“When we refer to ourselves as a regional hub, we understand that’s an earned position and not just going to happen because we’re in Sylva,” said Harris CEO Steve Heatherly. “Patients have choices, and we have to earn the privilege to be able to serve them.”

The health care industry has been in a constant state of fluctuation for the last five years with the passage and implementation of the Affordable Healthcare Act under President Barrack Obama and now with the proposed American Healthcare Act under President Donald Trump.

Now patients in rural America who’ve been covered under ACA are worried they’ll have fewer choices and options when all is said and done. 

On a more local level, some Western North Carolina residents are feeling the health care pinch with Mission Health announcing the closure of labor and delivery services at Angel Medical Center in Franklin and the potential closure of deliveries at Blue Ridge Regional Hospital in Spruce Pine. 

During a time when many rural hospitals are closing or having to reduce services to stay afloat, Heatherly said Harris — a Duke LifePoint hospital — is in a healthy financial position to grow and expand services for the needs of people in Western North Carolina. 

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“We’ve talked a lot internally about being the hub, but now is the time for us to be aggressive — to make ourselves available to patients, providers, and the community,” he said. “We also need to be gracious and humble and understand the long view of why patients choose to be here.”

Growing services

While Mission Health in Asheville is a much larger health system with tentacles reaching into a few of the most western counties — an outpatient center in Haywood County, and affiliations with AMC in Franklin and Highlands-Cashiers Hospital in Highlands — Heatherly said Harris has been a major health care player for Jackson, Swain, Macon, Graham, Clay and Cherokee counties in addition to also drawing many patients from across the border in Northeast Georgia.

Harris has made significant investments in its infrastructure and services in the last few years. The hospital campus in Sylva has a couple of big projects underway — a new emergency department being added on to the right wing and the renovation and expansion of the New Generations Women’s Center on the third floor. Completion of the new labor and delivery floor is scheduled for the end of the year, which is good timing for Harris considering AMC will cease deliveries in Franklin as of July 14. Harris will then be the closest option for women delivering babies — otherwise pregnant patients will have to travel 45 minutes to Haywood Regional Medical Center in Clyde or an hour and a half to Mission Hospital in Asheville. 

Heatherly said Harris was not made aware of Mission’s labor and delivery closure until a day before the public was informed, but the timing will certainly play to Harris’ advantage, and luckily the expanded service in Sylva will accommodate the inevitable increase in delivery volumes. 

“This has been a destination for women and children’s service for years — we felt it was important to invest in that facility to make it state-of-the-art so we can continue to reinforce the reality that this is a destination for families throughout Western North Carolina,” Heatherly said. 

Orthopaedics is another area Harris has invested in by hiring Dr. Tony McPherron — the only fellowship-trained orthopaedic surgeon west of Asheville who covers the total joint spectrum. McPherron is also trained in sports medicine, which is a high-demand service given the fact there are more than 2,000 student athletes in the region. 

“We recognize that there were people traveling far and wide to get those services to the extent that making those services more locally available was more advantageous for us,” Heatherly said. “We have 2,000-plus student athletes being served by trainers provided by our hospitals.”

Harris also has urology, gastro-intestinal and pulmonary services. With two pulmonologists already on staff, Heatherly said Harris is looking to recruit a third to serve the western counties. The hospital will also have a catheterization laboratory up and running in the next 45 days, which will allow Harris to provide full diagnostic imaging equipment used to visualize the arteries of the heart and treat any abnormalities. 

Mission Hospital has long been a destination for cardiac patients across WNC — it was recently one of two hospitals in the Carolinas to make the Top 50 Cardiovascular Hospital list by Truven Health Analytics — but Harris is in the process of expanding its cardiology capabilities to better serve the western counties. With two cardiologists on staff, Harris is probably looking to hire a third by next year. 

“This is the first time in the history of the hospital that we have an invasive cardiologist,” Heatherly said. Invasive cardiology uses open or minimally invasive surgery to identify or treat structural or electrical abnormalities within the heart structure.

