January 18, 2019
The state has negotiated important safeguards into the sale of Mission Health. Now it’s up to those who will lead both the new Mission Heath and the foundation that will handle proceeds from the sale to HCA Healthcare to ensure these guidelines are followed and WNC is well-served by the deal.
The sale cleared its final hurdle Wednesday, when NC Attorney General Josh Stein signed off on the $1.5 billion deal. Stein did, however, gain important concessions, especially on the future of the rural hospitals Mission owns and the Dogwood Health Trust's board membership and operations.
The changes double to 10 years the period HCA will be required to provide certain services at the rural hospitals, create an outside “independent monitor” to help ensure HCA lives up to terms of the deal, require geographical diversity on the Dogwood board and make the board’s operations more open to the public.
Risa Larsen, a leader of a group of Mitchell and Yancey county residents who had criticized the deal, said she was pleasantly surprised at how many new protections came out of the negotiations.
Mission operates, in addition to its flagship institution in Asheville, hospitals in Brevard, Franklin, Highlands, Marion and Spruce Pine, plus CarePartners. There already have been some reductions in services in those areas, and people there feared the sale could lead to loss of their hospitals.
In addition to increasing from five to 10 years the amount of time services must be retained, the new agreement provides a more detailed list of services designated. Also, local foundations must be allowed to bid on a hospital if HCA ever decides to sell or close it. And HCA must continue some spending on community programs.
The buyback is especially important to the people in those communities who put up money for a community institution, not an outpost of a for-profit company. They deserve the chance to regain control if HCA decides it no longer wants to operate their hospital.
The other major concern has been the board that will run the Dogwood Health Trust, which could disburse as much as $75 million a year to improver those societal conditions in Western North Carolina that affect health. As first set up, it appears to be simply a continuation of the Mission Health board, with little diversity either ethnically or geographically.
The Dogwood board must be “fully and fairly representative of Western North Carolina across all dimensions, including ethnic, gender and geographic,” says a summary released by the attorney general. It can have no more than five members from any one county by 2020 and no more than four by 2021. Five members from outside Buncombe must be added by 2021.
There are no specific quotas for gender or ethnicity, but adjustments are needed there as well. The 11 board members chosen thus far include one Cherokee Indian and four women. Two of the women, one Hispanic and the other African-American, were added after initial outcry about the lack of diversity.
The sale could be completed by month’s end. That means those charged with monitoring the outcome better get ready. The sale could benefit the area in a number of ways, not the least of which is the property taxes that will be paid once Mission is a for-profit. And then there is the money freed up for addressing social causes of ill health.
Dogwood could accomplish a great deal to address such problems as poverty and inadequate housing, problems that we know contribute to health issues. The overseers must make sure the money is spent productively, and that the terms under which a community institution is surrendered are fulfilled in the interests of the people.