The 8/31 press release states that “HCA has committed to maintaining key clinical services for at least five years.” The word “key” seems to carry a lot of weight in this sentence. Please list which clinical services are considered “key” under HCA’s commitment and which are not. Furthermore, what does “maintaining” mean? Will they be kept at the same staffing levels, etc.? Also, who has standing to enforce that agreement and how would such an agreement be enforced if there is a dispute as to whether HCA is maintaining the services?

The 8/31 press release states that “HCA has committed to maintaining key clinical services for at least five years.” The word “key” seems to carry a lot of weight in this sentence. Please list which clinical services are considered “key” under HCA’s commitment and which are not. Furthermore, what does “maintaining” mean? Will they be kept at the same staffing levels, etc.? Also, who has standing to enforce that agreement and how would such an agreement be enforced if there is a dispute as to whether HCA is maintaining the services?

The agreement stipulates that member hospital services, which are described on schedule 7.13b, will be maintained for 5 years.  For Mission Hospital and CarePartners, the time period is 10 years, and those services are described on schedule 7.13a.  Any exceptions to these protected periods are described in section 7.13 of the APA. The full APA and these schedules are posted on MissionHealthForward.org.

Obviously it is a very difficult if not impossible challenge to see into the future with perfect clarity.  Standards of care can change, technology can change and consumer preferences can change among other things.  Levels of staffing, for example, routinely change (whether up or down) as demand shifts and technology enables services to be provided more efficiently and effectively. As such, rather than trying to imperfectly define what “maintaining” means or to line item each and every possible service for time periods of 5 and 10 years, the services themselves are described generally and an exception process is defined.  A key feature of the agreement is that there are local advisory boards in place (built from the existing community boards) as well as an arbitration process described to settle any differences of opinion that can’t be otherwise resolved.

With respect to enforcement, the first relevant body is the local advisory board that has authority to make any changes to agreed upon services.  Should there be a dispute there, Mission Health would be the next line of defense to the extent that it remains in existence and has the wherewithal to push for enforcement.  Because Mission Health will ultimately not exist and because many provisions in the agreement persist to perpetuity, Dogwood Health Trust will have the ultimate enforcement role along with the assets to ensure its ability to do so. As a perpetual organization, it will be the ongoing steward and protector of the HCA Healthcare agreement.