Heatherly is certain that sometimes hardships create a barrier that people can’t overcome and the result is heart patients don’t get the preventative care they need to prevent a major health incident. 

“We had such a significant volume of patients traveling far distances to get those services and it creates hardships for their families,” he said. “We believe there’s a fairly significant pocket of folks in Jackson County and west that don’t receive adequate cardiology services because it hasn’t been locally accessible.”

Swain Community Hospital in Bryson City is also a Duke LifePoint Hospital and works closely with Harris in Sylva since Heatherly is CEO over both facilities. Swain Community is a critical access hospital with a 24/7 emergency room and full diagnostic services available. The hospital also offers “swing beds” for patients who may still need some recovery time before returning home but don’t necessarily need to be in an inpatient room at Harris or another facility that is farther away from their home and family. 

The Swain campus also has a pain clinic, a primary care unit with two physicians and two physician assistants and a fulltime pediatrician with Swain Family Care.

“We’ve expanded offerings to the community to include walk-in availability. You can typically get seen pretty quickly for an urgent condition and can call and get a same day appointment,” Heatherly said.  

Expansion in Franklin

Heatherly said many people in the region probably aren’t aware of all the services offered at the Franklin outpatient center in Franklin even though it’s been there for 20 years and serves hundreds of patients per day. 

The 25,000-square-foot building contains a full-time family practice, a full-time orthopedic surgeon, clinic hours with all of Harris’ rotating specialists, a full lab, physical therapy, a sleep lab and a full range of imaging services with the exception of a CT scan. 

“The depth and breadth of services there is probably not as well known to folks, but I think that particular facility is really just an expansion of efforts we’ve made to regionalize our hospital and make sure we’re offering services that are conveniently located,” Heatherly said. 

According to patient data, about 50 percent of Harris’ patients are from outside of Jackson County. In 2016, 54 percent of inpatient admissions and 40 percent of emergency room patients were from outside Jackson County. 

Harris’ Franklin outpatient center will play an important role in the hospital’s future growth, especially as it prepares to pick up more obstetrics patients following Mission’s decision to stop deliveries at AMC. Currently, an obstetrician from Harris holds office hours in Franklin once a week but Heatherly said a fulltime obstetrician will probably be needed there in the near future so pregnant women can get the full range of services they need through Harris.

“We’ll pretty much be operating a fulltime OB practice in Macon County and have wrap-around services available there as well,” Heatherly said. 

Heatherly said Harris decided it is important to invest in OB and pediatric services so it can be the only full service pediatric practice west of Asheville. He said Harris is also working on opening a pediatrics office in Franklin this summer.

“Our pediatric group is another great example of regionalization,” he said. “We have a pretty hefty patient population in pediatrics so as this OB transition evolves we’ll also be evaluating what pediatric presence do we need in Macon County.”

AMC President Karen Gorby said the hospital would continue to offer prenatal and postnatal services even though expecting mothers will have to travel to another health system or Mission in Asheville to deliver their babies. 

Mission and Harris will also be working together during this change to make for an easier transition — hopefully one that includes getting Mission’s physicians privileges at Harris. If that occurs, patients currently getting prenatal services at AMC can keep their doctor even if they choose to deliver at Harris. 

The rumor mill continues to speculate the real reason behind Mission’s decision to close the labor and delivery unit at AMC and many believe it’s because Mission is having a difficult time keeping a pediatrician on staff in Franklin. Gorby said there’s no truth to that rumor. 

She said AMC is in the process of converting four existing practices into a single, integrated “Rural Health Center” practice and that both women’s and children’s services will be located in the new location to better serve patients. This practice will include two OB/GYN providers and two pediatric providers.

“The consolidation will occur later this year, anticipated in September. Employees of the impacted practices were notified of this consolidation last Wednesday,” Gorby said. “Positions within the new RHC practice will be posted and staff will apply for those positions. Once consolidated, the current practice located in Sylva will be closing.”

Response to Mission decision

Heatherly said he didn’t know Mission planned to stop labor and delivery at AMC but he had some inclination given the current state of rural health care. 

