [Transylvania Regional Hospital]cancer center closure, billing issues, reduced staff, [and] high cost of services. These issues have been raised in additional community forums, in letters to HCA, in letters and conversations with the North Carolina Attorney General, and some are now being addressed through this lawsuit.”
In a statement emailed to medpage todayNancy Lindell, director of public and media relations for HCA’s North Carolina Division, wrote, “Once we are notified of the lawsuit, we will respond appropriately through the legal process.”
“This lawsuit is more than disappointing, especially since, at the request of Mayor Copelof, our company’s CEO, Sam Hazen, had a positive and productive meeting with Mayor Copelof and other community leaders less than a month ago,” he pointed. “We hoped the meeting would be the beginning of a thoughtful and ongoing dialogue about health care in the City of Brevard and the broader Transylvania County region. In fact, we provided the information requested during the meeting and hosted our first council meeting.” community this week. At no point did Mayor Copelof mention this seemingly long-planned lawsuit, which is frustrating and undermines what we thought were sincere efforts to build open and constructive relationships and lines of communication.”
Lindell said HCA will now turn its attention to “vigorously defending the lawsuit, while continuing to provide excellent health care to the citizens of Western North Carolina,” adding that the health system is “proud of our commitment to Western North Carolina.” North Carolina and the significant investments we have made to serve Brevard and improve patient care.”
She said that some of these efforts have included:
- Provide more than $277 million in charity care and discounts for the uninsured – $124 million more than in 2018, the year before Mission Health was purchased
- Invest more than $14 million in the Transylvania Regional Hospital for infrastructure projects, such as renovating three operating rooms, replacing MRI and CT machines, and adding a new helipad.
- Provide access to new specialties in Transylvania Regional, such as the recent addition of five new primary care providers to the area and revamping of primary care practices.
Meanwhile, another antitrust case filed against HCA, also related to the Mission Health purchase, is awaiting a trial on whether it can proceed in Buncombe Superior Court, the citizen times informed.
This earlier lawsuit, filed by a group of community members in August 2021, targets the main operation in Asheville and alleges exorbitant prices for care as well as declining quality, according to the citizen times. In particular, he garnered the support of North Carolina Attorney General Josh Stein, who filed an amicus curiae brief in the case.
As for the lawsuit brought by Brevard, the city stated in its lawsuit that it is concerned about the future of care in western North Carolina.
“Without intervention from this court, the future of health care competition in western North Carolina, traditionally a destination for many, including retirees from across the country, in part due to its prior reputation for high-quality health care quality and low cost, is at risk.”