AG Stein says OK to Mission sale… with stipulations

After nearly five months of deliberation, North Carolina Attorney General Josh Stein announced on January 16 he will approve HCA Healthcare’s $1.5 billion acquisition of Mission Health Systems to go through without a legal challenge – with a list of stipulations.

Last August, Mission Health announced its plans to be bought out by Tennessee-based healthcare giant HCA Healthcare, which immediately sparked concerns for rural communities with hospitals that are part of Mission Health System such as Angel Medical Center in Franklin and the Highlands-Cashiers Hospital. North Carolina Attorney General Josh Stein listened to those concerns and when announcing the approval of the sale, he included specific protections for health care in rural communities such as Macon County.

“His decision and approval is a big win for everyone in Western Carolina, including healthcare advocates, HCA, Mission, Dogwood Health Trust and local foundations,” said Highlands Mayor Patrick Taylor.

The Dogwood Health Trust Taylor mentions is one of the stipulations Stein specifically outlined in his approval.

The asset purchase agreement stipulated that a newly formed foundation called the Dogwood Health Trust would manage the proceeds of the sale, with an objective to use social determinants of health to improve the health and well-being of the communities Mission Health now serves. In addition, the board must be made up of members from the entire Mission/HCA area. The majority of board members may not be from Mission’s Buncombe county.

In the original draft of the agreement between HCA and Mission, HCA committed to providing services at the smaller regional hospitals such as those in Franklin, Highlands, Transylvania and other rural areas for five years. That commitment has now been extended to 10 years thanks to Stein without the loss of services.

In addition, not only Dogwood, but also the regional foundations, shall have the right to bid on the local hospitals if they would be sold or closed after that time.

Not only does the agreement require that services continue for 10 years, the agreement specifically states that the same level of services currently offered at the hospitals must continue. The agreement states that HCA is prohibited from closing any facilities or discontinuing services unless agreed upon by both a hospital’s local advisory board and an independent monitor. That monitor will also regularly review whether HCA is maintaining its overall commitments.

The agreement specifically states that HCA must keep the commitment previously made by Mission Health to rebuild Angel Medical Center in Franklin. HCA also may not reduce the number of beds or availability of services to be provided in the replacement for Angel Medical Center. The original agreement would have allowed HCA to make changes based on their discretion.

The sale also will have a specific focus on behavior health needs as well as battling the opioid epidemic in Western North Carolina. HCA agreed to build a 120-bed inpatient behavioral health hospital in Asheville, and it may not reduce the scale of that project to construct fewer than that number of beds.

Over the next five years, HCA will also be required to spend $25 million to fight the opioid epidemic throughout Western North Carolina.

HCA also agreed to continue supporting the same community programs Mission Health System has in the past by agreeing to spend at least $14.28 million for community service programs specifically, $7.5 million over the next 10 years along with $6.78 million in the next year to support certain named programs.

While layoffs of employees can be expected throughout the region at various health care facilities as a result of the acquisition, HCA did vow to give employees who lose their jobs locally, notification of job opportunities around the country in other HCA-owned facilities, which would also allow employees to retain their seniority.

By Brittney Lofthouse

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