BILLION-DOLLAR BILL.

AuthorMildenberg, David
PositionSTATEWIDE: West

After months of negotiations, Nashville-based HCA Healthcare agreed to pay $1.5 billion for Asheville-based Mission Health, the dominant hospital operator in western North Carolina. While the deal awaits an evaluation by N.C. Attorney General Josh Stein concerning the transaction's impact on competition and whether sale proceeds will benefit the region, Mission officials say they expect completion by year-end.

HCA also pledged $430 million over five years in capital expenditures and won't sell Mission's six rehabilitation and acute-care hospitals for at least 10 years. The two parties propose a $50 million fund to invest in innovative health care companies that would benefit the region.

The merger has drawn criticism because of concerns that for-profit HCA will benefit from future earnings that would have accrued to not-for-profit Mission and fears that quality of care will suffer. For many years, various surveys have ranked Mission as one of the nation's topper-forming hospitals based on patient outcomes, outpacing other N.C. peers.

But Mission is making the right move because HCA can maintain quality and operate more efficiently due to its vast size, says John Ball, an Asheville physician who chairs Mission Health's board. HCA had annual revenue of $44 billion in 2017, versus Mission's $1.6 billion.

While Ball says Mission would face unrelenting pressure to cut costs, the system's reports to bond-rating agencies show operating profit has increased in each of the last three fiscal years.

The key beneficiary of the sale is a new nonprofit foundation, Dogwood Health Trust, whose mission is improving health care...

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