"Zero chance."
That's the likelihood that SSM Health will close Jefferson City's St. Mary's Hospital if its proposed sale to MU Health falls through, JCMG President Jeff Patrick told the News Tribune's Editorial Board last week.
SSM and MU Health announced in August they were negotiating the possible sale of SSM Health's St. Mary's Hospital in Jefferson City and Mexico (the former Audrain Medical Center) and their associated clinics, following SSM's decision to leave the Mid-Missouri marketplace.
SSM and MU Health have said no final decision has been made, and both are still doing their "due diligence" in exploring the possible sale to MU.
Patrick - a Jefferson City native who is a graduate of the University of Missouri's Medical School - said last week that JCMG and the separate Coalition for Choice urged SSM Health's and MU Health's administrators to slow down the process for the sale, to allow time for more comments to be made from the public.
"It's really making a decision that's going to affect multiple generations here," Patrick said. "This is a huge decision - once you give this type of market power to an entity, it lasts forever. You can't pull back those types of situations."
JCMG and the Coalition for Choice said they've been told community members are hearing St. Mary's Jefferson City hospital - opened just five years ago - will close if the sale to MU Health falls through.
At last Monday's MU Health public forum on the proposed sale, SSM Chief Financial Officer Kris Zimmer said: "I hope no one on our team said that," adding: "I would not use those words."
Still, SSM Health said in an email Friday afternoon: "Continuing as we have been is not an option.
"We firmly believe that transitioning ownership to MU Health Care is the best way to ensure long-term sustainability and access to high-quality care for residents in Jefferson City, Mexico and surrounding communities."
Seeking improvements?
SSM Health has said it's been losing money on its Mid-Missouri operations and has decided to leave the market.
Patrick said JCMG has had a long working relationship with St. Mary's, and was pleased to see interim President Phil Gustafson had helped turn around the local hospital's financial situation.
He said JCMG administrators had worked with Gustafson and others to seek ways to improve the hospital's operations while also benefiting JCMG.
Patrick and JCMG Chief Executive Officer Ben Vallier also said they met about a year ago with Laura Kaiser, the new chief executive officer for SSM Health's St. Louis-based corporate office, and she told them that maybe MU Health would be the best fit to take over SSM's Mid-Missouri operations.
That was a couple of months before SSM issued its request for proposals that led to the current discussions with MU Health.
However, when asked to comment, SSM said: "This is false."
Hal Gibbs II, a Jefferson City attorney who's serving as general counsel of the Coalition for Choice and is a member of its board, said last week that local business leaders told him they are "overwhelmingly against the takeover."
SSM and MU Health officials have said they have been told the proposal has local support, and MU Health noted "two groups have been formed by Mexico business leaders in support of the transaction."
Gibbs said some opponents are unhappy with St. Mary's many efforts over the years to get financial support for the original hospital and for the new, 5-year-old facility. "All of that bringing the community together, and then when they want to sell, there's no (advance) discussion with the community about what needs to occur."
JCMG and the coalition also want SSM Health to "have a different approach" to its situation and its decision to sell the Mid-Missouri facilities.
Health care options
In its email Friday, SSM Health said: "We remain committed to balancing the interests of our patients, employees, physicians and communities as a guiding principle, and continue to work with key stakeholders in Audrain, Boone and Cole counties to ensure their perspectives are considered throughout this process."
Patrick noted JCMG provides its patients with numerous options when further care is needed, including St. Mary's, Capital Region, Boone and University hospitals.
"We send people to Barnes in St. Louis to Mayo (in Minnesota) (and) M.D. Anderson (in Texas)," he said. "We really value, and our patients value, having choices to go to different places.
"If we follow this path to this one, large health empire, it's going to be mostly exclusive insurance products where you don't get those choices, and we don't get those choices as to what to do with our patients."
Patrick said having one hospital serving the region with one favored insurance provider likely would result in the lower, in-network costs being covered only within the MU Health system.
"If, for instance, you want to go to Siteman at Barnes (in St. Louis) for your cancer care, it's going to be out-of-network and you're going to pay (extra) cash for that," he said. "That's how the large majority of people are going to end up."
In a separate email Friday, MU Health said: "It is important to note that this potential transaction will not eliminate patient choice in mid-Missouri.
"Private practice physicians, physician groups, ambulatory care centers, community health centers and other providers will continue to provide primary care and specialty services - including outpatient surgery, ultrasound and radiological services - and offer patients choices about where and how they receive their care."
