Ardent Health purchases Boone Health; CEO claims deal will help hospital avoid layoffs, invest in future
COLUMBIA, Mo. (KMIZ)
A publicly traded healthcare company is buying Boone Health, Boone’s CEO said Thursday.
Brady Dubois said during a news conference at Boone Hospital that Tennessee-based Ardent Health is buying the hospital.
The news conference came after the Boone County Commission approved the sale of Boone Health on Thursday after comment that lasted an hour and a half and included public comment questioning the transparency of the process.
The commission voted 3-0 to approve the sale.
Ardent stated in a news release the deal included a $47 million cash purchase price. The company’s stock has seen a steady increase this year, with a larger jump in the past two weeks.
A private equity company, Equity Group Investments, owns a 54% stake in Ardent.
Ardent Chief Medical Officer FJ Campbell said the company wants to build on the work Boone Health has already done rather than overhaul its clinical operations.
“Boone is an exceptional community, an exceptional healthcare system. And I want that to continue. Period. There is so much that Boone has accomplished clinically. I’m not looking to change that,” Campbell said.
Campbell also addressed concerns about Ardent’s ownership structure. Equity Group Investments owns a 54% stake in the company, raising questions about whether private investment could lead to a greater focus on profits than patient care.
But Campbell shot down those concerns, claiming that it is difficult to prioritize profits in healthcare.
“I’ve never found a way to do that successfully. If you aren’t able to effectively take care of your patients, you’re going to have more complications. You’re going to lose their trust and you’ll lose their business. The most effective way to have a successful and profitable hospital is to have successful clinical care. There’s no other way,” Campbell said.
Ardent has committed to invest $200 million in capital improvements over 10 years and to keep Boone Health workers on the payroll. The investment is expected to help upgrade the hospital’s facilities, equipment and technology while providing resources for future growth and expanded patient care. The purchase is expected to be finalized in the spring.
The sale includes the land and buildings that make up the hospital. Boone Health will keep its name under the agreement, and Ardent says it plans to retain current employees.
Campbell added that access to additional resources and capital from private investors is a benefit of the arrangement.
“We’re looking to do more, and that means we’re not looking to shed staff. We’re not looking to reduce services. And the way in which Boone was paid in the past isn’t going to change like the same experience with reimbursement doesn’t change because you work for a private equity company. The benefit in some ways, I work for a private equity company. We have access to more resources and capital,” Campbell said.
Boone Health has been operating for 105 years. Dubois said hospital leadership recognized it needed a partner to continue growing as health care costs and other financial pressures made it increasingly difficult to operate independently.
Mary Beck, chair of Boone Health’s Board of Directors, said the hospital worked with a consulting firm to identify potential health system partners. The process began about a year and a half ago, with 17 health systems initially considered before the board narrowed the field. Ardent joined the process during the last six months.
“We did have some very solid things that we wanted, and one of the top ones was about quality and compassion and a fit for our employees and the culture that we have here at Boone,” Beck said.
Boone Health officals say that the financial pressures facing hospitals that continued to mount throughout the process were a driving factor in the deal. Dubois pointed to insurance companies denying claims and later reclaiming payments for care that had already been provided, along with changes to Medicaid and Affordable Care Act coverage.
“When you look at the different challenges, especially with managed Medicare, you start looking at denials, you start looking at clawbacks. So we provide care to patients, we get paid for that care. And then the insurance companies six months later pull the money back. There’s so many different challenges,” Dubois said. “That was at the beginning of the process. Since then, it’s only gotten more challenging from a headwind perspective with cuts and Medicaid loss of deductibles, or assistance with the ACA plans and people going bare on insurance that used to have insurance, but they still need care.”
Beck also pointed to the impact of the One Big Beautiful Bill Act, which is expected to change healthcare coverage and reimbursement.
“The Big Beautiful Bill has really impacted so many people that can’t afford health care and or delay care,” Beck said. “What this is going to do is really allow that infusion of support financially.”
