Paulus: With respect to some of the recent property acquisitions and so forth, with the one on Hendersonville Road in particular, a hundred times out of hundred if it’s cheaper for me to buy a building over the long run than it is to lease it or build, I’m going to buy it 10 times out of 10. We’re at a point right now with real estate where prices are down. ...

Paulus: Relative to the campus, you’re probably going to see more (building) because I’m going to the board with a campus consolidation plan. We are stuck with a bunch of old, outdated, inefficient physical (buildings). Operating two separate campuses is a major challenge. It requires us to keep ambulances idling 24/7 to transport patients across the street; it requires us to maintain separate roofs, separate water supplies. ...

C-T: How much money does Mission have in the bank?

Paulus: Depending upon the vagaries of the market, it’s been right around $550 million. ...

For Dr. Nathan Williams, the reality of Mission Health’s economic muscle hit home during the spring of 2009.

In a study of rates, the hospital had determined his practice and 14 other physician groups were charging too much. He could either agree to new terms, or lose Mission employees — effective in 60 days.

“They did not invite us to talk with them, they did not bother asking us what we thought,” Williams said. ...

Mission CEO Ron Paulus says he understands the fears before and after the merger [with St. Joseph's Hospital] that made his company the largest employer in Western North Carolina ...

Since 1996, a year after the COPA [the agreement restricting Mission after it merged with St. Joseph's] went into effect, Mission has entered into major affiliations with 11 health care organizations. It also has launched Mission Medical Associates, a subsidiary operation that now directly employs 159 physicians.

The first economist to take a look at Mission’s business model was Gregory Vistnes, a vice president at Charles River Associates in Washington, D.C. He has served in senior positions in the Antitrust Division of the U.S. Department of Justice and the Federal Trade Commission’s Bureau of Economics. ...

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