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HCM Becoming Part of Methodist FAQs

Informational Forum Questions & Answers

Thank you for your interest in Hill Country Memorial (HCM) and the Informational Forum held by HCM in collaboration with the City of Fredericksburg on Monday, February 27, 2023. View the full recording of the Informational Forum.

Below you will find a list of questions from the Forum organized by category. We have included questions that were not asked during the Forum due to time limitations. There were some instances where there were multiple submissions of similar questions so we have combined those questions.

Process and Decision

Conflicts of Interest

If a Board member had a connection to HCA Healthcare, could these members have been influenced in any way or shared their opinions? If nothing else, can you see how this could seem like a conflict of interest to the community?

If a Board member had a connection to HCA Healthcare, how was that addressed during this process?

Do any of the HCM board members have any business relationships or affiliations with HCA Healthcare? Did any board members have a conflict of interest regarding HCA healthcare? Did any board members recuse themselves during the voting process to sell the hospital?

All HCM Board Members and Leaders are required to complete a Conflict of Interest disclosure every year. These disclosures are documented and reviewed annually by the HCM Governance Committee and further by the full Board of Trustees. Additionally, independent third party advisors including legal counsel review conflicts. If a conflict arises, a remedy to the conflict is implemented.

Proceeds Legacy Entity and the Foundation

Who gets the money from the sale? Where does the foundation money go? Who is the recipient of the purchase money? What will it be used for? Will the foundation be distributing funds to local non-medical organizations? How will that be initiated, if at all?

The proceeds from the transaction will be placed in a legacy entity and remain in the Hill Country community to ensure a strong investment in local health for generations to come.

Funds currently in the care of the Foundation will remain in the community and be invested into the community. A Conversion Committee has been formed with representation from the HCM Board and Foundation Board to determine an appropriate path forward for the legacy entity and the Foundation and how to address the needs of the community. We look forward to sharing more information about those activities soon.

Once the strategic plan and funding priorities for the new legacy entity and Foundation are determined and the process for grant applications is developed, the resulting, finalized information will be shared.

Who specifically is making decisions on behalf of the surviving entity employees, and why? Are HCM executives, or board members, securing positions for themselves in the new legacy organization? Conflict of interest?

The current HCM Board and leadership team have the responsibility and accountability for making decisions related to both Hill Country Memorial and the Legacy Entity.

Why are “surviving” entity employees with families seeing a reduction in benefits?

Team Members of the Legacy Entity have been provided with a generous benefits package that is different from the benefits package they received as HCM Team Members. With a smaller staff size, benefits had to change to more appropriately match the needs of the newly formed organization. The benefits package includes more insurance options than team member have enjoyed in the past and a different, more consistent time off policy for all team members.

Why did the Foundation continue to solicit donations while the hospital was pursuing a sale? How will those donations be returned to the donors?

HCM has continued to serve its patients throughout the process to evaluate acquisition and the selection of Methodist. Philanthropic gifts have been critical to that service and have been utilized to build and support patient care at Hill Country Memorial and have continued to improve the lives and care of patients in the Hill Country. Since the announcement by HCM to become part of Methodist, there have been no solicitations of new gifts to support Hill Country Memorial, except the Wellness Center and Thrift Store, because all entities except the Wellness Center and Thrift Store will no longer be non-profit and will no longer receive charitable donations. The Foundation is actively working with donors regarding gifts that were made after HCM’s announcement to join Methodist.


How much will leadership gain in compensation now and in the future from the sale? What personal benefit does the current CEO and leadership team stand to gain by the proposed merger? Are HCM executives receiving a severance as a result of this transaction?

Personal financial gain was not a determining factor in any decision related to this transaction. Although we have no reason to believe executives will not be offered positions, if an executive is not offered a position by Methodist they, like every employee at HCM, will be eligible for severance. Such severances are common in the healthcare industry and the Board retained a national compensation consulting firm to advise on severances prior to the agreement with Methodist.

Did the management group take bonuses in an economic down turn and is there a bonus involved to the management for completion of this sale?

The HCM senior leadership team compensation including bonuses is determined by a national compensation firm and comparative analysis. If bonuses were warranted based on leader performance, bonuses were administered in accordance with HCM compensation policy. The executive team was not incented to sell HCM.

Who is on the future Methodist advisory board? How were they selected? Who actually chose the 4 HCM members?

