Seek a bolder vision for U's medical center

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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A resurrected merger proposed by Fairview and South Dakota-based Sanford Health has provided one road map for the University of Minnesota Medical Center's future: adding its hospitals and clinics to a regional health care system with headquarters in Sioux Falls.

But given these institutions' foundational importance to Minnesotans' health and economic well-being, it's imperative to develop alternatives to a future determined by out-of-state executives for these facilities, which the U sold to Fairview in a controversial 1997 deal.

Needed as soon as possible is a competing plan from U leadership that includes a bold, Minnesota-led strategy to strengthen this academic health center and ensure state interests are the priority. Essential elements to cover: What would it take for the U to reacquire these flagship facilities and create a next-generation medical center that's a cutting-edge care destination for decades to come?

Legislators returning this week for the 2023 session should demand a detailed proposal like this as they scrutinize the proposed merger and hold high-profile hearings featuring expert testimony in the weeks ahead. Those hearings would complement the public listening sessions held by Attorney General Keith Ellison.

The state is fortunate to have two world-class medical campuses — the U and Mayo Clinic — attracting patients, top doctors, research funding, and entrepreneurs. Minnesotans have benefited from this for generations, with exceptional medical care available close to home. Health care-business synergies have made the state a medical device mecca.

Ceding the future of critical facilities at the U to an organization with insufficient experience running a major-league academic health center is troubling.

To be sure, Sanford has an impressive track record running a large regional network. And in a recent interview with an editorial writer, Sanford and Fairview CEOs provided assurances about the merged system's commitment to the U's medical center and made a case for the benefits of it being part of a larger, financially stronger organization.

But teaching hospitals like those at the U bring entirely different management and financial challenges. Doing research and training the next generation of physicians is expensive. These activities also take time, diverting physicians from revenue-generating patient care.

If the merger goes through, Sanford would have a learning curve, a reality that's a bigger deal than it might seem. Recruiting and retaining top doctors and researchers is daunting. Putting "under South Dakota management" on the U's facilities could result in a brain drain that is difficult to undo.

Feedback from doctors and staff about the possible Sanford merger has been "overwhelmingly negative," Myron Frans, the U's senior vice president for finance and operations, told an editorial writer last week.

Out-of-state management of U facilities was among the most serious concerns when Sanford first tried to merge with Fairview in 2013. That merger fell apart after then-Attorney General Lori Swanson publicly interrogated Sanford executives, and legislators introduced bills preventing the transfer of U hospitals to entities outside of the state's borders.

The latest merger attempt opens new possibilities for the U facilities' future. Language within the U-Fairview operating agreement appears to allow the U to unwind this alliance and bring back its flagship assets if Fairview pursues a merger with another organization.

For that reason, the primary responsibility for providing an alternative plan to Sanford management rests with U leadership. They need to deliver soon, with details in particular about cost. This would almost certainly involve a substantial public investment.

Legislators should also be aware that across the nation, the trend is for universities to exit academic health center management agreements with outside firms, particularly those that involve out-of-state organizations.

"Our inquiries reveal that such out-of-state arrangements have failed, leading to universities taking back their facilities and operations. Examples of where out-of-state relationships have been unwound include Oklahoma University, Tulane, USC and St. Louis University. Indeed, some of the leading academic health centers in the country find universities owning and governing their facilities: Michigan, Penn, UCLA, UCSF, Washington and Ohio State, among others," the U said in a statement to an editorial writer.

There are many other reasons to be concerned about a Fairview-Sanford merger, with studies suggesting consolidation leads to higher health care prices. That's among the reasons the Star Tribune Editorial Board is skeptical this deal would benefit consumers even though it would aid Fairview's ailing financials.

But the future of the U's medical center must remain sharply in focus as the debate escalates. Legislators need to understand that this vital institution is at a critical juncture, providing a historic opportunity to undo a dubious 1997 deal and think boldly about how it might best serve Minnesota in years to come.