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From YouTube: City County Meeting on Mission/HCA Transaction
Description
County Commissioners and City of Asheville discuss an update on the Mission Health/HCA Transaction - Oct. 16, 2018
A
Pretty
much
all
or
mostly
here,
so
why
don't
we
let
me
get
started.
We
may
have
another
couple
of
folks
joining
us
coming
from
other
meetings,
but
we
have
a
critical
mass
here.
So
mayor,
Mannheimer
I,
understand
is
out
of
town
today,
so
she
won't
be
with
us,
but
what
we
have
Vice
Mayor
when
Whistler
with
us
and
other
members
of
City.
A
Want
to
say
thanks
to
everyone
for
getting
together,
this
is
kind
of
the
we've
had
a
couple
of
other
previous
sit
downs
with
our
colleagues
from
Mission
and
folks
who
are
working
on
the
formation
of
the
dogwood
trust,
and
so
this
is
kind
of
just
I.
Think
another
opportunity
for
us
to
get
an
update,
ask
questions
and
and
have
a
good,
have
a
good
dialogue.
So
I
just
want
to
say
thank
you
to
everyone
for
being
with
us
and
but
I.
Think
probably
most
everyone
knows
you
know
probably
most
everyone
here,
but.
A
Why
don't
we
just
go
around
and
just
everyone
introduce
yourself
and
and
then
we'll
turn
it
over
to
you
guys
to
kind
of
kind
of
give
us
some
updates
on
things
happening
and
I'm
sure
we'll
have
a
good
discussion.
So
thanks
for
being
it
right
here,
I'll
start
off
with
browny
Newman
I'm,
the
chair
of
the
County
Commission.
We'll
start
this
way
and
then
we'll
get
the
outside
people
to
Vijay
Kapoor.
B
A
F
I
said,
I
am
John
Paul
I'm,
chair
of
the
mission
Alice's
Board
of
Directors
with
me,
is
my
colleague
to
change
from
into,
as
she
say
they
just
said:
Charitable
Trust
Board
of
Directors,
we're
very
pleased
to
take
this
opportunity
to
brief
you
on
the
status
of
of
the
transaction
with
instigating
up
here,
as
well
as
the
status
of
your
trust.
We
really
appreciate
your
interest
each
other,
but
it
says
about
a
five-minute
brief
statement.
It
started
about
opinions,
have
questions,
so
we
hope
to
have
a
conversation.
So
thank
you
very
much.
F
First,
a
little
background
on
the
mission
of
Mission
Bell
is
to
improve
the
health
of
the
people
of
Western
North
Carolina.
It's
that
mission,
that
the
mission
health
or
is
the
steward
on
is
that
mission
that
is
consistently
guided
at
deliberation.
How
best
to
meet
the
mission
has
been
the
subject
of
several
strategic
planning
retreat
over
the
last
few
years
of
mission
board.
Until
recently,
our
default
position
was
to
remain
independent.
Why?
F
Because
we've
done
very
well
infinitive
mission,
as
you
know,
has
been
named
by
IBM
Watson
children
analytics
top-15,
Health
System,
six
of
the
last
seven
years,
no
other
hospital,
no
other
health
system
in
North
Carolina
has
achieved
that
designation,
no
other
system,
our
hospital
in
the
United
States
has
achieved
that
regular
jurisdictional
insiders.
In
that
way,
that
blinking
is
my
face
on
pinion.
It's
based
on
hard
data
with
regard
to
quality
and
efficiency,
while
maintaining
and
improving
quality,
consistently
cut
cost
compared
with
a
peer
group
of
North
Carolina
hospitals
chosen
by
the
state.
F
Our
cost
per
case
is
about
a
thousand
dollars
less.
Over
the
past
five
years,
we've
taken
240
million
dollars
out
of
the
annual
cost
won
and
in
the
most
recent
fiscal
year,
including
September
30th,
we
took
70
million
dollars
out
there's
another
reason
to
remain
independent.
No
potential
partner
could
offer
an
advantage
to
us
in
increasing
revenues,
decreasing
cost
or
improving
quality.
Until
such
an
advantage
could
be
shown
which
would
remain
independent.
That
was
the
assumption
of
the
board,
but
West
North
Carolina
has
a
demographic
problem.
F
Our
citizens
are
older,
sicker
were
less
insured
and
those
are
the
rest
of
the
state
or
the
nation.
In
addition,
our
region
is
not
only
the
epicenter
of
the
oil
crisis,
but
behavioral
health
issues
threaten
to
overcome
our
energy
resources
missions.
Emergency
department
is
the
business
and
Carolinas,
and
many
of
those
patients
are
behavioral
issues.
In
addition,
Western
North
Carolina
has
a
health
economics
problem.
F
F
Nearly
three-quarters
of
the
remaining
patients
are
covered
by
the
dominant
insurer
in
the
state
and
the
outcome
of
our
negotiations
last
year
demonstrated
they
were
unwilling
to
raise
rates
to
meet
inflation
even
on
their
level
murmurs.
So
the
board
was
faced
with
a
difficult
choice,
remain
independent
and
continue
to
cut
expenses
every
year
at
52.
Second,
isn't
just
to
break
even
or
find
a
suitable
partner.
Our.
F
Was
that
remaining
independent
is
not
a
long-term
viable
option,
because
it
would
mean
very
shortly
cutting
clinical
programs
and
clinical
services
all
the
low-hanging
food.
