Fairview and Sanford: Merger risks degrading care and inflating profits

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Attorney General Keith Ellison has asked for public input on the proposed merger of Fairview Health Services with Sanford Health. I'm glad that the AG asked, because as a disgruntled former Fairview physician, I don't think Fairview would have much interest in my opinion.

I am the former medical director of Fairview Home Care and Hospice. I worked for Fairview for 15 years. We had an outstanding staff, particularly in our hospice work, with which I was primarily involved. We provided a great service to our patients and their families.

Because of financial shortfalls, Fairview chose to sell our division to a Texas for-profit company owned by private equity for $53 million in 2020. It is well known through a significant body of research that for-profit hospices perform poorly on accepted quality metrics as compared to nonprofit hospices. And it's also well known that private equity is purchasing more and more health care companies so it can turn a short-term profit. They see health care in general, and hospice specifically, as an enormous cash cow — which it is, especially if it is degraded by reducing services.

To me the whole concept of combining hospice care and for-profit structure is an oxymoron. But we have a free market system. So hospices are mostly for-profit. These companies have business models that facilitate maximizing the profitability of dying patients. And so it goes.

Because of the new methods of operation, change in values, and perceived disinterest in quality of care, there was a mass exodus of former Fairview Hospice employees from the new for-profit entity. Nurses, social workers, doctors, nurse practitioners and chaplains left to join other organizations — myself included. So I'm not terribly trusting of Fairview's corporate decisionmaking as it pertains to the best interests of patients and staff.

Two vital areas should concern us when it comes to evaluating health care in general and this merger specifically: the cost of health care for the patient, and the quality and accessibility of care.

As pointed out by experts in a Dec. 2 Star Tribune article, this merger, should it proceed, would not save consumers money. It may provide savings for the corporation, but this most likely won't be passed on to us. Unless … pressure is applied.

The cost of health care is frightening: According to Medicare, "U.S. health care spending grew 9.7 percent in 2020, reaching $4.1 trillion or $12,530 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 19.7 percent." We spend twice as much per person as other developed countries and do worse by the most important health metrics. As a country we are at the bottom of the bucket of developed countries in the quality of our health care.

And just as important, we don't understand that medical treatment is only responsible for about 10% of the reduction in premature death due to illness in our country. Much more important are the genetics, socioeconomic status, lifestyle choices (smoking and drinking) and, very likely, stress.

But health care companies (medical specialty groups, hospitals, pharmaceutical companies, biotech companies, etc.) have been extremely successful in marketing their products. Health care is a business and conducts itself accordingly. Even so-called nonprofits are primarily concerned with their operating margins — or you could say profits.

What specifically should Minnesota require of Fairview and Sanford to allow this merger to take place and receive the tax benefits of its nonprofit status? These two corporate entities should be required to commit to the following:

First, in collaboration with the U they should establish, with an ongoing endowment, a center for the study and application of cost-effective health care. So much of what is delivered as medical/health care in Minnesota and the country is unnecessary and often harmful and does not benefit patients. Estimates are that unnecessary medical treatment amounts to 30% of all medical costs. And this unnecessary treatment has an enormous cost. A Johns Hopkins University published study in 2016 concluded that the third leading cause of death in our country is "medical error." Health care costs are the leading cause of personal bankruptcy.

So the center should be established and the research should be applied to patient care at Sanford-Fairview. Evidence of that application should be presented to the state annually. And confirmation of savings to patients should be required.

This center, based at the University of Minnesota, would also develop and promote "shared decisionmaking" within health care. Research has found that when patients are objectively given their options, which is required according to the Minnesota Patient Bill of Rights, patients most often choose less aggressive and less costly health care.

Second, Sanford-Fairview should be required to collaborate with the U on developing a center for geriatric medicine and nursing. The U should be ashamed of its performance in this critical area of health care. As a land grant university, it has a service mission to the citizens of Minnesota. It has defaulted on that responsibility for over 20 years since it abolished the division of geriatric medicine in 2001.

Seventy percent of health care costs are consumed by health care related to chronic illness — most of these incurred on treating the elderly. Older Minnesotans deserve health care that is both high quality and cost effective. They should not simply serve as a cash cow for corporate medicine.