Written by Jennifer Fitzgerald
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The Western North Carolina healthcare industry touches the entire population
—and in many ways.
You may not give much thought to the medical field in Western North Carolina unless you or a loved one are sick. But the local medical industry should not be taken for granted—it has a large financial impact throughout the region. Consider the following data from the Asheville Area Chamber of Commerce Economic Development Coalition for the Asheville Metropolitan Statistical Area (MSA), which consists of Buncombe, Haywood, Henderson, and Madison counties:
+ Healthcare and Social Assistance is the largest major industry in the Asheville metro. It is considered a key economic driver in the area, along with steady population growth, manufacturing, and tourism.
+ With over 34,000 employed as of 2018, the industry grew 28%, 2008-2018; 16%, 2013-2018; 4%, 2016-2018.
+ There are approximately 1,400 establishments in the Healthcare and Social Assistance industry with overall growth of 232 establishments since 2008.
+ The regional industry overall pays higher average earnings per job ($62,055) in the region as compared to the state ($56,778) and nation ($60,726). This also has a notable impact for our area.
A Healthcare Legacy
Western North Carolina has been known for healthcare dating back to the early 20th Century. A mini exhibit at the Swannanoa Valley Museum & History Center displays details of healthcare in the early 1900s when many people came to the area for their health. First, small sanatoriums cared for tuberculosis patients, but as the reputation for clean air and restorative healthcare spread, larger facilities were built that provided a higher quality of care.
Built on the former Buckner dairy farm two miles west of Black Mountain, the Western North Carolina Sanatorium was one such facility completed in 1937. The facility was able to serve approximately 500 patients. With the advent of penicillin, the need for sanatoriums declined.
Mission Health, the region’s largest healthcare provider today, has a history dating back to 1885 when four women raised money to start a hospital by selling flowers on the streets of downtown Asheville. They opened a hospital on October 6, 1885, in a rented five-room house with donated furniture and materials.
National Trends, Local Impact
The Western North Carolina region is following many national trends in healthcare employment. Jeffery E. Heck, MD, CEO, MAHEC (Mountain Area Health Education Center) and Associate Dean, UNC School of Medicine, shares that the biggest trends in practice specialties across the United States are toward specialization and urbanization.
“We see fewer physicians choosing to be become general surgeons, for example, and instead going into subspecialties like orthopedic surgery. Specialists also tend to practice in larger cities. Unfortunately, what we need here in WNC are more general practitioners, like those trained in family medicine, who can provide a full spectrum of primary care for the people in their communities.
“Here in our predominantly rural region, we have a shortage of professionals across almost every healthcare discipline: family physicians, general surgeons, ob/gyns, psychiatrists, family nurse practitioners, dentists, dental assistants—you name it; we probably need it. There are some counties that don’t have any psychiatrists or general surgeons, for example.”
Heck says the best way to fill this critical gap is to recruit healthcare professionals who are from this area with the idea that they are more likely to work here if they were raised here. Also known is the fact that physicians tend to establish their practices within 100 miles of where they receive their medical education. Thus, the importance of providing high-quality medical training here in Western North Carolina.
“Various studies have looked at the impact of adding a family physician to a rural community and have found that one family physician can generate nearly $1.5 million for the community and up to 25 additional support jobs,” says Heck. “A general surgeon or ob/gyn can generate more than $2.7 million in revenue.”
MAHEC’s mission is to train the next generation of healthcare professionals for Western North Carolina through quality healthcare, innovative education, and best practice models that can be replicated nationally.
“Put simply,” continues Heck, “our mission is to improve the health and wellness of our region. MAHEC was established 45 years ago with federal and state funding to help develop and support the healthcare workforce in North Carolina’s 16 westernmost counties. We took that mission and initial funding, rolled up our sleeves, and worked with community health partners and leaders to identify our region’s most pressing health needs and develop strategies for addressing them.
“Over the years, we’ve grown tremendously because we are committed to working collaboratively with our community health and hospital partners like Mission Health, Pardee, the Charles George VA Medical Center, and other rural hospitals and healthcare organizations across the region. This approach has proven very effective, and we’re now the largest AHEC in the state and likely the nation.
“Here in Western North Carolina, we take care of each other. This is especially true when you drive more than a few miles outside of Asheville. The majority of Western North Carolina is rural, and that’s really where MAHEC’s heart is—improving rural heath. We are committed to ensuring that every Western North Carolinian from Murphy to Spruce Pine to Rutherfordton has access to high-quality healthcare and community resources that support living well.