Indeed,
all
the
fruit
that
already
been
cut,
and
it
would
mean
no
new
behavioral
health
hospital,
no
replacement
hospital
in
Franklin
and
a
potential
closure
of
some
of
the
critical
access
hospitals,
individual.
F
What
HCA
brought
to
the
table
was
ultimately
was
the
ability
to
maintain
health
care
in
the
region,
the
kind
of
commitment
to
quality,
accessibility
and
affordability
that
the
people
of
this
region
have
come
to
expect
Commission's
the
economy's
not
in
clinical
areas,
but
in
the
back
office
functions.
In
addition,
in
our
negotiations,
they
agreed
to
maintain
services
and
facilities
for
substantial
periods
of
time
at
all
of
our
hospitals.
A
guarantee
far
better
than
mission
alone
could
ever
have
made.
F
They
also
get
McNair
and
see
the
level
of
charity
care
equal
to
or
better
than
the
largest
health
system
in
the
state.
Further
is
part
of
the
transaction
omission
relationship
that
may
have
will
not
only
be
preserve,
but
the
enhance,
so
healthcare
preserves
to
the
extent
possible
health
care
preserve
to
the
extent
possible
and
the
conversion
foundation
buck
would
Health
Trust
the
largest
foundation
per
capita
in
the
country,
which
is
projected
to
spend
roughly
75
million
dollars
annually
in
Western
North
Carolina.
F
What
we
turn
the
social
determinants
of
health
health
status
of
individuals
is
determined
by
a
variety
of
factors,
and
health
care
is
only
responsible
for
about
fifteen
to
twenty
percent.
Other
factors
and
Janice
will
mention
these
in
more
detail,
are
more
important.
Health
care
helps
people
to
get
well
when
they're
young,
but
dogwood
health
trust
will
try
to
do
is
tell
people
eat
well
and
stay
well.
Finally,
as
part
of
the
transaction
Commissioner,
they
say
they
will
each
contribute
each
contribute.
Twenty
five
million
dollars
to
an
Innovation
Center
to
help
small
businesses
in
the
region.
F
Mission
has
already
committed
fifteen
million
dollars
each
to
each
of
the
six
legacy
foundations,
including
the
care
partners,
foundation
and,
finally,
there's
an
item
of
importance.
The
city
and
county
governments,
HCA
will
pay
property
and
sales
tax
is
estimated
to
be
from
15
days
into
25.
Minutes
on
annual
status
of
the
transaction
today
is
that
of
an
asset
purchase
agreement
among
mission
and
its
affiliated
organizations.
On
the
one
hand,
HCA
on
the
other,
the
agreement
was
transmitted
to
the
Attorney
General
on
September
1st.
F
The
Attorney
General
by
statute
has
30
days
to
perform
the
review
and
can
request
another
30
days,
but
there
is
a
catch.
The
30
day
period
begins
only
when
the
AG
determines
that
they
have
all
the
relevant
information
to
review.
While
we've
been
working
with
the
AG's
office
since
early
summer,
they
have
yet
to
say
that
the
review
carrier
has
started.
F
D
J
G
And
again,
my
name
is
Janice
Bremen
and
I.
Am
the
inaugural
chair
of
the
dogwood
Health
Trust
foundation
and
government,
Health
Trust
and
I'm,
going
to
tell
you
a
little
bit
about
formation
and
what
we're
doing
currently
a
lot
of
the
information
has
been
shared
by
John,
but
I
want
to
elaborate
on
that,
so
the
dog
would
help.
Trust
is
the
fiduciary
organization
which
will
see
will
receive
upon
completion.
G
You
have
an
eighteen
and
opposed
to
the
transaction
between
HCA
and
mission
health,
the
sale
proceeds
from
the
transaction
first
and
foremost
the
money
received
will
serve
to
dramatically
improve
the
health
and
well-being
of
the
people
and
the
communities
of
Western
North
Carolina.
There
has
been
significant
interest
surrounding
the
foundation
and
I
hope
to
provide
you
additional
information
today.
G
So,
as
I
said
earlier,
several
fiduciary
responsibilities,
let
me
explain
how
was
formed
and
what
the
charge
will
be.
The
asset
purchase
agreement
calls
for
HCA
choose
to
give
the
mission.
You
know
1.5
billion
dollars
for
the
center.
Our
hope
that
the
trust
will
receive
this
money
in
early
2019
based
upon
the
closure
of
the
agreement.
This
amount
of
money
will
get
be
a
game-changer
for
Western
North
Carolina.
The
purpose
of
the
of
the
trust
will
spin
off,
as
John
said,
50
to
75
million
dollars
per
year,
starting
in
2020.
G
So
we'll
get
the
money
in
2019.
In
any
rule,
we
will
prepare
to
give
grants
and
assistance.
These
dollars
will
be
focused
on
individual
community
needs
throughout
the
region,
because
we
recognize
that
each
community
and
its
citizenry
is
different
than
every
other
committed
in
Western
North
Carolina
and
the
focus
will
be
on
social
determinants
of
health,
meaning
the
things
that
are
many
drivers
of
health
and
well-being.
That's
not
health
care
per
se.
But
that's
what
happens
to
you
or
you
mean
to
be
to
have
health
care.
G
The
trust
will
be
a
non-operating
foundation,
which
means
that
it
will
not
be
operating
the
programs,
but
it
will
be
partnering
with
nonprofits
government
agencies
and
others
to
solve
issues
in
the
region.
The
trust
has
and
will
continue
to
engage
national
and
statewide
experts
to
assess
the
strengths
of
areas
in
our
communities.
