FAQs

The process undertaken by the Mission Board of Directors was informed, thoughtful, painstaking and strategic, leading to the unanimous decision to sign the Letter of Intent with HCA Healthcare. Moreover, it was guided by a long-range view of the best interests of the people of western North Carolina and the surrounding region.  The Mission Board was and is committed to preserving and expanding high quality, cost-effective care for everyone in western North Carolina for generations to come, not just with a world-class health system, but now with the potential of an extraordinary foundation to help fill in the gaps left by inadequate social services.  We have entered the due diligence process and will continue our effort to make sure this is the right, best course for Mission Health and our team members, patients and communities.

Not really.  It isn’t that other consolidation “motivated Mission” but rather that the same external factors driving broader market consolidation – relentless pressure from payors, government and businesses to do more with less along with ever-increasing expectations for health systems to serve as a social safety net – also impact Mission Health.  Until payors and the government are willing to accept their responsibility for demographic and other challenges unrelated to health system performance, consolidation will not only continue, but accelerate.

Effectively yes.  The letter of intent, subject to due diligence, envisions a 3 year transition from Mission Medical Associates to HCA Healthcare’s employed physician group.  We are just now entering the due diligence phase to be followed by a regulatory approval phase.  So still a long way to go. We invite you to keep informed on the website.

Government, businesses and payors are demanding that healthcare providers assume more risk and continually reduce costs.  As a result, healthcare mergers and acquisitions are taking place across our country and our state at an unprecedented pace. The Mission Board, all of whom are community members who care deeply about ensuring access to high quality care for the people of western North Carolina for generations to come, knew that it was essential that we act from a position of strength to shape our desired future. Given the inevitability of consolidation, we wanted it to be our choice long before we are forced to make one. It’s from this position of strength that we are able to ensure that our selected choice is as invested as we are in our mission, people, patients, providers and communities.

A Letter of Intent (LOI) means that the parties have mutually agreed to further evaluate a potential relationship between them using a defined process and within certain parameters.  Said another way, the LOI provides an outline of what an agreement might ultimately look like but it is fully contingent upon additional information and is non-binding.

After a careful and thorough search, Mission Health’s Board is assured that HCA Healthcare is right for our team, patients and communities. HCA Healthcare intends to grow here in western North Carolina by investing in increased access to care, expansion of existing and new services and supporting our communities with the creation of a very significant foundation, which would be administered by people in our communities for the people who live in our communities. With tens of millions of dollars to invest annually, the foundation’s potential is life-changing.  The Board was also impressed with HCA Healthcare’s nine consecutive years of being designated as one of the “World’s Most Ethical Companies” by the global leader in advancing the standards of ethical business practices, the Ethisphere Institute.

As Mission Health moves through this process, we pledge to be as transparent as possible and share information in a timely manner. We also have created a website dedicated to keeping our patients, team members and communities informed. We invite you to visit MissionHealthForward.org regularly.

Our goal in pursuing joining HCA Healthcare is to be an even stronger organization going forward than we would be alone.  While some positions will likely change or be eliminated over time due to changes in market demand as they have been for years, we do not anticipate significant changes, but beyond what we typically experience or that would be required as we evolved and expanded our organization alone, without an HCA Healthcare relationship.  Additionally, HCA Healthcare plans to invest and grow here so, importantly, we do expect new jobs and new opportunities to be created – particularly for clinical staff.

HCA Healthcare has a proven track-record of making meaningful investments in its communities – not just for its healthcare operations but beyond.  A key component of this agreement, should it move forward, is the creation of a very substantial foundation.  While the final details still need to be worked out, its assets will be focused on the people who live in our communities.  With the potential of tens of millions of dollars or more available every year for improving the health of the residents of western North Carolina and beyond, the possibilities of this new foundation are nothing short of transformational.  In addition, HCA Healthcare will pay local and state property, sales, use and other taxes that will support our local community governments.

HCA Healthcare has unique scale benefits and broader capabilities that are difficult, if not impossible, to match.  Understanding the unique, special needs of our patients, particularly those in remote and rural areas, we look forward to the possibility of expanding access and accelerating improvements while gaining efficiencies.

A key component of this agreement, should it move forward, is the creation of a very substantial foundation.  While the final details still need to be worked out, its assets will be focused on the people who live in our communities.  With the potential of tens of millions of dollars or more available every year to improve the health of the residents of western North Carolina and beyond, the possibilities of this new foundation are nothing short of transformational.  That’s great news for our patients and communities!

