SIOUX FALLS, S.D. (KELO) — Minnesota meetings on the proposed Sanford Health and Fairview Health Services of Minneapolis start Tuesday evening in St. Paul.

Minnesota Attorney General Keith Ellison scheduled four meetings this month around the state to get feedback from Minnesotans on the proposed merger.

All the community meetings below are open to the press and the public. They will also be livestreamed on Attorney General Ellison’s Facebook Page, according to the MN Attorney General’s Office.

One of the four meetings is set for Worthington from 6 to 8 p.m. on Jan. 25 at the Worthington High School cafeteria, 1211 Clary St. The meetings end Jan. 31 in Grand Rapids.

While this proposal has been called a merger, the name of the combined system will be Sanford Health. Sanford Health CEO Bill Gassen will serve as president and CEO with Fairview CEO James Hereford serving as co-CEO through one year of the closing date, according to Sanford Health.

The proposed merger would impact nearly 80,000 employees in the two systems. Sanford employs about 47,000 people while Fairview employs about 31,000 employees.

Fairview’s sites include the University of Minnesota hospital called University of Minnesota Medical Center  which on the medical center’s website said is the “flagship location for M Health Fairview.”

Fairview has 11 hospitals, more than 80 primary and specialty care clinics. The system also has retail and specialty pharmacies, rehabilitation centers, physician network, senior care housing and long-term care facilities, and medical transportation.

Sanford has 47 medical centers, 2,800 Sanford Health physicians and advanced practice providers, 170 clinical investigators and research scientists. The health system also owns more than 200 Good Samaritan Society senior care locations. It also has eight global clinics.

Fairview and Sanford proposed a merger nine years ago but those fell apart after Minnesota lawmakers and the Minnesota Attorney General got involved.

Health industry experts have called the proposed merger between the two non-profits a multi-billion dollar merger.

Fairview has reported net operating losses for the past two years. The system reported a net operating loss of $284.5 million for the nine months ending Sept. 30, according to Becker’s Hospital Review.

On the flip side, Sanford Health reported billions of dollars of revenue to the IRS in 2021.

Various health industry experts, research and industry publications say reasons to merge include reducing healthcare costs and improving patient care. Other reasons include a smaller system may not be able to financially continue without a partner.

Published research varies on the benefits and negative impacts of mergers and acquisitions.

In January of 2020, Harvard Medical School published a report that said its research on healthcare mergers showed that consolidation “did not improve hospital performance, and patient-experience scores deteriorated somewhat after the mergers.”

 An April 2022 publication called “Impact of hospital mergers: a systematic review focusing on healthcare quality measures” shared by the National Library of Medicine, said “there is no strong evidence of improvement or worsening of HQM in hospital mergers.” The report also called the available analysis and research on the topic was limited.

The American Hospital Association said in a 2021 report that “Our updated econometric analyses continue to indicate that through hospital acquisitions, hospital systems have been successful in reducing costs, lowering expenditures, and improving quality.”

The two systems serve somewhat different populations as Sanford touts its large presence in rural America.

Fairview’s system is mainly located in metro areas or suburban areas.

Fairview nurses have the option to be union members. The union was part of nearly 15,000 nurses who threatened to strike in Minnesota in December.

The Minnesota Nurses Association has gone on the record opposing the proposed Sanford and Fairview merger.

This isn’t the first time Fairview and Sanford have discussed a merger and this is at least the fourth time for Sanford to announce a possible merger.

A proposed merger with UnityPoint Health of Iowa in 2019 fell through. A proposed merger with Intermountain Healthcare of Utah in 2021 also fell through as Sanford announced it ended the talks.

Mergers and acquisitions in the health care field are not new.

In 2014 there were 95 hospital mergers, acquisitions or joint ventures, according to Harvard Medical School.

A 3rd Quarter report of health care merger and acquisitions provided by Kaufman Hall said “activity between hospitals and health systems in Q3 2022 remained low, with 10 announced transactions, but comparable to slower activity in Q3 2021, which had seven announced transactions.”

Mergers and acquisitions in health care has gotten the attention of federal regulators.

The KFF reported in July 2022 that the Federal Trade Commission had blocked four hospital mergers.

In addition to the four meetings, the MN AG’s office has provided other ways for the public to submit feedback. From the AG’s website: “A dedicated web form where all Minnesotans may leave their comments or concerns is now available on the Attorney General’s website. The form is also linked on a new Fairview/Sanford landing page at www.ag.state.mn.us/sanford-fairview. Minnesotans who wish to communicate their comments or concerns by phone may leave voice mail in a dedicated mailbox by calling (651) 296-3353 (Metro area) or (800) 657-3787 (Greater Minnesota) and pressing option 2, or may speak to an analyst live by calling the same numbers and pressing option 1.”