If
you
attended
the
event
on
September
30th,
you
got
to
hear
one
of
our
national
experts
on
social
determinants
of
health.
G
Her
name
is
Rebecca
Oney
and
we
will
be
engaging
her
teen
and
other
experts
going
forward
to
help
us
to
engage
up
to
create
our
grant
and
our
evaluation
criteria
going
forward.
Another
immense
responsibility
of
the
trust
will
be
the
enforcement
of
the
guarantee
that
HCA
makes
in
an
asset
purchase
agreement.
This
is
no
small
responsibility.
G
Hca
will
agree
to
make
to
maintaining
services
and
the
rural
hospitals
and
on
the
main
campus
going
forward
for
a
period
of
time.
They
will
agree
to
build
up
a
behavioral
health
facility
in
Buckman
County
and
replacement
Hospital
in
Franklin.
They
also
agreed
to
maintain
a
charity
policy
that
is
equal
or
greater
to
the
biggest
nonprofit
health
system.
The
state
all
of
these
guarantees
and
others
that
they
will
make
in
the
asset
purchase
agreement
will
be
monitored
by
the
trust.
G
These
are
protections
for
the
health
care
of
our
citizens
for
10
years
and
beyond,
and
we
have
been
asked
how
the
adult
with
Health
Trust
Board
members
were
selected.
Let
me
give
you
some
background.
The
matter
first
and
foremost,
the
mission
Health
System
Board,
has
that
ultimate
legal
responsibility
to
oversee
both
the
delivery
of
healthy
health
care
and
the
delivery
of
resources
from
the
sale.
The
mission
board
approved
the
first
six
board
members
and
the
remaining
three
board
members
that
we
named
a
little
later.
G
There
are
certain
criteria
that
are
that
appear
on
the
dogwood
Trust
website
that
you
can
see
where
we
chose
the
the
board
members
and
we
chose
them
because
of
several
factors.
One
is
their
knowledge
and
health
care
delivery,
their
civic
engagement,
their
regional
representation
and
passion
for
the
citizens
of
Western
North
Carolina.
The
trust
plans
to
name
two
additional
members
by
the
end
of
2018.
We
are
seeking
to
enhance
the
board's
regional,
gender
and
racial
diversity.
G
So
what
are
our
next
steps,
as
you
can
imagine,
because
it's
an
early
formation
stages.
We
have
a
laundry
list
of
Texas
to
do,
much
of
which
is
neither
sexy
nor
exciting.
But
what
is
exciting
is
that
that
we
will
be
going
out
into
the
region
in
the
next
two
to
three
months
and
we
will
be
engaging
nonprofits,
elected
leaders
and
others
and
actively
listening
to
what
they
think
they
need.
In.
G
We
will
be
developing
staffing,
a
staffing
plan
and
CEO
criteria
and
we
hope
to
name
our
other
two
additional
board
members.
So
that
gives
you
a
little
update
on
what
we
relative.
As
you
can
tell.
We
have
a
lot
of
we
like
to
have
a
lot
of
things
on
our
plate,
but
we're
trying
to
take
those
off
very
rapidly
to
the
best
benefit
for
the
region's.
D
I
just
wanted
to
make
a
comment.
I
did
have
a
brief
meeting
yesterday
with
Jennifer
Harris
and
and
what
you
say
is
true
that
they
believe
that
they
are
still
waiting
on
some
data.
The
attorney
general's
office,
I'm,
sorry,
Jennifer
arrogance
with
the
attorney
general's
office,
but
they
are
very
much
aware
of
that
that
there
is
a
pressure
to
get
this
done
by
the
end
of
the
year.
I
think
on.
It
is
fair
to
say
that
they
want
to
meet
that
deadline.
D
F
I've
had
the
pleasure
of
reading
all
the
correspondence
of
things
on
the
attorneys,
because,
for
the
most
some
of
the
questions,
yes
over
em
I
mean
but
further
information
is
the
real
cost
of
this
is
the
cost
of
people
at
Mission,
Impossible,
local
level,
I'm
certainty
breeds
uncertainty
and,
where
I'm
able
to
include
positions,
the
entire
leadership
of
revenue
cycle
team,
that's
the
people
who
help
bill
and
bring
in
the
money
as
well
after
the
post.
They
figured
that
their
jobs
for
even
though
we
could
I
the
attention.
F
They're
gonna,
like
so
there's
real
stress
on
both
the
caregivers
and
the
rest
of
the
team
at
this
stage
in
the
monetary
cost,
is
about
twenty
million
dollars
per
month.
30
microts
delayed
most
of
that
money
is
to
do
power.
Part
of
that
money
is
for
spur
interest,
so
both
the
human
cost
and
the
ability
to
continue
to
deliver
care
and
quality
level
is
what's
threatening.
If
we're
delayed
beyond.
D
I
just
was
expressing
the
fact
that
they
acknowledged
the
fact
that
that
was
a
deadline
that
they
were
trying
to
work
to.
I.
Think
it's
important
to
realize,
though,
that
you
all
have
been
working
on
this
for
what,
over
a
year
and
the
rest
of
the
community
has
to
catch
up
and
then
that
it
has
to
take
whatever
time
it
has
to
take.
C
C
F
C
F
F
F
Several
others
with
regard
to
modular,
I,
finance
and
satellite,
and
then
there's
the
input
that
the
advisory
board,
which
is
happening
to
me,
I,
have
people
xx
original.