“There’s a certain economic reality we all have to deal with,” he said. “We knew there would have to be a rationing of care in some way — our geography and history of serving patients made us best positioned in women’s and children’s services.”

He also agreed with Mission CEO Ron Paulus’ statements on the difficulties that come with an aging demographic in WNC, which is one of the factors that led AMC to stop deliveries. The women’s unit at AMC was losing at least $1 million a year, which prevents the hospital from investing money into other needed services in the community.   

“That is reality — everyone has to decide where can we make an investment for the maximum impact,” Heatherly said.

Even though the elderly population in the region is growing much faster than the younger generations, there is a unique dynamic in Jackson County because of the large student population at Western Carolina University and the younger employees being attracted at Harrah’s Casino and Resort. 

But a labor and delivery unit in Western North Carolina isn’t automatically a money-losing enterprise, Heatherly said, adding that it depended on the volume of deliveries and how much a hospital needs to invest to get to that needed volume. Harris already had a large volume of births and spending $5.5 million to keep and grow that line of business was worth the investment to keep the service in the community. 

Aging demographics and cost aside, Heatherly said the region has a population with a lower per capita income that is less likely to seek medical services if those services are farther away. Traveling from Franklin to Sylva — let alone Franklin to Asheville — to see a doctor is not realistic in many scenarios. 

“It creates a real hardship on families. We have to be smart in a rural community — without a vast population we can’t offer every service but we need to work regionally to make sure people have access to those services,” he said.

Residents in Macon County have voiced concerns about the transition of delivery services to Harris. The assumption by some has been that all high-risk pregnancies will have to travel to Mission in Asheville to deliver because Harris doesn’t have the capabilities to deal with those cases, but Heatherly said that isn’t always true. He said Harris could handle pregnancies considered high risk due to things like asthma, diabetes, hypertension, a history of miscarriages, opiate addiction, preeclampsia, twins, obesity, and other conditions. 

Although some are saying pregnant women from Franklin who are on Medicaid are being turned away by obstetricians at Harris, Heatherly said that isn’t true. No woman would be turned away for services because they are on Medicaid, he insisted. 

“We’ll be working with Mission during this transition because what we’re all interested in is making sure folks in the middle of this change — especially those patients currently pregnant — are educated about their choices and have access to local care,” he said.  

Working regionally

Even though Harris considers itself a fierce competitor for patients, it also has to work as a health care partner to make sure patients receive the care they need whether it’s at Harris or another hospital.

“We’re seeing a huge impact on patients not having to be transferred away from their local facilities — more and more are able to stay here,” Heatherly said. “But when it’s appropriate to transport for something we can’t do for them here, we work collaboratively with others in the region.”

If the patient can get better services at Mission Hospital or Haywood Regional, then that’s where they will be transported. Heatherly said Harris also isn’t trying to duplicate services offered locally. For example, Harris was looking to expand behavioral health but decided against it once Haywood announced it would be adding more beds to its wing to accommodate more mental health issues. 

Mission’s decision to stop delivering babies at Angel Medical Center has the community asking a lot of questions about Mission’s nonprofit health care system model versus Duke LifePoint’s for-profit model. On the surface, people tend to assume a nonprofit model would be more beneficial to patients since the focus isn’t on turning a profit. However, Heatherly said there isn’t much of an operational difference in how a nonprofit and a for-profit hospital are run. 

“I was here when Harris was part of a larger not-for-profit system and I’ve seen us go through the transition to for-profit with Duke LifePoint, and the operating considerations we have today are fundamentally the same,” he said. “We have to focus on providing high quality care, providing a great patient experience and doing those things in an efficient manner — that’s true of every hospital.”

He can say that Harris is fortunate to be under the Duke LifePoint umbrella because the larger company has been willing and able to invest money that allowed Harris to expand its services. 

“In our former existence I couldn’t see a path to that. I think we have the benefit of being part of large and diverse organization that can make those types of investments,” he said.