HCA Healthcare intends to use Mission Health as its platform for growth and expansion across the region.  They plan to invest and grow here so, importantly, we do expect new jobs and new opportunities to be created – particularly for clinical staff.  Fundamental to HCA Healthcare’s philosophy is to provide the support and resources needed for local leaders, service providers and clinicians to best meet the needs of their patients, with the same high-quality care they have come to expect and deserve.

HCA Healthcare is attracted to Mission Health for many reasons, including the reputation of Mission Health clinicians and broader team to deliver best-in-class care and patient outcomes and our shared commitment to innovation.  Mission joining HCA Healthcare would also be HCA Healthcare’s entry into North Carolina allowing for additional growth opportunities.

HCA Healthcare was founded 50 years ago by two physicians in Nashville, Tennessee.  It is one of the nation’s most respected healthcare providers, operating 177 locally managed hospitals and 119 surgery centers located in 20 states and in the United Kingdom.  HCA Healthcare does not presently have any operations in North Carolina.  HCA Healthcare is committed to the care and improvement of human life and shares our deeply held commitment to our people, patients and communities.  HCA Healthcare offers hundreds of clinical trials each year as part of its commitment to advancing medicine and, for the past nine years, HCA Healthcare has been named one of the “World’s Most Ethical Companies.” You can learn more about HCA Healthcare here.

There are far more similarities than there are differences.  Fundamentally, all hospitals are obligated to meet the same federal and state requirements and are held to the same quality and patient safety standards.  One obvious difference is that for-profit organizations pay taxes, which helps benefit communities.  Here is a quick comparison.

HCA Healthcare has committed to maintain Mission Health’s charity care policies.  It also has a long history of caring for all members of the communities they serve, especially patients who participate in programs like Medicaid and Medicare.  HCA Healthcare is committed to giving back to their communities, providing $2.8 billion in uncompensated care, meaning they subsidize gaps in Medicare and Medicaid payments and cover costs of care for uninsured patients. Additionally, HCA Healthcare donated $23.6 million in cash contributions to local charitable organizations last year alone.

The good news is that access to the same high-quality of care patients deserve and have come to expect from Mission Health will not change should we join HCA Healthcare and there is a respected body of data to support this.  According to a 2014 study by the Harvard School of Public Health, switching from not-for-profit to for-profit status does not lower the quality of care they provide nor reduce access for poor or minority patients.

Absolutely not.  First, it is inconsistent with their mission and the Hippocratic Oath sworn by its founding physicians.  Second, federal law protects patients who are in need of emergent care, and it is illegal to require up-front payments for that care.  Those laws apply to all hospitals — whether they are for-profit or not-for-profit.  A report by Harvard School of Public Health confirmed that not-for-profit hospitals and health systems switching to for-profit status maintained their level of care for poor patients or at-risk populations.

Tax benefits will apply anywhere that Mission Health owns property or provides taxable services. We don’t yet have an estimate of the potential impact locally.

Healthcare costs aren’t driven by the ownership of a facility but rather by the input costs incurred to provide care. Therefore, we don’t expect that patients will see any significant changes related to the transaction. However, one of the benefits of joining HCA Healthcare will be increased efficiencies, so we look forward to the expanding access and accelerating improvements.

No, not anything more specific or different than any other Mission Health entity.  Mission Hospital – McDowell is an important member of the Mission Health system.  As for all of Mission Health, we believe this is the right choice for our communities, patients and team members and truly transformational for all of western North Carolina.  HCA is excited about the brand-new Mission Hospital – McDowell and looks forward to serving the community for a very long time.

McDowell patients can look forward to the same high-quality care, delivered by their trusted caregivers that they deserve and have come to expect.  But in addition, the remarkable new Foundation that will be created to improve the health of the people of western North Carolina and the surrounding region will be a game changer for our community’s health, including but not limited to the McDowell community.

Thank you for your question about whether Mission Health will become a for-profit company if it joins HCA Healthcare.  The answer is yes. However, being a for-profit would not change how Mission approaches patient care. All hospitals are required to meet many of the same federal and state requirements and are held to the same quality and patient safety standards.  Both for-profit and non-profit hospitals provide charity care.  A key difference is that as a for-profit organization, Mission would pay taxes, which would benefit our communities.  Click here for a quick comparison of for-profit and not-for-profit hospitals.

Yes. This really was exactly the right time to pursue such a transaction.  We have worked tirelessly over many years to create a highly attractive, high performing organization – from the perspective of quality, efficiency and financial performance.  The Board was very deliberate in its desire to make decisions about Mission’s future from a position of strength, because they are the fiduciaries responsible for ensuring that our community is well served for many, many decades to come.  It is only from a position of strength, that the strongest relationships can be created.