The Advisory Board will include four members selected by the current HCM Board, four members selected by Methodist in collaboration with HCM, and the current Chief of Staff. Currently four members of the Advisory Board have been named: Dale Crenwelge, Dr. Michael, Johnson, Penny McBride, and John Willome. The current HCM Board selected the four HCM-appointed members of the Advisory Board.

Will the current board be willing to resign and allow the City Council and County to name a new trustee board moving forward?

HCM has a process for naming a self-perpetuating board that has existed since the very beginning. The board has the authority to act on behalf of and the accountability to be responsible for HCM. It would be inappropriate for entities with no understanding of the current healthcare environment to make broad decisions about the governance going forward. Further, the HCM board is non-political.

HCM Physicians and Team Members

Are Medical Group physicians being paid significantly less with Methodist than they currently are being paid? How will offering our hospital employed doctors and other healthcare professionals less money than they are currently making improve the scope and depth of services currently rendered? Who will fill these positions then these valuable healthcare workers leave?

We negotiated this agreement with the best interests of our team members, physicians, and our community in mind, and that includes ensuring rewarding career opportunities. We are proud to share that all team members at Hill Country Memorial were given employment offers by Methodist Healthcare, and all physicians were extended offers to continue practicing at our hospital under our new ownership, pending successful onboarding. We are not at liberty to discuss the details of compensation. We can say that the calculation for compensation may be different but the net to the physician is the same.

How will the decision to go with Methodist impact the current HCM workforce, including the Executive Team and the leadership of the current CEO?

Methodist Hospital Hill Country leadership is being determined at this time. When decisions are finalized we will update the answer to this question.

Will you please give us insight into what HCM has done to fix the nursing shortage here and how will the sale to Methodist impact this shortage?

Hill Country Memorial has actively engaged with Hill Country University Center and Central Texas College to address local nursing challenges. Additionally, we have partnered with several nursing schools in San Antonio and the Hill Country. As part of Methodist, we will have expanded access to recruiters and the affiliation with the Galen School of Nursing will strengthen our pipeline of nurses. We will also have access to more clinical sites for nursing students as part of the Methodist system.

How many hospital personnel were told they had to be here tonight?

Other than the four team members who were working to assist the University Center staff in coordinating the event, zero team members were told to be at the Informational Forum. Conversely, they attended the Forum because they are interested community members who wanted to attend.

What percentage of our hospital employees (including business administration personnel) are going to involuntarily lose their job to the sale? Was this factored into the decision to sell? What does Methodist plan to do with current employees?

We are proud to share that all team members at Hill Country Memorial were given employment offers by Methodist Healthcare, and all physicians were extended offers to continue practicing at our hospital under our new ownership, pending successful onboarding. Executive team members are typically excluded from guaranteed employment in a merger/acquisition. The wellbeing of our existing team was a high priority in the Board’s evaluation process. The HCM team performance was evaluated and considered to be remarkable. Methodist wanted to ensure the remarkable care Hill Country residents had come to know and expect could continue uninterrupted.

Have Board Members had a chance to talk to/interact with any hospital employees other than the top administrators to get a feel of employee morale?

As members of the Hill Country community, board members regularly have interactions with members of the HCM Team.

Once you decided to sell the hospital, why did HCM administration continue to hire non-essential staff including physicians to provide care to underserved communities through the self-proclaimed financially sound rural hospital system? How many physicians did you hire, not to mention other staff who hoped and planned to work for a community hospital…after you had decided to sell?

We had an accountability to the community that we continue to grow and replace key clinical positions, including physicians. The services that we expanded during this time were in response to the needs of the community and a continued investment in growth opportunities.

Every HCM team member and physician is essential and they are the foundation of what makes HCM what it is. It was critical that we ensure high quality care continued uninterrupted throughout the process to evaluate acquisition and then in the selection of Methodist. Our commitment to quality throughout has been unwavering. HCM is proud to have added 8 new physicians to our Medical Group since 2020 and many team members who are dedicated to delivering remarkable care.

How much of a part do you consider the deterioration of the culture plays in the difficulty in attracting and retaining a strong HCM workforce? If we are having financial troubles (as we have had before) how much of this can be fixed by bringing our remarkable culture and service back? What do you think would be the best way to bring “remarkable” back? Will the sale of Hill Country Memorial to a large for-profit change what makes our hospital special?

HCM uses Gallup, a global analytics firm, to measure and benchmark team member engagement. With more than 80 years of experience, Gallup serves 90% of Fortune 500 companies and has 35 million respondents in their database. HCM’s percent engaged team members is world class by Gallup standards.

