For a hospital system organized as a not-for-profit charity, Mission Health made a lot of profits. The money left over after Asheville-based Mission subtracted its expenses from its revenue — what would be called profit at a for-profit hospital — grew year after year, right up to 2018, when Mission’s directors surprised nearly everyone by announcing plans to sell out to Tennessee-based HCA Healthcare, the nation’s biggest chain of for-profit hospitals. Mission at the time was as strong financially as it had ever been, which Mission’s executives said made it the perfect time to sell. They cited trends and studies suggesting that the Mission system faced a bleak future of relentless cost-cutting. The cost-cutting apparently didn’t include the paychecks of Mission executives, which grew for years untouched by the financial scalpel.
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