Mission Health announced late last summer that it had signed an agreement to sell itself to the Hospital Corporation of America (or HCA) for the pretty price of $1.5 billion. The board voted unanimously in favor of the sale as a way to improve care + efficiency within the system. The sale was subject to review by N.C. Attorney General Josh Stein, whose office analyzed documents, terms of the agreement + whether or not over a billion dollars was a fair price point. Stein okayed the sale last week which means it will officially move forward.

But why sell? Mission Health CEO Ron Paulus told NPR that the main motivating factors were strained finances + the board’s desire to invest in new technology, research + clinical skill.

Mission Health System is currently classified as a 501c3 nonprofit, which is the most popular model for hospitals in the country. In 2018, Mission Hospital provided over $100 million worth of free care in western North Carolina – but that won’t cease with this sale – they’re creating a dedicated health foundation called Dogwood Health Trust with the sale funds.

From a boom to the local economy and the title of one of the “World’s Most Ethical Companies” to keeping the same logo and locations staying open, here are 10 #DYK facts about the HCA coming to WNC here. ⬇️

1️⃣ Mission Health was started by a group of women in the 19th century.

In the spring of 1885, a group of women including Anna Woodfin + Fanny Patton (yes, that Woodfin, that Patton) decided that Asheville needed a hospital and that they would sell flowers downtown to raise the money to create it. The women called themselves the Little Flower Mission. 🌼The first iteration of Mission Hospital opened that same year in a five-room rented house.... and the rest is history.

2️⃣ Mission Health is Buncombe County’s largest employer.

Mission Health leads the Buncombe County Board of Education, Ingles, the Biltmore, and the V.A. Medical Center as the county’s largest employment, according to the Asheville Chamber of Commerce. More than twelve thousand people clock in to Mission Health every day. That number includes more than a thousand medical professionals with 50+ medical specialties, and 30+ pediatric sub-specialists.

3️⃣ Mission Health’s annual economic impact totals $1.75 billion.

The system as a whole is licensed for 1,056 beds across eighteen counties, and includes the following care centers:

• Mission Hospital

• Mission Children’s Hospital

• Angel Medical Center

• CarePartners

• Highlands-Cashiers Hospital

• Transylvania Regional Hospital

• Mission Medical Associates

• Mission Hospital McDowell

• Blue Ridge Regional Hospital

4️⃣ Hospital Corporation of America is a for-profit company.

HCA, headquartered in Nashville, Tennessee, is the country’s largest for-profit hospital chain + one of the largest in the world. The company runs 178 hospitals across 20 states, as well as a few in the United Kingdom. In fact, one out of every 22 emergency room visits occurs at an HCA-affiliated hospital.

The company has also been named as one of the “World’s Most Ethical Companies” by the Ethisphere Institute for nine consecutive years. The Institute honors companies who drive positive change in the business community based on core values of ethics, corporate responsibility, culture, governance + leadership.

5️⃣ Expect a boom to local economy from the sale.

Because of its protected nonprofit status, Mission Health has never been required to pay property taxes or sale taxes. HCA, on the other hand, will fork over a sizable chunk of change in state + local taxes due to its for-profit status. That could be as much as $10 million according to some estimates.

6️⃣ Dogwood Health Trust will be in charge of the proceeds from the sale.

DYK: nonprofits can’t be sold in the traditional sense of the word. When a nonprofit dissolves, the board of directors are required to distribute the proceeds to other organizations that are charitable in nature. In the case of Mission Health, that money will go to recently-founded Dogwood Health Trust.

Dogwood will play a crucial role in the merger by assuming responsibility for remaining cash assets from the sale + enforcing the terms of agreement from the sale (more on that later).

And what about the money, honey? Dogwood is set to receive between $50 and $100 million, which it will use to fund programs that address the unique health needs of western North Carolina. Mission Health is confident that the trust’s impact on healthcare needs will be “nothing short of transformational!”

7️⃣ Mission is working with HCA to create a transition plan for employees.

According to statements released by Mission, staff, management + daily operations will be unaffected by the merge. Employees will not be required to re-apply for their positions, and benefits through HCA are expected to be very similar to what Mission offered its employees.

Clinical staff members will keep their jobs (and there will likely be a few open positions due to increased funding soon 👀), as will administrative positions for at least twelve months. After that time period, major administrative reorganization is a possibility. As for the Mission Health logo we all know + love? It’s not going anywhere. Facilities + clinics will still bear their Mission Health branding despite HCA ownership.

8️⃣ New medical technology will arrive at the hospital.

One of the driving factors of the merger was Mission Health’s desire to have access to more innovative technology. One example of what HCA will bring to the area is its cutting edge research in tumor DNA analysis at its Sarah Cannon Cancer Institute.

HCA will also provide greater access to clinical trials, research, predictive modeling + specialized geriatric emergency services that center around healthy aging.

9️⃣ Per the terms of the agreement, all of Mission’s current healthcare locations will remain open.

HCA has agreed to continue operating key clinical services for at least five years, and all acute-care and rehab hospitals for at least 10 years. That does not include St. Joseph's Hospital in Asheville, as the hospital was already planning independent ownership transition.

Dogwood Health Trust is responsible for ensuring that these conditions are followed.

🔟 In fact, a few new medical centers are on the way.

Another stipulation of the sale is how much money WNC residents can expect HCA to put into the system. HCA has agreed to spend $430 million in capital expenditures over the next five years the following objectives:

• Completing the Mission Hospital Center for Advanced Medicine at the main Mission campus

• Building a replacement hospital for Angel Medical Center in Franklin, NC

• Building a behavioral health hospital in Asheville. Behavioral health focuses on improving + preventing mental health, substance abuse + more.

The Mission/HCA merger is following something of a national trend; almost 1 in 5 of the country’s 5,550+ hospitals were acquired or merged with another hospital between 2013 and 2017, according to NPR. Maybe we’re on to something.

What are your thoughts on the merger? We’d love to hear from you. Reply to this email or drop us a note on Facebook or Instagram.

— Stephanie