My
mission
would
have
to
agree
upon
on
a
majority
vote,
both
parts
so
for
people
Commission
for
people
from
each
day,
three
people
from
each
would
have
to
agree
to
make
change.
So
my
point
here.
C
C
A
lot
of
questions
that
folks
have
you
known
about
HCA
right.
You
know
you
all.
You
all
are
giving
us
the
perspective
from
missions
end
and
you
are
spending
a
lot
of
time
doing
it.
You
know
one
of
the
things
I
think
would
be
helpful
and
bless
this
before
understanding
is
the
opportunity,
perhaps
for
HCA,
to
be
able
at
some
point
to
be
either
with
us
or
with
others,
as
you
know,
as
a
way
of
kind
of
essentially
reinforcing
a
lot
of
what
you
all
are
telling
us
here
since
theoretically,
the
deal
gets
done.
C
F
That's
pausing
and
we've
talked
with
them
about
that.
We
will
talk
with
them
again
about
that.
The
interesting
piece
is
the
H
day.
Business
plan
in
the
past
has
been
the
buying
of
distraught
hospitals
of
stress
hospitals
and
when
we
talk
with
them
about
how
did
the
community,
except
when
you
came
in
before
they
said
the
community
has
left
us,
we've
never
had
a
situation
where
the
community
is
a
little
bit
strange
about
it.
So
I
think
they've
taken
some
education
and
I
think
they
would
be
happy
to
have
the
dialogue.
F
K
Do
you
all
know,
and
this
it
might
be
better
put
to
HCA
but
they're
on
here?
So
I'll
ask
you,
do
you
know
if
there
you
know
wages
for
people
like
techs
and
nurses
oops,
you
know,
maybe
it's
somewhere
on
the
lower
end
of
the
pay
scale.
Is
there
do
you
know
what
HGH
plans
are
in
those
two
pages
or
those
opposed
to
them
can
either
continue
to
make
a
wage
that
will
allow
them
to
live
or
two.
F
H
F
That
it's
J's,
which
is
in
this
and
so
forth,
location
from
a
board
perspective.
We've
not
asked
about
that.
However,
the
transition
plan
is
being
now
worked
on
by
a
CHR
people
and
how
HR
people,
but
we
don't
know
at
this
point
what
further
changes
would
be
mainly
regard
about
to
step
back
one
of
the
things
one
of
the
analytics
we
did
in
in
considering
whether
to
stay
independent
was
five
years
out.
G
Training
education,
but
HDA
has
a
lot
of
opportunities
to
be
placed
within
their
their
system
because
they
are
so
facilities,
so
we're
hoping
in
that
is
here.
But
we
certainly
understand
your
concerns,
because
we
want
to
make
sure
that
we're
down
to
all
the
employees
that
perhaps
don't
have
a
job
moving
forward
after
the
first
year
that
we
will.
J
F
Board
created
530
million
to
be
able
to
support
employees
in
the
transition
and
there's
that's
that's
available
for
employees
for
job
placement
rate
ocation
or
transfers
with
that
sort
of
thing.
In
addition,
as
Janice
points
out,
HCA
has
almost
300,000
employees
throughout
the
country
have
about
10,000
open
the
positions
at
any
time.
Many
of
those
can
be
done
from
home,
ribbon
your
site
when
swatch
entity
and
MIT
as
well.
F
So
we're
hopeful
that
you
know
our
employees
here
who
may
lose
their
positions
will
have
the
opportunity
to
I
attained
CA
will
rise
to
the
top
of
the
vested
ACA,
and
then
we
could
possibly
be
able
to
work
from
here.
So
any
any
transaction
like
this,
some
people
will
lose
their
jobs,
we're
trying
to
do
the
best.
We
can
to
minimize
that
and
to
maximize
the
chance
they
have
in
transferring
to
ACH
Ives.
J
G
Business,
you
know
they're
still,
there
still
are.
They
still
want
to
live.
High
quality
come
out
high
spec,
so
some
of
these
wages
are
market
driven
if
they
lose
their
employees.
They
are
in
the
same
situation
as
others
in
the
community
that
can't
hire
people
so
I
think
I.
Think.
From
that
perspective
there
are
their
wages.
I
can't
say
this
for
sure,
but
I
think
that
would
be
I
would.
K
K
F
L
L
F
E
F
G
B
A
It's
almost
forward,
it's
just
sort
of
how
the
business
model
works
in
terms
of
how
it
will
be
more
successful
under
HCA
the
whole
system
that
HCA
has
as
opposed
to
mission
as
a
standalone
organization.
You
know
when
we
hear
about
well,
you
know
it
has
a
lot
to
do
with
just
the
economy
of
scales,
their
organization
and
the
efficiencies
that
go
along
with
that,
and
but
you
know
when
people
think
of
it.
You
know
what
I
hear
people
ask
me
about.
This
is
like.
A
B
A
A
Are
those
efficiencies
clearly
outweighing
the
things
that,
in
some
ways
are
kind
of
advantageous
to
the
way
mission
operates
today
and
I'm
just
curious
as
part
of
the
due
diligence,
the
board
is
done
and
the
staff
have
done
kind
of
how
deep
of
a
dive
you've
taken
to
look
at
that?
Because,
obviously
that's
all
true,
then
that's
you
know
it
could
just
be
a
better
model
going
forward.
If
it's
not
true,
then
you
know,
of
course
there
would
be
this
concern
about.