“We’ve been at this for 45 years now, and we still have a long way to go, but we’re committed to going the distance. We couldn’t do it without our many local, regional, and state partners who are also committed to improving clinical health and the broader social determinants of health—the factors that affect where we work, live, and play—that account for approximately 80 percent of our health and quality of life.
“We have a longstanding and strong partnership with the University of North Carolina system as one of North Carolina’s nine Area Health Education Centers. The state AHEC office is actually located on the Chapel Hill campus, although it is a separate entity.
“Many of our faculty here at MAHEC have UNC faculty appointments and collaborate with the university on interdisciplinary research. Our residency programs attract graduates from UNC schools including medical, pharmacy, and public health.
“It just made sense to leverage our partnerships with UNC and Western Carolina University to bring more academic resources to our region, so we can train more learners where we need them. UNC Health Sciences at MAHEC is uniquely positioned to develop best-practice models to transform health in our region and across the U.S. Our vision is to become a leader in rural health education and practice.”
UNC Health Sciences at MAHEC, MAHEC’s academic health center, supports the entire healthcare workforce pipeline. MAHEC runs hands-on programs for middle and high school students, provides college internships, and is home to branch or affiliated campuses of the UNC School of Medicine, UNC Eshelman School of Pharmacy, and UNC Gillings School’s Master of Public Health Program. MAHEC has clinical teaching practices, residencies and fellowships in a variety of primary care areas including family medicine, ob/gyn, dentistry, clinical pharmacy, psychiatry, general surgery, and rural medicine.
Over the last several years, state appropriations have enabled MAHEC to add and expand a number of their residency and fellowship programs. There are two family medicine residency programs in Asheville and Hendersonville that have a total capacity of 51 residents. They are in the process of developing a residency program in Boone that will bring total capacity up to 69 residents. The general surgery and psychiatry programs can accommodate 25 and 16 residents, respectively. There are six dental residents and five pharmacotherapy residents each year. They also have rural, sports medicine, and hospice and palliative care fellows. Over the past 45 years, they have graduated 523 medical and dental residents.
“If all of the current residents in our programs choose to stay in our region, and many do, that is well over $100 million in annual potential revenue, which doesn’t take into account all of the highly skilled positions associated with MAHEC and UNC Health Sciences at MAHEC, which combined employ nearly 700 people,” says Heck. “You can see how an academic health center promotes health on every level—individual, community, and economic—especially in rural areas like ours.
“We’re about to open a second dental teaching practice in Polk County in partnership with Isothermal Community College and St. Luke’s Hospital. We’ve started rural teaching practices in Yancey and Mitchell counties in collaboration with Mountain Community Health Partnership and have plans to establish additional rural sites in the near future. We’re also in the process of developing a new family medicine residency program in Boone in partnership with the Appalachian Regional Healthcare System. UNC Health Sciences at MAHEC also provides continuing education to approximately 10,000 healthcare professionals across our region annually. Our scope is broad because the healthcare needs in our region are broad.”
If you are contemplating your career path, you may want to consider the medical field. According to MAHEC, there is a need for more psychiatrists with a generalist focus who can support primary care practices where rural patients go for care. General dentists who will treat patients who may be underinsured are needed and also more family physicians and nurse practitioners who can treat a wide range of needs in their communities, so patients can get the care they need where they need it.
Pardee UNC Health Care in Hendersonville notes that, nationally, the current trends show that physician assistants, nurse practitioners, athletic trainers, medical assistants, pharmacy technicians, physical therapists, radiation therapists, surgical technicians, registered nurses, and pharmacists jobs are on the rise. Pardee is currently recruiting for registered nurses, nursing assistants, surgical techs, sterile techs, pharmacy, and lab positions.
At AdventHealth Hendersonville, formerly Park Ridge Health, they are seeing an increase in the need for nursing and nursing support jobs, Certified Nurse Assistants (CNA) in particular. Their clinical locations are looking to grow their team of Certified Medical Assistants (CMA).
For Mission Health, healthcare information technology and analytics function within most any role is on the rise, along with pharmacy tech and pharmacist, and clinical informatics. There is always a need for experienced RNs in med-surg areas. Also needed are nursing managers, EP techs, neurophysiology techs, PolySom techs, experienced CNAs who intend to stay CNAs, paramedics, specialty echo sonographers, physical and occupational therapists, and assistants.
Know Your Audience
Known for its draw as a retirement destination, the population of Western North Carolina in many counties reflects this and medical providers tailor their services for an older demographic. While AdventHealth in Hendersonville is committed to providing care for every age and every stage of life, an example of meeting the whole-health needs of retirees is the new AdventHealth Medical Group Primary Care at Carolina Village. It is an on-site clinic providing primary healthcare to the people who call the Carolina Village retirement community in Hendersonville home.