We have posted a voluntary disclosure on EMMA website (MSRB.org – Municipal Securities Rule-Making Board) for current bondholders. To learn more, please click here .  We cannot speculate on why markets react the way they do.

Thank you for your question about how becoming a for-profit might impact the uninsured. Joining HCA Healthcare would not change how Mission approaches patient care or treatment of the uninsured in any way.  Regardless of status, all hospitals are obligated to meet the same federal and state requirements and are held to the same quality and patient safety standards. 

 Also, you might be interested in this study by the Harvard School of Public Health that determined that switching from non-profit to for-profit status appears to boost hospitals’ financial health but does not appear to lower the quality of care they provide or reduce the proportion of poor or minority patients receiving care.  Here’s the link: https://jamanetwork.com/journals/jama/fullarticle/1917437

Thank you for your excellent questions.  First, none of the existing Foundations within the Mission Health system are part of the contemplated transaction with HCA Healthcare.  Those foundations will remain intact. 

Second, the newly formed foundation contemplated as part of this transaction will receive all of the proceeds from the transaction.  Those proceeds will be determined by the ultimate purchase price paid, and any remaining balances within Mission Health after retiring all outstanding debt, payables and adjustments for working capital.  It is those total proceeds that will be used to improve the health of the people in western North Carolina and the surrounding region.  While many details remain to be determined, including the specific structure of the newly created foundation, a rule of thumb might be that 5% of foundations assets are spent yearly in support of its mission.

We have created this website to be dedicated to providing you information and updates about this transaction. It contains all public available information at this time. Given the Letter of Intent begins a further evaluation of a potential relationship, it’s just too early to speculate what HCA Healthcare’s expanded access to care may entail for western North Carolina. There is this LOI period, followed by a due diligence phase and then a regulatory approval phase. So still a long way to go. We invite you to keep informed on the website.

Thank you for your question about how becoming a for-profit might impact quality of care and treatment of the uninsured.  The proposed transaction is about preserving and expanding services and there is no plan to discontinue behavioral health services. 

Joining HCA Healthcare would not change how Mission approaches patient care. All hospitals are required to meet many of the same federal and state requirements and are held to the same quality and patient safety standards.  Both for-profit and non-profit hospitals provide charity care.  A key difference is that as a for-profit organization, Mission would pay taxes, which would benefit our communities.  Here is a quick comparison of for-profit and not-for-profit hospitals:  https://missionhealthforward.org/wp-content/uploads/2018/03/Mission-Health_comparison-chart_r4-1.pdf

Further, you might be interested to know that HCA Healthcare is the second largest provider of Behavioral Health services in the nation.  Even more, the letter of intent specifies that HCA Healthcare will continue Mission’s in-flight capital projects, including a new Behavioral Health hospital.  Simply put, HCA Healthcare has a significant commitment to patients requiring Behavioral Health support.  Also, you might be interested in this study by the Harvard School of Public Health that determined that switching from non-profit to for-profit status appears to boost hospitals’ financial health but does not appear to lower the quality of care they provide or reduce the proportion of poor or minority patients receiving care.  Here’s the link: https://jamanetwork.com/journals/jama/fullarticle/1917437.

Although Mission Health has signed a letter of intent with HCA Healthcare, we do not have the answers to every possible question.  However, as the letter of intent is currently structured, subject to due diligence, all of Mission Health, including CarePartners and Eckerd Living Center would become part of HCA Healthcare, operating under the current name.

Thank you for your question about Mission Health’s non-profit status if we join HCA Healthcare.  Mission Health would begin operating as a for-profit enterprise after all regulatory approvals have been obtained and the deal is finalized.  However, being a for-profit would not change how Mission approaches patient care. All hospitals are required to meet many of the same federal and state requirements and are held to the same quality and patient safety standards.  Both for-profit and non-profit hospitals provide charity care.  A key difference is that as a for-profit organization, Mission would pay taxes, which would benefit our communities.  Click here for a quick comparison of for-profit and not-for-profit hospitals.

Thank you for your question about Mission’s EMS services. Importantly, Mission Health is not going anywhere. This proposed transaction is about preserving and expanding healthcare for the communities of western North Carolina.  While it is too soon to have answers to every possible question, there is nothing that we know of at this time that would impacts Mission Health’s EMS services.

