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Independent Monitor

Roles and Relationships of the Independent Monitor… and Who Pays them?

There have been a lot of discussions and even more questions about the Independent Monitor (IM), the role it plays, and most importantly, how it is paid and whom it reports to. The Dogwood Health Trust website has created a very informative set of Frequently-Asked Questions about the IM. Following are the Dogwood Health Trust's FAQs:

What is the “Independent Monitor” and what is its role?

The Independent Monitor is a highly qualified firm that helps monitor HCA’s compliance with the promises it made when it acquired the assets of Mission Health System. Among those promises are: 

  • Keeping Angel Medical Center, Blue Ridge Regional Hospital, Highlands-Cashiers Hospital, McDowell Hospital, and Transylvania Community Hospital operating for 10 years, and continuing all existing services for five years

  • Completing the new tower on Mission’s Asheville campus (complete)

  • Building a 120-bed inpatient behavioral health hospital in Asheville

  • Constructing a new facility for Angel Medical Center

  • Implementing an agreed-upon policy of uninsured and charity care at all hospitals

  • Investing $232 million in general capital expenditure within five years

  • Spending $750,000 per year for 10 years in Community Contributions

  • Providing $25 million over 5 years in an innovation/investment fund to invest in businesses located in western North Carolina that provide innovations in the delivery of health care

  • Continuing the graduate medical education program

  • Continuing long-term acute care services at the St. Joseph campus of Mission Hospital for two years 

  • Continuing Mission’s community activities, services, and programs for at least 12 months (complete)


Gibbins Advisors, a healthcare consulting firm headquartered in Nashville, TN, serves as the Independent Monitor.  

Who works with the Independent Monitor?

Several organizations work with the Independent Monitor to ensure HCA honors its obligations:

  • ANC Healthcare, Inc. (the company that is winding down the former Mission Health System). As ANC works through its wind-down activities, Dogwood Health Trust will eventually assume ANC’s role with regard to the Independent Monitor. 

  • An Asheville Advisory Board that focuses on Mission’s Asheville campus and CarePartners

  • Five local advisory boards that focus on Angel Medical Center, Blue Ridge Regional Hospital, Highlands-Cashiers Hospital, Mission McDowell Hospital, and Transylvania Regional Hospital. 

  • The North Carolina Attorney General

How does the Independent Monitor do its work?

The Independent Monitor visits all hospitals to become familiar with their operations and reviews regular reports from HCA. HCA also shares these reports will all of the organizations listed above. In addition, the Independent Monitor offers an avenue for WNC residents to share any concerns or feedback related to compliance issues.

How can community members share their feedback?

Gibbins Advisors will conduct town hall community meetings in the first quarter of 2020 in each of the hospital regions to provide information on its role and to gather feedback on concerns or issues related to compliance matters under its scope. It plans to also launch an informational website in early 2020 and enable the public to submit feedback via an online web portal at

For example, among the Trust’s first investments will be $25 million over five years to help fund programs and services addressing substance use disorders for residents of Western North Carolina in partnership and collaboration with the NC Department of Health and Human Services.

What happens if HCA doesn’t honor the agreement?

If the Independent Monitor, the applicable advisory board and HCA cannot come to an agreement about a change in HCA’s obligations, then ANC will attempt to resolve any dispute.  If the dispute cannot be resolved, ANC or the Attorney General may choose to pursue the matter through the courts. Dogwood Health Trust will eventually assume ANC’s role in this regard.

There is also a team of staff members that assures the day-to-day operations of the Trust.

Who pays for the Independent Monitor’s work?

ANC currently pays the Independent Monitor’s services. Dogwood Health Trust will eventually assume ANC’s role in this regard.

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