HCA-Mission Health deal OK'd by N.C. attorney general

North Carolina's attorney general approved hospital giant HCA Healthcare's $1.5 billion acquisition of Asheville-based Mission Health on Wednesday, after nabbing commitments from HCA meant to protect the state's healthcare industry.

"Access to healthcare is truly a life or death issue," North Carolina Attorney General Josh Stein said in an announcement. "We kept that fact in mind as we conducted our review of this transaction. After extensive negotiations, I am satisfied that this new agreement protects healthcare in western North Carolina, ensures that the full value of Mission's assets will continue to be used for public purposes, and requires that the Dogwood Health Trust will be independent and representative."

Stein said Nashville-based HCA also agreed to enforcement measures that allow the attorney general's office to pursue legal action if the hospital system breaks its commitments, which include providing services at local hospitals for at least 10 years, building new North Carolina facilities, and supporting community service programs that Mission supports.

The Dogwood Health Trust is a not-for-profit foundation created by Mission Health in July 2018 that is to receive the net proceeds of the HCA deal and use them to make investments in healthcare and address social determinants in North Carolina communities.

As part of the negotiations, Stein said the trust agreed to improve diversity on its board to better represent the communities it serves. It also agreed to certain transparency measures, including providing an annual report on how it is using its funds.

The attorney general's approval is just one—albeit an important—hurdle to HCA and Mission tying the knot. The Federal Trade Commission will also have to approve the deal before the systems can merge. HCA and Mission Health first agreed to combine in August 2018. Mission said it expects the deal to close Jan. 31.

If the deal closes, Mission would continue to be managed locally under the Mission brand while HCA's backing would boost its operations, capital access, clinical trials, research, predictive modeling and analytics, Mission said when the announcement was first announced.

HCA currently has no operations in North Carolina, and a Modern Healthcare Metrics analysis showed it may see a fellow market leader in Mission, which holds a 49.5% market share across the 11 counties it operates in.