We anticipate that the due diligence process will take 90-120 days to complete. If we confirm in this next discovery phase that joining HCA Healthcare holds the great promise and potential that we believe it does and definitive agreements are signed, that will trigger a 90-day regulatory review period. If regulatory requirements are met, Mission Health would then become a member of the HCA Healthcare family sometime later this calendar year.

HCA Healthcare intends to use Mission Health as its platform for growth and expansion across the region, so we do expect new jobs and new opportunities to be created – particularly for clinical staff. While some positions will likely change or be eliminated over time due to changes in market demand as they have been for years, we do not anticipate significant changes beyond what we typically experience or that would be required as we evolved and expanded our organization alone, without an HCA Healthcare relationship.

Thank you for your question about whether Mission Health will become a for-profit company if it joins HCA Healthcare.  The answer is yes.   We certainly understand your concern about the potential impact on your student loans, and we are investigating options to mitigate or eliminate that concern.  Unfortunately, it is too early to have any definitive guidance at this time, but we will communicate more as the options become clearer.

Being a for-profit would not change how Mission Health approaches patient care. All hospitals are required to meet many of the same federal and state requirements and are held to the same quality and patient safety standards.  Both for-profit and non-profit hospitals provide charity care.  A key difference is that as a for-profit organization, Mission would pay taxes, which would benefit our communities.  Click here for a quick comparison of for-profit and not-for-profit hospitals.

Thank you for your question about prior work history at HCA Healthcare.  We do not have an answer to that question at this time, but we will explore that issue further during the due diligence period over the next 90-120 days.

We have signed a letter of intent to explore a relationship with HCA. It is far too early to have definitive answers to many questions. That said, if HCA Healthcare were to acquire Mission Health, subject to due diligence, it would acquire the entirety of the health system, including Mission Hospital, Angel Medical Center and other Mission Health member institutions. Mission would not “remain autonomous”, it would be part of HCA Healthcare as would Angel Medical Center.

HCA Healthcare has a long, proven history of investing into the communities it serves – from expanding access to urgent and primary care to enhancing specialty services. We do know HCA is committed to investing and helping move healthcare forward in each of our local communities by helping improve access and maintain quality and clinical outcomes. We’ll know more as our conversations continue over the next several months and due diligence is performed as described in the letter of intent.

The North Carolina Attorney General’s Office is required to review and approve the proposed transaction. With respect to the FTC or the US Department of Justice, it’s important to note that HCA Healthcare does not currently operate in North Carolina.  While we can’t presume to speak for regulators, we do not anticipate any competitive concerns.

As a result of the contemplated transaction, Mission Health would become part of the HCA Healthcare family.

Importantly, Mission Health, and our facilities, will remain in western North Carolina—providing the same world-class care and services, with the same people and the same name as it has for the past 133 years.  Together, Mission Health and HCA Healthcare will bring the strength of Mission Health’s clinical excellence with HCA Healthcare’s commitment to investing in western North Carolina through improved access to care and the creation of a new foundation that would invest tens of millions of dollars each year to improve the health of our 18-county region, including a focus on the social determinants of health.

We are still early in the process, but we are excited about the possibility of joining HCA Healthcare.  Any transaction remains subject to due diligence and eventual approval by the Attorney General.  Given the promise and potential we believe this holds for western North Carolinians, we are hopeful this transaction will proceed smoothly and receive the required regulatory approvals.

The decision was most certainly shared with the community on March 21, 2018.  As the community governing body, the Board has both the legal and fiduciary responsibility to thoroughly deliberate, vet and approve courses of action they believe to be in the best interest of the communities Mission Health serves.  The Board adhered to these responsibilities when considering, approving and then communicating its decision to explore joining HCA Healthcare.

It’s important to note that each Board member is also a community member, volunteering his or her time because they care deeply about ensuring access to high quality care for the people of western North Carolina for generations to come. It’s their commitment to their community that governs all of their decision-making.

Transylvania Regional is our major facility in the area and it would benefit, like our other facilities, from this proposed transaction.  Moreover, although we are still early in the negotiation process, HCA Healthcare has made initial commitments to ensuring that our capital projects in flight continue. Our patients in Transylvania, Polk and Henderson counties can look forward to the same high-quality care, delivered by their trusted caregivers, that they deserve and have come to expect.

While we understand that everyone has their own perceptions, we do not agree with the characterization of “prior to Mission taking over” and subsequent to Mission enabling the hospital to remain viable and dramatically improving both clinical and operating performance. Service offerings are driven by what can be done safely and effectively in any given community.  In view of the fact that the community isn’t changing with this contemplated transaction, it would be unlikely that services would change significantly.  Mission is very proud of the work we have done in collaboration with the Highlands Cashiers Board and the community.