Boone County commissioners noted that the outcome without the sale would likely be the hospital going out of business, which would have other implications for quality of care.
“If we have one hospital system in this county, all of us are going to suffer,” Northern District Commissioner Janet Thompson told a citizen during public comment.
Dubois said the hospital also faced difficult decisions if it had not reached an agreement with Ardent, with potential layoffs on the horizon.
“Would it have happened next week? No. Would it have happened? Yeah, we would have had to streamline and restructure. We had restructured debt. We’d had to restructure service lines. We’d had to restructure a lot of things. And when you use the term restructure, it would have been bad,” Dubois said.
Dubois told commissioners that Ardent will keep Boone’s charity care policy.
Hospital leadership and a representative with Juniper Advisory, which helped the health system’s Board of Trustees find the buyer, said costs were increasing and reimbursement is expected to decrease when the One Big Beautiful Bill Act comes into effect next year.
Presiding Commissioner Kip Kendrick said a “no” vote by the commission would kill the deal and likely be “devastating.”
According to the commission documents, Boone Health’s Board of Trustees determined that it was not “financially feasible” for the hospital operations to continue operating as an independent organization.
Under the new agreement, Ardent will have final authority over how the hospital is run, and Boone Health’s publicly elected Board of Trustees will be dissolved. The hospital’s existing Board of Directors will have input, along with a community advisory board Ardent typically establishes at hospitals it acquires. That advisory board provides community input on issues such as quality of care and improvements, but final decisions will rest with Ardent.
Residents took to the mic during the public hearing section of the commission meetings to voice their concerns about the lack of input the public was given throughout the process.
“The process was done in private. Nobody had anything, any input. There were no public meetings about it,” Boone County resident Roy Hartley said.
Another resident Dave Raithel said the public was not allotted enough information or time to understand the sale.
“Give the public a reasonable amount of time to absorb the terms of the agreement,” Raithel said. “You might find people sympathetic, but as it is now, no one wants to touch it because we don’t like how it’s been brought out.”
The commission acknowledged the residents’ concerns and said the decision they had to make about the current situation of Boone Health was not made by the commission. Their decision came down to what the future of the hospital would be.
“It scares me, on the other side of this of this balance, to think that Boone Hospital won’t be here,” Northern District Commissioner Janet Thompson said.
Southern District Commissioner Justin Aldred brought up the future of the 2,300 staff members employed by Boone Hospital, saying the commission has to also take into account the staff and their families’ futures.
Dubois said during the meeting that Boone Health staff who are in good standing will have the option to stay and keep their pay rate if the partnership moves forward.
The deal also has potential implications for health care outside of Columbia. In October 2024, the Audrain County Commission, County Health Department and Boone Health signed a letter of intent to begin building a Medicare-certified critical access hospital in Mexico after a string of owners failed to deliver on promises to reopen the hospital.
Dubois said Ardent has experience with rural health care and could help Boone Health pursue plans it previously struggled to execute.
“They have a tremendous track record in rural health care. They’re experts in that area, and that’s what they’re looking to do here with us is to help us grow and compound what we’ve already started,” Dubois told ABC 17 News. “We’ve had a lot of plans, but we haven’t been able to execute.”
When asked about the future of the proposed Mexico hospital, Dubois said the possibility remains open.
“I think there’s always potential,” Dubois said. “It’s an attractive market. We just got to continue to work through a lot of processes there.”
Campbell said Ardent is evaluating other opportunities in Missouri, but cautioned against making promises about specific projects.
“What I want people to appreciate is that there are going to be multiple opportunities for growing in this state. We are looking at a number of them actively and carefully. What I don’t want to do is overpromise and underdeliver. We did not come to Missouri to have one hospital. We will want more. We will get more,” Campbell said.
Campbell also welcomed the public scrutiny surrounding the sale, saying community feedback can help the hospital moving forward.
“I want them speaking up. Those people will help us. I applaud those individuals who spoke up today,” Campbell said.
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