A
Maybe
it
runs
for
ten
years,
but
then
it
hits
you
know,
maybe
if
that
isn't
true
in
the
drags
on
that
model,
don't
are
not
wait
by
the
efficiencies.
Maybe
it's
not
such
a
good
long-term
solution,
but
I'm
just
kind
of
curious
to
hear
any
additional
thoughts
around
how
much
of
a
detailed
dive
in
that
the
finances
of
that
has
been
taken
to
kind
of
get
comfortable
that
that's!
That
really
is
gonna
play
out.
That
way,.
F
A
couple
of
examples:
the
average
Hospital
in
the
country
average
level
my
pocket
asteroid
country
loses
about
nine
and
a
half
cents
on
the
dollar
for
every
Medicare
patient.
My
mission
a
couple
of
years
ago,
I
lost
or
were
loosing
about
six
since
I'm
about
two
years
ago,
eh
today
made
two
point:
five
citizens
and
is
breaking
even
now.
So
there's
a
ten
percent
ten
cents.
There
is
it's
a
measure
of
their
efficiency.
F
Second
example
when
I
may
have
recalled
a
couple
years
ago,
we
made
an
arrangement
with
GE
for
innovation
here
at
the
hospital
part
of
20.
Money
from
them
is
to
be
able
to
buy
from
them
and
a
cheaper
rate,
and
we
suggested
that
they
give
us
the
cheapest
rate
that
they
give
any
other,
and
they
said
not
a
chance.
Each
CAA
has
that
one
so
so
that
two
examples
that
they
buy
the
concept
they
can
buy
volume.
F
One
of
the
things
that
they
do
is.
As
you
know,
drug
prices
are
spiking
up
and
down
and
up
in
America
they
can
buy
volume
at
the
lowest
level,
that's
available
on
the
spot
market
and
store
that
so
that
they
don't
have
to
pay
the
kind
of
cost
that
we
have
to
pay
on
drugs,
so
supply
chain
is
that
it's
the
main
place,
but
also
then
IT
and
revenue
cycle.
F
What
HD
can
do
in
four
regional
centers
is
almost
covers
all
of
their
revenue
cycle.
Things
for
we
have
to
have
a
lot
of
people
be
able
to.
It
could
never
get
to
the
kind
of
stay
with
the
head,
so
the
board
need
to
deep
dive
and
in
the
three
areas
where
we
know
that
they
can
save
money,
which
is
revenue,
cycle,
I'd,
say
in
HR.
In
addition,
we
looked
at
their
clinical
stepping
patterns
and
how
they
went
about
that.
F
Their
staffing
patterns
are
in
some
cases
better
than
ours,
in
all
cases,
the
same
as
ours.
As
far
as
numbers
of
nurses
per
case
per
unit-
and
so
you
know,
we
looked
at
they're,
not
cutting
in
the
clinical
side,
which
is
what
matters
to
patients
and
which
matters
to
us,
they're
cutting
in
the
places
where
they
can
be
more
efficient.
F
B
Thanks,
first
of
all,
I
think
I
need
to
give
full
disclosure
here,
because
I
have
several
good
friends
in
the
AG's
office
and
one
reached
out
to
me
yesterday
and
I
talked
come
for
about
an
hour
and
I'm
gonna
share
with
you.
The
concerns
I
shared
with
him
and
I
have
two
one
is
from
what
I
read
on
HD
a
1i.
It
was
obvious
to
me,
and
you
pointed
that
out
that
they
have
built
franchise,
a
lot
on
failed
hospitals.
You
know
they've
gone
in
and
they've
rescued.
The
other
is
that
we
are
the
first.
G
B
B
Care
of
I
want
to
see
them
represent
and
from
what
I
see
at
the
board
the
board
of
the
foundation
when
I
work
at
diversity
and
just
geographically
I,
don't
feel
that
the
eighty
County
area
is
being
represented.
The
way
it
should
be
if
we
are
going
to
take
care
of
all
the
people
in
these
areas,
sure
welcome
town
and
Asheville
will
be
fine.
But
what
about
the
outlying
areas.
G
B
G
G
Crisis
representatives,
housing
representatives,
food
insecurity
represented,
so
we
will
have
those
people
at
the
table
and
we
certainly
you
know.
The
thing
that
we
had
to
do
starting
up
was
a
lot
of
our
work,
going
forward
as
government
governments
and
just
setting
up
the
foundation,
and
we
needed
some
people
who
had
that
expertise
and
a
lot
of
these
people
that
are
on
the
board
have
a
regional
have
regional
connections.
They
know
people
have
in
the
region
and
that
their
territories
to
reach
out
in
the
regions.
G
We
feel
like
we're
getting
a
good
representation,
and
if
you
could
meet
with
some
of
those
board
members
you
would
find
their
passion
is
its
intact
and
it's
truly
addressed
exactly
what
you're
talking.
So
you
know,
we
hope
to
show
you
more
with
you
our
order,
selection
and
the
next.
Probably
two
previous.
G
F
E
You
so
we
are
working
with
HC,
I
am
coordinating
schedules
and
calendars
and
some
other
things
we
do.
As
you
know,
we
do
some
legislative
roundtables.
Every
quarter
they'll
be
joining
us
for
our
next
legislative
roundtable
and
we're
working
with
dates
now.
So,
yes,
it
will
be
with
us
the
end
of
November,
beginning
of
December
in
some
cases,
because
we
have
so
many
that
we
do
at
one
time
and
as
you
can
imagine-
and
you
may
not
know
this,
but
they've
just
been
through
two
tremendous
hurricanes
within
their
system.