With regard to your questions about potential future changes on the Highlands Cashiers campus, what we can say today is that HCA has a long, proven history of investing in the communities it serves – from expanding access to urgent and primary care to enhancing specialty services; HCA is committed to investing and helping move healthcare forward in each of our local communities by helping improve access and maintain quality and clinical outcomes.  We’ve only just entered the LOI and will begin having these more specific conversations about how HCA would move forward with respect to current or planned future projects within each local community.  We’ll know more as our initial conversations continue over the next several months.

Mission has no ownership of the Highlands Cashiers Foundation and has never had any ownership of that Foundation.  Rather, it is an independent, tax-exempt foundation supporting Highlands Cashiers Hospital. As such, it is distinct from and not part of the HCA Healthcare and Mission Health relationship currently in due diligence.  That money has always been, and will always remain in that Foundation supporting that Foundation’s purposes.

HCA Healthcare intends to use Mission Health as its platform for growth and expansion across the region, so we do expect new jobs and new opportunities to be created – particularly for clinical staff. While some positions will likely change or be eliminated over time due to changes in market demand as they have been for years, we do not anticipate significant changes beyond what we typically experience or that would be required as we evolved and expanded our organization alone, without an HCA Healthcare relationship.  Also, HCA as a for-profit company will pay taxes in each community where it has facilities or provides taxable services

Mission Health’s Board continually explores what is best for Mission Health and the health and well-being of the residents of western North Carolina. In that context, the Board has reviewed whether remaining independent is in the best interests of the community every year or so for the past eight years. In light of relentless pressure from payors, government, businesses and others to reduce healthcare costs, mergers and transactions have been taking place at an unprecedented pace within the healthcare industry and that pace is likely to accelerate even further. Given the inevitability of eventual consolidation, the Mission Health Board wanted it to be our choice from a position of strength long before we are forced to make one. After a careful and thorough search, the Board is assured that HCA Healthcare is right for our team, patients and communities. It’s from this position of strength that we are able to ensure that our selected choice is as invested as we are in our mission, people, patients, providers and communities.

Mission Health has approximately 12,000 team members and 2,000 volunteers.

Yes, as the result of the signing of the Letter of Intent, Mission Health and HCA Healthcare have begun the due diligence and definitive negotiation phase of process.

The Mission Health Board of Directors’ intent is to preserve and expand Mission Health’s world-class quality of care within a rapidly consolidating healthcare industry. Payors, government and businesses are demanding that healthcare providers continually reduce their costs. The Mission Board, all of whom are community members who care deeply about ensuring access to high quality care for the people of western North Carolina for generations to come, knew that it was essential that we act from a position of strength to shape our desired future. Given the inevitability of consolidation, we wanted it to be our choice long before we are forced to make one. It’s from this position of strength that we are able to ensure that our selected choice is as invested as we are in our mission, people, patients, providers and communities.

This transaction doesn’t impact anyone’s insurance coverage, and we don’t anticipate any changes in that regard.

We are still early in the process, but we are excited about the possibility of joining HCA Healthcare and, given the promise and potential we believe this holds for everyone in western North Carolina, we are hopeful this transaction will receive the required regulatory approvals and be able to move forward. But with or without HCA Healthcare, Mission Health’s Board is always exploring what is best for Mission Health and most importantly, the health and well-being of the residents of western North Carolina. That is the key fiduciary duty of the local community members who comprise the Mission Health Board of Directors and who govern Mission Health; it is a continuous process. That model has worked for more than a century, and it will continue to work whatever the outcome of these particular discussions.

While we are still early in the process, it is HCA Healthcare’s desire to retain current management as a platform of growth in the Carolinas. Current management is one of the many reasons that HCA Healthcare is interested in Mission Health. It is anticipated that Mission Health would remain as an independent division of HCA Healthcare with current management operating the division and overseen by HCA Healthcare. As is true with every topic, all decisions are subject to due diligence on both sides and the choice of individuals in management.

This proposed transaction is about preserving and expanding care. Importantly, although we are still early in the negotiation process and haven’t completed due diligence, HCA Healthcare has made initial commitments to ensuring that our capital projects in flight continue, including Angel Medical Center and the Mission Hospital for Advanced Medicine. If HCA were to acquire Mission Health it would be responsible for constructing a new hospital facility in Franklin. Until that time, if ever, Mission Health remains responsible for the new facility. Our patients in Franklin can look forward to the same high-quality care, delivered by their trusted caregivers, that they deserve and have come to expect.