Methodist is proud of the HCM culture and it is one of the many things they are committed to retaining as we move forward. Hill Country Memorial defines remarkable as performing in the top decile of the nation. The team has continued to deliver on that promise with its high quality and best in class experience results. The team at HCM makes the culture and it is that team which will sustain the culture going forward.

The HCM Team and Physicians are the foundation of everything HCM is built upon. Their work every day ensures a remarkable culture for the patients we have the opportunity to serve. HCM has experienced much of the same recruitment challenges as other healthcare organizations. As part of Methodist, HCM will have expanded access to recruiters and critical affiliations to strengthen candidate pipelines.

Can the board of trustees guarantee there will be no retaliation against our doctors for honestly expressing their opinions? The same for the entire HCM team?

The HCM culture is built on trust and diversity of thought. Respectful discourse is welcomed and critical to making us better. Retaliation is not a part of the HCM culture and will not be tolerated.

Do you think the majority of our physicians, nurses, and hospital employees are in favor of the sale? Have you taken a poll? What % would you estimate are in favor of the sale? Do you think our community healthcare providers have valid input into this decision? If so, why haven’t you sought their opinions?

Our team including physicians, nurses and employees have been very supportive of the decision to become part of Methodist. We have not taken a formal poll. As dedicated members of the healthcare community, they have seen firsthand the intensified headwinds we continue to face in rural healthcare.

As fiduciaries, the HCM Board of Trustees has the responsibility and accountability for stewarding the hospital’s mission and ensuring quality healthcare remains accessible in the Hill Country. This includes making the decision to sell HCM to ensure quality healthcare is sustained locally. Assessments by trusted, third party advisors, longstanding, legal counsel, and healthcare trend data were the critical inputs needed for the Board to make prudent decisions about a sustainable path forward.

Please explain PHO and its benefit to the FB community? How will the proposed severing of ties with the PHO impact patient care?

The PHO is a Provider-Hospital Organization that enables physicians and the hospital to access payor contracts. The primary benefit to the community is ensuring that local physicians and the hospital can effectively contract with various insurance products. Methodist determined that more insurance products will be accepted based on utilizing their pre-existing agreement, than are currently contracted through the PHO. There is no indication that patient care would be impacted by this decision. Discussions are in place with the current PHO leadership for the entity to continue to serve independent physicians.

Service and Quality

The community helped purchase the MRI yet locals, to save money, go to other places to have their MRI’s where they are cheaper. Why is an MRI so much more in Fredericksburg?

HCM has an in-hospital MRI and as such is subject to in-hospital billing practices. We understand that patients can seek services like a freestanding radiology service elsewhere. A partnership with Methodist will enable us to explore opportunities we have not had as an independent hospital. Becoming part of Methodist ensures strong investment in capital to continue to meet the needs of the Hill Country community.

Which services would have been cut if the Board chose to remain independent?

In respect for our team who work to serve our community every day we have not and will not share those services. Those services are critical to the health of our community and we were not willing to cut them.

Have you recently watched the PBS report on HCM hospital that aired in March 2016 titled: “After Tragic Mistake, Rural Hospital Transforms into Model of Success”? If so, what are your key takeaways from the news segment?

The story shared in the PBS report was a pivotal moment in HCM’s history that continues to shape our quality journey today. Quality is part of the fabric of HCM and is critical component of what makes HCM remarkable.

What do you mean we would have “access to” Methodist doctors and services? Will these be in Fredericksburg or would we have to go to San Antonio?

As part of Methodist, we will have expanded access to physicians including greater access specialists who will come to the Hill Country community to offer additional, expanded services. These physicians would be available here so patients would not need to drive to San Antonio to access them.

Why if care is to remain local, Methodist employees (HCM employees) won’t be able to see local physicians since the local physicians aren’t on those insurance plans?

Methodist has broad access to major insurance companies and will work hard to contract with payers so we can serve as many patients (including employees) as possible and provide coverage to care for the most people. We see no reason why employees would not be able to see local physicians.

The Board of Trustees

How were the current members of the Board of Trustees selected?

The HCM Board of Trustees was selected using the process outlined in the HCM bylaws. The board ensures broad representation that reflects the community it serves and ensures trustees represent diverse areas of expertise and acumen. This process was originally crafted when HCM began and has been a steadfast part of the governance process for more than 50 years.

Why are there 5 business men from out of town, on the big system board, when they don’t live here?