“They tell us they love not having to navigate traffic or arrange transportation for the doctor’s appointments,” says AdventHealth Hendersonville VP of Physician Services Christy Sneller.
Western North Carolina is also known as a great place to vacation with a wealth of outdoor activities. Lucretia F. Stargell, Vice President, Business and Service Line Development for Harris Regional Hospital/A Duke LifePoint Hospital and Swain Community Hospital/A Duke LifePoint Hospital, shares that because Western North Carolina is known for its scenic beauty attracting people who want to raft, kayak, canoe, hike, bike, and participate in other outdoor activities, it’s important for their hospitals to serve the communities of Sylva and Bryson City and the surrounding region with high quality emergency care, urgent care, and inpatient and outpatient subspecialty care for those who live here and those who visit.
“As it relates to Western North Carolina, as small rural hospitals, we are sensitive to the large influxes of seasonal visitors who come to the mountains for vacation and we are staffed to support increases in volume,” she says. “In addition to providing high quality care to residents, part-time residents, and visitors, we are attuned to the role our local hospitals play with respect to economic development. We are pleased to be one of the region’s larger employers. Having a strong and viable local hospital supports economic growth through new businesses locating in our communities and in growing the year-round and seasonal populations.”
Asheville and Buncombe County maybe considered the medical mecca for the region, but the outlying counties, such as Polk County, offer quality care to their residents and visitors alike.
Marche Pitman, County Manager for Polk County and Lindsey B. McGaha, Senior Business Specialist, Polk County Local Government, shares the following data: It is estimated that Polk County has roughly 820 employees in the healthcare industry. Of those employees, wages range from $8.44 to $31.41 (estimate) an hour depending on classification (practitioners, technical, and support occupations) and experience level. There are multiple healthcare facilities within the county; however, one of the largest employers within this industry is St. Luke’s Hospital.
St. Luke’s is a Critical Access Hospital (CAH). This designation is given to rural hospitals by CMS to serve residents who would otherwise be a distance from emergency medical care. However, even with being a hospital in rural America, St. Luke’s is reasonably close to other major healthcare facilities in Hendersonville, Asheville, Spartanburg, and Charlotte. St. Luke’s has been found a top performer in more than one area by multiple establishments.
In addition, St. Luke’s is home to Rosenberg Bone and Joint, a regional leader in orthopedic surgery. Rosenberg is well-known for hip and knee replacements, and is a Federally Qualified Health Center (FQHC). Their mission is “affordable healthcare for all” (including underinsured and uninsured), and they offer services in many areas to help patients from having to travel or go to multiple offices.
Patient = Consumer
How has the healthcare industry changed in the past years? Perhaps one of the biggest changes is the role of the patient, which has shifted to a consumer with more options available.
“We have seen healthcare change significantly over the past five years,” says President and CEO, Pardee UNC Health Care, James M. Kirby, II. “Patients are now considered ‘consumers’ who can choose where they receive medical care based on quality, location, and affordability. To serve our patients well, we must continually strive to provide the best quality care at a reasonable price. We do this by forecasting growth and placing high quality, convenient, accessible urgent care, primary care, and specialty care facilities within those locations.”
Scott Miller, AdventHealth Hendersonville, Chief Operating Officer, explains that today consumerism is a large part of healthcare with customers expecting great care, but also wanting convenience and a good patient experience.
“Healthcare is becoming more consumer-centric,” says Jimm Bunch, AdventHealth Hendersonville, President and CEO. “There is more consolidation and far more focus on wellness and personal responsibility. We continue to see debates over how to provide the best care and at the same time help make sure that care is more affordable.”
In Buncombe County, Mission Health is facing many of the same challenges as hospitals across the country, such as governmental mandates, personnel shortages, and access to care.
“Here in Western North Carolina, we have the additional challenges of a generally older, sicker, and more under or uninsured population, so this exacerbates the challenges inherent in providing healthcare anywhere,” says Greg Lowe, President, North Carolina Division (Mission Health is a part of the North Carolina Division of HCA Healthcare).
“Certainly, technological advances continue to mean we have more opportunities to deliver effective, evidence-based, innovative care. We know that healthcare is personal, and it is delivered one patient and one person at a time. So, I think the combination of better technology and efficiency along with a very individualized approach is something we’re going to continue to see evolve. Those same advances in technology mean more care is delivered in outpatient or other settings.”
Recently purchased by HCA Healthcare, Lowe notes that Mission and HCA already had much in common before the sale.