E
E
They
just
went
through
to
the
one
in
South
Carolina
and
the
one
that
they
they
just
went
through
in
the
Panhandle,
where
they
have
hospitals
significantly
impact
wards
significantly.
So
so
what
happens?
When
the
happens?
They
are
incredibly
great
at
that
work.
Basically,
the
gentleman
that
runs
our
division
will
oversee.
E
This
transaction
has
been
on-site
in
those
places,
moving
people
out
of
hospitals,
moving
them
to
six
locations,
so
they've
been
really
focused
on
that,
which
meant
we
had
to
move
a
couple
of
these
meetings
out
further
than
we
don't,
but
I
hear
you,
we
hear
you
they
hear
you
I
have
brought
this
back
as
as
dr.
Paulus,
as
has
the
board
chair
saying.
We
need
to
get
you
in
and
clearly
to
get
them
in
before
the
clock
isn't
gonna
started
ticking.
E
F
Sighing
I'm
a
can,
did
you
see
yeah?
Yes,
we
could've
waited
and
if
we
waited
we
lost,
we
lost
two
really
major
things.
One
is
we
have
lost
the
foundation.
Is
we
wouldn't
have
gotten
the
kind
of
purchase
price
we
getting
now
if
we'd
waited
tyler's
we're
great?
In
that
the
other
pieces,
we
would
have
no
negotiating
capability
to
get
the
kind
of
guarantees
both
permission
and
for
the
regional
hospitals
that
we
have
now.
J
Feel
much
better
if
they
have
more
of
a
concept
of
idea
what
this
was
going
to
be
like
when
you,
google,
HCA
layoffs
when
you
go,
google,
the
CEO
makes
312
times
more
than
the
median
employee
in
2017,
where
the
median
average
wage
is
$55,000
a
year.
Those
are
all
things
without
meeting
face
to
face,
and
you
know,
as
Alice
said
this
thing
going
on
a
really
long
time
and
to
be
a
good
neighbor
to
be
someone
you
know
so
welcome.
J
So
the
longer
it
goes
on,
people
that
work
at
the
hospital
are
getting
more
and
more
nervous,
they're,
aware
of
different
structures
and
I
I
think
had
someone
come
to
reassure
them,
but
maybe
they
don't
want
to
reach
there,
then
maybe
you
know
if,
if
you
all
have
all
set
up
a
contingency
plan
to
help
displaced
workers
that
just
all
needs
to
the
fear,
so
you
know
I
think
initially.
We
had
good
thoughts
about
all
this
because
the
longer
it
dragged
on
without
ever
you
know,
BJ
has
certainly
asked
many
times.
J
G
L
E
Leaders
from
HCA
have
been
in
the
hospital,
hundreds
of
them,
hundreds
of
them
meeting
with
staff
they're
taking
back
ideas.
They
have
said
many
times,
Wow
in
any
particular
division.
We
might
talk
about
wow,
you
guys
are
doing
some
great
work,
we'd
like
to
take
that
back
to
e
to
the
HT
a
family,
so
they
have
been
in
the
hospital
in
all
of
our
hospitals
and
looking
at
the
facilities
and
talking
to
our
team
leaders
and
discussing
hey.
How
do
you
do
it,
and
so
it
has
not
been
you're,
not
seeing
it.
E
D
One
of
the
really
remarkable
things
I
think
about
mission
and
they're
in
their
system
has
been
the
leadership
they've
demonstrated
with
respect
to
our
safety.
The
collaboration
with
may
have
and
live
on,
and
then
we
have
others
in
that
I'm,
not
quite
sure
about
the
FQHCs
and
CCW
NCE
and
of
course,
by
up
and
I
know.
D
F
I'll,
take
the
residency
part
and
part
of
they
had
quite
an
innocent
routine.
Continue
our
mission
just
saying
they.
When
you
own
kind
of
tracked
with
me
a
or
five
years,
normally,
we've
been
on
a
three-year
rolling,
that's
fine
good
things,
so
that's
set
and
the
contract
blue
is
overtaken
c8.
They
must
be
think
it's
awfully
important.
Second
of
all,
I
see
a
you
because
of
the
number
of
hospitals
has
had
better
teaching
hospitals
actually
trained
as
more
residents
than
any
other
system
in
the
country
and
part
of
the
part
of
a
a
pas.
G
I
will
talk
about
you're,
talking
about
safety,
net
organizations
and
and
community
and
missions
community
benefits
program.
So
you
know,
mission
is,
is
very
generous
with
those
programs,
and
there
is
some.
There
are
some
your
entities
that
going
forward
in
the
2020
nineteen
that
that
will
continue
funding
some
of
those
safety
net
organizations.
At
that
point,
at
the
point
that
we
go
out
in
terms
of
the
same
session,
it's
one
of
the
first
things
we
will
do
is
we
will
work
with
policy
organizations
that
have
been
in.
G
They
should
support,
particularly
those
organizations
that
are
not-for-profit,
that
have
been
doing
critical
work
couple.
So
we
intend
developing
partnerships
and
open
health
trust
to
to
ensure
that
you
know
that
their
funding
is
not
Dennis
negative,
and
so
that's
you
know,
that's
a
big
part
of
our
listening
sessions
that
we're
going
to
be
having
we
have
yell.
So
we
have
a
list
of
those
partners.
We
will
continue
to.