The HCM Board is comprised of community members who represent the diversity of the Hill Country and includes, among others, physicians, local business owners, lawyers, healthcare administrators, real estate professionals, and leading community volunteers. Every one of the board members lives in the Hill Country Memorial service area and uses the hospital, and represents the community.


For concerned citizens who were encouraged to stay home and stream due to parking and space limitations, how can they ask questions and receive timely answers?

Would you be willing to come back to another Forum soon after this one to answer new questions and ones unanswered from this Forum due to time? Also, would you be willing to listen to community members who may not agree that all viable options were contemplated by the Board and that there may be a better, different solution to the problems you identified and were trying to solve by selling? How does hospital leadership intend to be transparent about the sale, integration and transition moving forward? Are you as a board willing to meet again and listen to those that may differ from what consultants and corporations have told you?

Based on the feedback we have received in response to this Forum we have heard it has been helpful for the community and answered many of their questions. We look forward to additional forums in the future with Methodist so we can gain input into the strategic direction of the organization going forward. Additional questions may be sent to

Why are all board members not present at this forum tonight? If the board is so confident that their vote to sell the HCA is the best solution, why are they not present at this forum to champion what they have decided for us. The Board has been described as courageous several times in the paper. If they are so courageous, why did they choose not to attend this event? How many hospital board members are present this evening to answer our questions?

Most HCM Board Members were present at the Informational Forum and seated throughout the facility. Due to scheduling conflicts and personal circumstances some of the Trustees were unable to attend.


What is being announced?

Hill Country Memorial announced today that it has entered into an agreement to become part of the Methodist Healthcare System of San Antonio. Hill Country Memorial thoughtfully selected Methodist Healthcare as a partner because of its commitment to excellence in care, proven record of quality, and in partnership, our ability to expand access to care. Pending standard regulatory review and approvals, this combination will begin a new chapter of growing healthcare services in the region and will deepen care offerings and grow accessibility for the Hill Country community.

  • When will these changes be effective?

We expect changes to be effective in early 2023.

  • How will patients and their families be impacted?

The health of our patients and their families is our priority. In the near term, patients can expect their care to continue uninterrupted. We are excited to share more news about expanded and enhanced services in the coming months.

  • Is my/my family’s insurance still accepted?

We will continue to accept Medicare and Medicaid and ensure we accept a broad range of insurances. We will work hard to contract with payers so we can serve as many patients as possible and provide coverage to care for the most people. As we finalize those details in the coming weeks we will share more information.

  • Can I still see the same provider?

Yes, our patients can continue to receive remarkable care from the providers they know and trust. And in fact, there will be more providers for services locally requiring less travel for patients and better access to care right here close to home. As changes related to this partnership are implemented, rest assured that the high-quality healthcare you’ve come to expect from us will continue. This means continued access to your healthcare provider and uninterrupted ongoing care, right here in the Hill Country.

  • Will I now have to travel to San Antonio for care?

Patients can still receive care and access services locally. Additionally, our partnership with Methodist Healthcare will enable us to deepen offerings for our community, with new or expanded services right here in the Hill Country.

  • Why did Hill Country Memorial choose to be acquired?

Hill Country Memorial has always been committed to caring for those who call the Hill Country home. This decision means we can deepen the care offered and that quality care continues to be delivered right here, locally. As we looked at the changing healthcare landscape, we recognized there are clear challenges that could potentially impact the level of care our community has come to expect. We are confident that becoming part of the Methodist Healthcare System will ensure high quality health care is available here, and that care grows to meet the changing needs of the Hill Country community.

  • Why did Hill Country Memorial choose to partner with Methodist Healthcare?

Hill Country Memorial’s Board and leadership evaluated potential partnerships with the utmost care and consideration. Following extensive conversations with several hospital systems and consultation from outside experts, the Board and leadership team unanimously agreed that Methodist Healthcare was the best fit for Hill Country Memorial’s current culture and communicated a vision to facilitate the growth and services needed in this community. Methodist Healthcare is a known and trusted provider throughout the Hill Country. We share a deep commitment to and proven record of delivering quality care and will continue to strengthen local healthcare through expanded services and access and capital investment.

  • What happens next?

Hill Country Memorial will immediately begin the integration process with Methodist Healthcare, which we expect to be completed in early 2023. We are committed to ensuring that our community, physicians, patients and team members are informed every step of the way. We will continue to provide regular updates as more information becomes available. Updates will continue to be posted on our website as they are made available.