“We share the same values and purpose, and we are driven by our mission to care for and improve human life. For both organizations, our focus has been and remains first and foremost on our patients. By combining the best of Mission Health’s clinical outcomes and high quality care with the economies of scale and expertise, we look forward to a bright future that allows us to improve more lives in more ways.
“More specifically, the regional hospitals that are part of Mission Health now have a 10-year guarantee based on the terms of the sale, when there would have been no guarantees prior to that. HCA Healthcare is committed to continuing to invest in those communities, as well as in behavioral health programs and other necessary resources. With these combined forces, we believe we can make a positive impact, providing treatments patients need and the quality care they deserve.”
Mission Health’s $404.4 million Hospital for Advanced Medicine is scheduled to open this fall at the corner of Biltmore Avenue and Hospital Drive on the Mission Hospital campus, according to Sonya Greck, MSN, RN, Senior Vice President, Patient Safety Net Services and Behavioral Health. The 12-story, 630,000 square foot tower will have 220 patient rooms, a significantly expanded state-of-the-art emergency department with 97 beds, consolidated operating, pre-op, and recovery space, along with interventional cardiology and radiology space that allows for true multidisciplinary, team-based interventional care.
“The facility was designed with patients and families in mind, with features such as sleep-in rooms and indoor and outdoor gathering space,” says Greck. “Each of the patient rooms will feature a whole new world of smart technology. Patients will see their in-room television transformed into a care-delivery, education, communication, and entertainment hub from which they can learn more about their condition. Outside the room, digital signage by the door highlights information between the patient and their care team. Security is also enhanced by the smart room. Real-time locator equipment inside and outside the room can pick up on radio-frequency identification in team member badges, allowing patients to see who is entering their room. When a team member enters the room, the patient immediately receives a picture and a name on their television monitor.”
Nature and culturally-inspired artwork will be on display throughout the hospital. By providing positive distractions to patients, the art will play an integral role in supporting the healing process while enhancing the patient, family, staff, and community experience. More than 500 residents of Western North Carolina responded to Mission Health’s call for artists.
In an ever-changing environment, there are always obstacles for healthcare providers to overcome. Lucretia Stargell explains that demands on healthcare in the United States are limitless and there have been a lot of changes in delivery and reimbursement over the last five years.
“We are focused on continuing to serve people in the communities where they live and are committed to figuring that out on an annual basis through strategic and workforce planning,” says Stargell. “As our population ages, we are finding ways to continue to grow services locally.
“An example would be the expansion of our cardiology service over the last two years to include three cardiologists and diagnostic cardiac catheterization. Prior to 2017, cardiac caths were not available in the local community. On the flip side, populations around the country are becoming more mobile and rooted in handheld technology. We are meeting this demand by developing and investing in telemedicine partnerships that provide convenience to patients and access in places where it has been difficult to travel to see a provider.
“The ability to recruit staff and physicians can be a challenge for small rural hospitals like ours. We have a good history of recruiting physician talent in drawing providers in dozens of specialties to the mountains of Western North Carolina. As national data indicates, some searches can be more difficult than others. We are not unlike other hospitals in America facing the nursing shortage. It can often be a challenge to recruit and retain nurses.”
James Kirby shares that the reimbursement models for Medicare and Medicaid are constantly changing and can vary by state. With the evolving landscape of private insurance, Pardee UNC Health Care is also seeing a rising complexity in the reimbursements for services and among payers.
“The potential privatization of Medicare could also impact healthcare in the future,” he says. “These national and state trends have the potential to seriously impact our hospital and healthcare system. As the county hospital for Henderson County, we see any patient who walks through our doors, regardless of ability to pay. In addition, Pardee has one of the most generous charity care programs within our region. When reimbursements are reduced for services provided, we are forced to continue to provide much-needed services on leaner budgets. Our relationship with UNC Health Care allows us to maximize our resources across a statewide system, providing some efficiencies within our budget and areas, such as pharmacy costs.”
“At the end of the day, any evaluation of healthcare trends should be closely aligned with healthcare needs,” adds Jeffery Heck. “Here in Western North Carolina, our communities are largely rural, our population is aging, we’re struggling with opioid misuse and its devastating effects, our minority and disadvantaged community members are not living as long or as well, and too many of us still don’t have access to medical and community resources we need to live our best lives.
“These are the trends we are looking at here at MAHEC. Luckily, there are a lot of other wonderful organizations across our region looking at them as well. These are big challenges, no doubt about it. But our strengths and determination are even bigger, especially when we come together to address them.”