G
Think
about
about
the
mm
trust
is
what
we
want
to
do.
Is
we
want
to
intervene
before
they
ever
need?
That
said,
we
want
to
create
opportunities
for
people
to
be
well
and
to
to
live
up
to
their
potential
and
less
from
China,
so,
whether
that
be
food,
insecurity
or
opioid
crisis
or
or
housing
or
transportation.
All
of
those
things
that
that
prevent
people
could
mean
well
in
the
first
place,
we're
gonna
we're
gonna,
try
to
to
create
a
safety
net
for
them
prior
to
them,
making
resources.
H
Just
just
a
couple
of
things,
one
is
I
have
been
fortunate
to
be
able
to
come
to
a
few
meetings
in
the
baby
bath
and
mr.
sailfin
it
was
the
last
one
was
extremely
helpful.
We
had
some
confusion
among
the
commissioners
and
and
I
was
able
to
get
I
know.
Mr.
Whiteside
was
was
time
that
he
was
translated.
H
To
me,
from
I
explained,
as
chairman
was
talking
about
the
efficiencies
that
HCA
wins.
A
lot
of
detail
and
I
was
I
was
for
one
very,
very
excited
about
the
possibility
of
and
being
able
to
deliver,
affordable
or
affordable
healthcare.
In
the
mission
that
mission
health
has
been
in
trying
to
do
and
doing
well
for
years,
I
have
been
part
of
a
major
acquisition
when
I
was
with
and
I'm
very
briefly
saved
when
I
was
with
Clayton
Homes
Berkshire
Hathaway
bought
us
out,
I've
been
with
the
company
for
25
years.
H
And
but
we
were
in
a
market
that
was
against
manufactured
housing
from
lending
standpoint,
we
were
doing
very
well
as
a
lender,
but
everybody
else
was
terrible.
The
stock
market
was
brutal,
we're
having
to
react
and
make
determinations
based
on
all
those
external
clients.
What
happened
was
when
our
Trethewey
coming
in
bought
the
company,
all
the
fears
we
had
never
came
to
fresh
because
of
the
efficiencies,
because
it
took
us
out
of
all
the
political
mass
out
of
the
mess
within
the
high
the
stock
market.
H
So
many
decisions
ever
based
on
external,
that's,
so
the
information
I
receive
about
HCA
about
their
efficiencies.
I've
received
it
very
possible
to
me
the
guarantees
you're
making
for
team
members
is
proactive.
It's
not,
though
I
think
it
comes
from
a
genuine
concern
and
from
from
a
very
good,
you
know
personal
position
that
we
definitely
should
be
concerned
about
the
wages
we
should
be
concerned
about.
You
know
those
are
people
having
a
job
I,
don't
think
you're
you're
not
concerned
about
that
I.
Think
you're,
taking
proactive
steps
to
make
sure
that
that
is
done.
B
H
H
I
H
E
H
Necessarily
interested
in
being
one
of
those
as
slow
as
a
thing
I
think
there
are
things
within
the
system
that
will
do
that
because
it
has
to
pesco
through
the
AG.
Has
these
but
I
do
hear
some
concerns
on
the
community,
but
also
here
a
tremendous
amount.
A
lot
of
excitement
from
people
that's
going
to
be
able
to
I
mean
my
understanding,
I'm,
trying
to
think
of
a
variance.
Tell
me
a
very
expensive
piece
of
equipment
that
you
have
to
buy
laser
night.
I,
don't
know
what
that's
called
bury
it
over
Amish
anymore.
H
Amish
are
not
okay.
My
understanding
is.
If
mission
pays
this
this
amount
here,
they
see
a
tape
somewhere
down
here.
I
mean
just
an
incredible
difference
in
that
and
to
me:
that's
where
the
savings
comes
from,
not
necessarily
not
from
the
I
think
we
should
be
concerned
about
the
wages,
but
they
would
be.
They
would
be
foolish
foolish
as
a
corporation
to
come
in
and
cut
people's
pay
because
that
that
goes
through.
That
goes
through
the
system
like
wildfire
and
you
you
lose
quality
people
and
you
never
get
into
that
position.
H
If
they're,
if
they're
very
good
at
all
than
that,
would
be
from
a
leadership
standpoint,
bullish
on
their
part
but
should
be
verified
as
people
talk
about
its
concern.
When
you
do
that
message
out
there,
but
I
was
just
blown
away
by
the
information
I
received
about
the
efficiencies
about
how
they
were
able
to
actually
make
money
on
Medicare
and
Medicaid,
and
that
that
translates
into.
I
K
E
K
Investments
that
they
make,
but
that
I
agree
with
Joe
I
think
there's
a
there's
a
enormous
opportunity
here
that
help
this
community
make
incredible
gains
and,
frankly,
I
think
you're
gonna
have
a
hard
time
moving
away
50
to
75
million
dollars
a
year
is
the
mission
you
know
they're
just
so.
You
know
there
are
opportunities.
We
are
ripe
and
ready.
We.
G
Know
that
first
we'll
have
perhaps
we'll
have
a
little.
You
know
a
little
problem.
Getting
you
know,
dispersed
same
amount
of
money,
but
but
we
have
the
whole
purpose
is
to
do
it
well
to
do
it
with
accountability
and
to
and
to
get
results
that
we
want.
So
we
would
err
on
the
side
of
caution
rather
than
just
throwing
money
out
into
the
community
willy-nilly,
and
so
the
other
thing
is,
it
has
to
cover
the
18
counties
so.