  • ¿Qué se anuncia?

Hill Country Memorial anunció hoy que ha llegado a un acuerdo para formar parte del Methodist Healthcare System of San Antonio. Hill Country Memorial seleccionó cuidadosamente a Methodist Healthcare como socio debido a su compromiso con la excelencia en la atención, historial comprobado de calidad y, en asociación, nuestra capacidad para ampliar el acceso a la atención. A la espera de las revisiones y aprobaciones reglamentarias estándar, esta combinación iniciará un nuevo capítulo de crecientes servicios de atención médica en la región y profundizará las ofertas de atención y aumentará la accesibilidad para la comunidad de Hill Country.

  • ¿Cuándo entrarán en vigencia estos cambios?

Esperamos que los cambios entren en vigencia a principios de 2023.

  • ¿Cómo se verán afectados los pacientes y sus familias?

La salud de nuestros pacientes y sus familias es nuestra prioridad. A corto plazo, los pacientes pueden esperar que su atención continúe sin interrupciones. Nos complace compartir más noticias sobre servicios ampliados y mejorados en los próximos meses.

  • ¿Todavía se acepta mi seguro o el de mi familia?

Continuaremos aceptando Medicare y Medicaid y nos aseguraremos de aceptar una amplia gama de seguros. Trabajaremos arduamente para contratar a los pagadores para que podamos atender a la mayor cantidad de pacientes posible y brindar cobertura para atender a la mayoría de las personas. A medida que finalicemos esos detalles en las próximas semanas, compartiremos más información.

  • ¿Puedo seguir viendo al mismo proveedor?

Sí, nuestros pacientes pueden seguir recibiendo una atención extraordinaria de los proveedores que conocen y en los que confían. Y, de hecho, habrá más proveedores de servicios a nivel local que requerirán menos viajes para los pacientes y un mejor acceso a la atención aquí mismo, cerca de casa. A medida que se implementen los cambios relacionados con esta asociación, tenga la seguridad de que continuará la atención médica de alta calidad que espera de nosotros. Esto significa acceso continuo a su proveedor de atención médica y atención continua ininterrumpida, aquí mismo en Hill Country.

  • ¿Tendré que viajar ahora a San Antonio para recibir atención?

Los pacientes aún pueden recibir atención y acceder a los servicios localmente. Además, nuestra asociación con Methodist Healthcare nos permitirá profundizar las ofertas para nuestra comunidad, con servicios nuevos o ampliados aquí mismo en Hill Country.

  • ¿Por qué decidió adquirir Hill Country Memorial?

Hill Country Memorial siempre se ha comprometido a cuidar de aquellos que llaman hogar a Hill Country. Esta decisión significa que podemos profundizar en la atención que se ofrece y que se continúa brindando atención de calidad aquí mismo, localmente. Mientras observamos el panorama cambiante de la atención médica, reconocimos que existen desafíos claros que podrían afectar el nivel de atención que nuestra comunidad espera. Estamos seguros de que convertirse en parte del Methodist Healthcare System garantizará que haya atención médica de alta calidad disponible aquí, y que la atención crezca para satisfacer las necesidades cambiantes de la comunidad de Hill Country.

  • ¿Por qué Hill Country Memorial eligió asociarse con Methodist Healthcare?

La junta directiva y el liderazgo de Hill Country Memorial evaluaron las asociaciones potenciales con el mayor cuidado y consideración. Luego de extensas conversaciones con varios sistemas hospitalarios y consultas de expertos externos, la Junta y el equipo de liderazgo acordaron por unanimidad que Methodist Healthcare era la mejor opción para la cultura actual de Hill Country Memorial y comunicó una visión para facilitar el crecimiento y los servicios necesarios en esta comunidad. Methodist Healthcare es un proveedor conocido y confiable en Hill Country. Compartimos un profundo compromiso y un historial comprobado de brindar atención de calidad y continuaremos fortaleciendo la atención médica local a través de servicios ampliados y acceso e inversión de capital.

  • ¿Qué sucede después?

Hill Country Memorial comenzará de inmediato el proceso de integración con Methodist Healthcare, que esperamos que se complete a principios de 2023. Estamos comprometidos a garantizar que nuestra comunidad, médicos, pacientes y miembros del equipo estén informados en cada paso del camino. Continuaremos brindando actualizaciones periódicas a medida que haya más información disponible. Las actualizaciones se seguirán publicando en nuestro sitio web a medida que estén disponibles.