I WAS WONDERING IF YOU COULD PROVIDE A STATEMENT ON THE RECENT VOTE TAKEN BY THE LOCAL MEMBERS OF THE HIGHLANDS-CASHIERS HOSPITAL NOT TO UNWIND FROM ITS CURRENT AGREEMENT WITH MISSION AND TO SUPPORT MISSION IN ITS EFFORTS TO EXPLORE AN ACQUISITION BY HCA.

I WAS WONDERING IF YOU COULD PROVIDE A STATEMENT ON THE RECENT VOTE TAKEN BY THE LOCAL MEMBERS OF THE HIGHLANDS-CASHIERS HOSPITAL NOT TO UNWIND FROM ITS CURRENT AGREEMENT WITH MISSION AND TO SUPPORT MISSION IN ITS EFFORTS TO EXPLORE AN ACQUISITION BY HCA.

The Highlands-Cashiers Hospital Board of Directors understood deeply the many benefits that will come with an HCA Healthcare affiliation and the very grave dangers that would result from any purported “spin-off.”

In general, rural hospitals suffer from all of the same challenges as other hospitals, but are further stressed with smaller populations with more challenging demographics (including payor mixes) that make sustainable service offerings difficult, and fewer physicians and other clinicians who want to live and practice in rural areas.  Difficulties in recruiting to and retaining physicians and other clinicians in rural areas are multifactorial, including: patient volume limitations that makes maintaining specialized skills difficult or impossible; challenges for non-medical spouses in finding employment in rural areas; access to educational opportunities that such professionals frequently desire and, ironically, the economic stresses that rural hospitals face which result in negative implications for long-term practice and/or employment stability.

Fortunately, since joining Mission Health, its rural hospitals’ combined operating margin has risen steadily from a negative $16.4 million in FY10 to a positive $11.7 million in FY17, a net improvement of +$28.2 million resulting from Mission Health’s support, lower cost of operation and more.  So today, while there is still an annual struggle to maintain performance for every provider under the Mission Health umbrella, the overall financial condition of Mission Health’s rural hospitals is much improved.  But every rural hospital is always just one step or change away from distress – the loss of one or more doctors, yet another Medicare or Medicaid cut, or demands from a dominant insurer that the rural hospital subsidize inflation on the cost of the care provided to its enrollees.

Highlands-Cashiers Hospital has continually and dramatically improved its operating performance with Mission’s support (as have all of our member hospitals), and with the addition of HCA Healthcare’s cost savings and expertise, Highlands-Cashiers Hospital has by far its very best opportunity to be sustainable over the long term.

With the contemplated transaction with HCA Healthcare, every entity within Mission Health will have very significant protections that it lacks today, including protections against program closures or being sold or closed entirely.  Most importantly, HCA Healthcarehas a very strong track record of enhancing the operations of its hospitals.  HCA also has a proven history of investing in the communities it serves and supporting healthcare in each community.

Additionally, if the transaction with HCA Healthcare is consummated, Mission Health will forgive and eliminate nearly $80 million in combined debt owed by its member hospitals.  That’s an extraordinary, direct contribution to each local community.