At last Monday's public meeting, MU Health Care CEO Jonathan Curtright said buying the SSM Mid-Missouri facilities would help provide better care for "1 million Central Missourians," through their primary care doctors, their medical facilities and through the research being done at the University of Missouri.
"The patient will be the center of everything there is," Curtright said.
However, part of last week's JCMG presentation to the News Tribune included copies of newspaper and journal articles - from August 2011 to Nov. 28, 2018 - all generally questioning the "integrated delivery" approach to health care that's at the heart of MU Health's proposed purchase.
Those articles generally reported health care costs increasing in health care markets throughout the United States, because of the mergers of once-competing facilities.
If the SSM sale to MU Health goes through, Patrick said, "There's no question (MU Health) will use that market power to charge higher prices to insurance companies, so all the major insurers will be paying a lot more money to MU Health to get their services and be part of their network."
Insurance companies then will have to "charge employers much higher prices because they're paying MU Health more," Patrick said, "and then the employers will charge their employees much higher prices.
"So, it's going to harm all of our employers, all of our employees (and) the people who don't have access to health care through employment and have to buy health care on their own.
"It's a killer for the community," Patrick said.
Articles and studies
Neither Patrick nor Vallier could point to any published article or study supporting the integrated health care model.
However, MU Health said in its Friday afternoon email: "By deepening its presence in Jefferson City and Mexico, MU Health Care can help to ensure continued and expanded access to affordable, quality care for all those living in Missouri.
"Integrated care can help ensure long-term growth of jobs and clinical services in our community. MU Health Care is uniquely positioned to improve care in Cole and Audrain Counties through integration and expansion of care opportunities in the region, while providing stability and continuity for employees and the community.
"The Jefferson City and Mexico communities would benefit from better patient care, local decision-making and keeping jobs local."
Patrick said there's "no evidence that these mergers increase the quality" of health care.
MU Health's email Friday cited an American Hospital Association study "that discusses the benefits of hospital mergers and acquisitions."
And SSM Health said, "The leading health systems in the country are integrated health care delivery systems. Integrating care across the continuum of services has been proven to improve patient care and reduce the overall cost of care.
"This transition will enhance efficiencies and drive sustainable health care in the region, ensuring important resources and jobs remain in Missouri.
"In fact, it will create opportunities for MU Health Care to train more physicians, nurses and other health professionals to care for patients throughout the state - especially those in underserved, rural areas."
Antitrust complaint
Patrick and Gibbs said the proposed sale would create a monopoly that would violate state and federal anti-trust laws.
Missouri's law prohibits what's called "restraint of trade" and also says it's illegal to "monopolize, attempt to monopolize, or conspire to monopolize trade or commerce in this state."
And at FTC.gov, the Federal Trade Commission said the federal laws "proscribe unlawful mergers and business practices in general terms, leaving courts to decide which ones are illegal based on the facts of each case. Courts have applied the antitrust laws to changing markets, from a time of horse and buggies to the present digital age.
"Yet for over 100 years, the antitrust laws have had the same basic objective: to protect the process of competition for the benefit of consumers, making sure there are strong incentives for businesses to operate efficiently, keep prices down, and keep quality up."
SSM deferred comments on the anti-trust allegation to MU Health, which said Friday: "Transfer of SSM's Mid-Missouri facilities to MU Health Care makes sense if it will benefit the community, MU Health Care and Capital Region Medical Center.
"A final decision on whether to seek legislation has not been made at this time. If sought, legislation would be intended to provide express authority and regulatory certainty for the transaction."
However, changing the current laws would be wrong, Patrick said.
Gibbs said last week that the coalition's supporters "understand what monopolies do and the negative aspect of monopolies. They want choice - they provide choice in our community with regard to all of their businesses - and they understand the significance of having that choice and wanting to protect our community from increased health care costs as well as reduced quality of care that results from monopolies."
MU Health is hosting a second Jefferson City public forum 5:30-7 p.m. Monday at the Special Olympics-Missouri Training For Life Center, 305 Special Olympics Drive.
MU Health noted last Monday - and again Friday - that it has posted information about the proposed sale at muhealth.org/ssm.
The site includes a list of frequently asked questions and their answers, and includes a link for people to send their comments - pro or con - to the MU Health administrators, who said the email link is checked regularly and all comments are read.