A Sanford-Fairview merger would be bad for health care in Minnesota

Fairview Health Services and Sanford Health announced plans to merge last month, and we can expect their paid spokespeople to provide the corporate ooze of goodwill. They will tell us that the merger is a chance to offer higher consolidation of care, improve quality of care and care coordination, and save health care dollars. Both companies are at the heart of our community’s public health.

Only a gullible fool would engage in such nonsense. Positive rhetoric does not outweigh the hard facts about receiving health care from large corporate multi-hospital systems that employ their own doctors, such as Fairview and Sanford. This deal could raise the cost of our health care, from deductibles to pharmacy costs, while failing to deliver better care. Bigger is not better. As a physician and health care consumer, I hope our Attorney General, Governor, and Legislators will consider:

  1. Multi-hospital physician practices have market power given their size and drive up the prices of services for both consumers and insurance companies. Market power allows the corporate system to negotiate higher prices for doctors, hospitals, pharmacies and therapies within their umbrella. The cost of care is taller in these systems. Fairview’s merger with Sanford crescendos their market power.
  2. Large hospital systems exploit health care dollars by moving the site of care to a hospital campus, artfully charging both a physician fee and a facility fee. Consequently, consumers have higher out-of-pocket costs.
  3. These large networks skillfully lock users into one system: their system. This includes everything from pharmacies to hospitals, primary care clinics, urgent care use and where your MRI is being done. There is reduced flow to other systems, such as the clinic closer to your neighborhood.
  4. Mega-healthcare companies expertly control the flow of referrals. Within these systems, there is a higher volume of specialty referrals, resulting in higher health care costs.
  5. The size of these corporations eliminates competition in the regions. The Twin Cities, for example, is largely controlled by three systems: Fairview Health, Allina Health and Health Partners. All three have associated insurance companies.
  6. Multihospital health systems carry 19.8% higher costs than physician-owned organizations.
  7. The doctor-patient relationship is devalued. Money drives your care when you see your doctor. Health plans effectively reduced face-to-face appointment times and increased booked appointments. Doctors’ schedules are so hectic that they tend to look at the computer more than you do. The human factor slipped away, replaced by the almighty dollar and “efficiency.” As a physician, looking at the patient improves clinical judgment. Money efficiency does not necessarily improve medical problem solving.
  8. Health quality data are no better with hospital-based corporate care. These companies have not been proven to provide better quality of care.
  9. Life expectancy in the United States has refused in the last ten years. Congratulations, the United States of America is ranked 40th in the world! The last ten years correlate with the growth of these large systems.
  10. Out-of-control health care costs are outpacing wage growth. Health care spending increased 87% from 2000 to 2019. Median household income increased 10%. We all feel the pinch.

The cost of worker burnout and the financial burden of health care costs borne by Minnesota families are on the line. A bigger system is not the solution. Fairview is a perfect example.

Minnesota has a chance to be a national leader and address the problem of integrated hospital and physician networks that are being unscrupulous with our health care dollars and the quality of medical care. It’s high time we looked at real statistics, numbers generated by reliable external sources, to guide our health into the future.

Legislators, roll up your sleeves. People, write to your local authorities. Allowing this merger will only make matters worse.

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