G
That
50
to
75
million
cannot
go
all
the
way.
You
know
all
good
about
the
county,
but
we
know
that
you
know
we
are
the
center
of
the
population
mass
and
we
perhaps
might
have
more.
You
know
more
need
and
in
our
community,
but
we
need
to
have
those
sessions
they
are
being
there
being
scheduled
and,
as
we
speak,
I
will
tell
you.
Our
first
session
is
up
an
excuse
time
and
virtual
area.
We
have
had
some,
you
know,
pushback
from
the
search
group
and
we
want
to
maybe
alleviate
some
of
their
concerns.
G
B
You
know
what
I
think
the
big
hurdle
here.
The
permission
is
your
success.
You
know
we're
use
the
quality
healthcare
heck
I
wouldn't
be
here
today
if
it
was
a
permission,
but
all
of
us
were
used
to
that
and
that's
where
it
becomes
uncomfortable.
You
know
we
said
wait.
What
are
you
doing
to
us?
You
know
you
know
you
get
and
that's
where
I
think
the
people
need
to
feel
comfortable.
You
know
with
them.
We
need
to
get
fat
across
too,
because
that's
I
think
that's
it.
You
know.
Sometimes
you
success.
B
F
One
thing
that
gives
us
optimism
is
that,
as
I
finish,
that
said,
it
says
business
plan
is
to
the
rescue
to
distress
hospitals.
This
is
the
first
time
that
they've
gone
for
a
system
that
is
really
successful,
I
really
kind
of
thought.
Why
did
we
do
that
couple
reasons?
What
is
the
geographic
ruse
if
they
have
no
hospitals
in
North
Carolina
among
all
of
us
out
east
and
that's
where
they're
all
things,
so
they
would
like
to
expand
any
of
your
life.
F
The
second
and
more
important
piece
is,
with
the
coming
sense,
that
there
will
be
pain,
solid
ation
across
the
country
in
the
health
system
over
the
last
10
to
20
years,
perhaps
leading
to
only
10
to
15
systems,
they've
taken
the
first
leap
of
buying
a
successful
system,
and
that
gives
them
a
platform
in
the
market
that
is,
unlike
any
other
for-profit
platform
and
market.
They
can't
blow
this
one
and
keep
that
platform,
so
they
that's
something
that
really
gives
us
optimism,
and
there
has
been
perspective
of.
H
I
think
the
other
thing
too
last
thing
that
they're
gonna
want
to
do
in
the
market.
Yes,
three
from
singer
three
and
a
half
percent
employment,
because
it
spend
time
trying
to
prove
anybody.
I
mean
the
biggest
biggest
deterrent
that
we
have
right
now
to
worry
about
whether
you
know
I
mean
you're,
always
I
would
say.
We
always
worry
about
some
top
level
positions.
They
get
moved
around
shuffle,
but
they
probably
get
all
first
within
that
HCO
system,
but
on
the
levels
where
we
really
have
heartburn,
which
is
entry-level
positions.
H
I
I
Kapoor
mentioned
some
of
the
concerns
about
language
and
the
ability
to
make
changes
to
the
APA
as
far
as
what
hospitals
might
close
down
the
road
within
a
ten-year
period.
What
leverage
with
the
trust
have,
since
you
mentioned
you're,
going
to
be
the
gatekeeper
or
to
make
sure
there
is
enforcement.
G
Physicians,
that
offer
services
somehow
let
the
community,
so
we
didn't
have
the
ability
the
Health
Trust
can
take
them
to
arbitration.
We
can
sue
them,
we
can.
We
can.
We
can,
even
you
know,
buy
back
some
of
the
services
and
and-
and
you
know,
operate
them
through
the
trust
do
funding
through
the
just.
So
there
are
a
number
of
interaction
things
that
we
will
be
able
to
do
that.
E
I
G
G
Kind
of
information,
okay,
I-
think
that
that's
the
better,
the
virtuous
or
virtuous
path,
but
we
don't
anticipate,
they
don't
have
any
reason
to
do
you
think
that
would
be
detrimental
to
their
moral
system
or
to
our
to
our
local.
You
know
with
our
new
tower
and
all
of
that
that
you
know
they
are.
They
are
good
at
operating
their
good
health
care
providers,
and
so
they
have
sometimes
some
qualities
that
that
mirror
missions
as
far
as
their
health
care
delivery.
So
I
am
you
know
we
will
have.
G
G
Well,
well
believe
it
or
not
there.
Their
main
concern
was
women.
They
said
you
know.
50%
of
us
are
women
and
their
main
that
their
their
main
concern
was
that
we
had
not
representatives
women
on
the
board.
Well,
because
there
are
two
ins
and
then
seven
minutes,
so
we're
going
to
be
looking
for
women
to
reveal
that,
but
we
are
going
to
make
them
we're
going
to
have
a
very
honest
conversation
for
what
they
say
so
I
think
that's
next
week.
G
A
A
And
dogwood
tries
to
set
up
you
know.
Obviously
the
investments
it'll
be
able
to
make
is
one
of
the
big.
You
know
big
benefits
of
this,
the
property
tax
benefits
of
local
government
and,
of
course,
significant,
can
we're
going
to
be
investing
those
in
just
some
of
the
same
types
of
things
that
I
think
we
want
to?
We
haven't
made
any
decisions
about
what
to
do
with
that
cuz.
It
hasn't
happened,
yet
we
don't
want
to
get
ahead
of
that,
but
I
think
we
wanna.