The merger of North County Health Services and Sanford Health is expected to bring in new and expanded health care services for Bemidji: cardiology, women's health, neuroscience, orthopedics and oncology.
Both health care systems last week announced they had signed letters of intent stating their plans to merge.
Sanford will invest at least $75 million throughout 10 years for facilities, recruitment and technology to improve and expand current health care services.
NCHS and Sanford spokesmen since have been working to educate the public and their employees about the expected merger, but some local people still have questions.
For example, retired Dr. Ted Will, also a former NCHS board member, has been fighting for cardiology services in Bemidji for years.
Will was one of about 20 people who attended a public forum Monday morning at North Country Regional Hospital to ask questions about the planned merger.
Leading the forum were Paul Hanson, NCHS president and CEO; Dan Olson, the vice president of Sanford Clinic-Bemidji (the former MeritCare Clinic); and Steve Rogness, a member of the NCHS board. Also speaking was Dr. Howard Hoody, a physician with Sanford Clinic.
Will asked them if guarantees exist that cardiology would, in fact, be added. He said he was told the same promises before, when the Bemidji clinic merged with MeritCare.
Rogness told him the additional services were specifically stated in the letter of intent.
Will also asked about timelines for when the new and expanded specialties would be added.
Rogness said the letter of intent covers a 10-year period, but additions could certainly be made at any time.
"The 10-year timeframe is definitely the max(imum)," Hanson said.
Rogness also said that if Sanford fails to meet the terms of the agreement, then the NCHS "board has the perfect right" to cancel the contract after 10 years.
Sanford Health joined with MeritCare in November 2009, so the merger with NCHS, when complete, will result in the hospital and clinic being members of the same corporation.
Joy Johnson, vice president of business and development for NCHS, explained one example of how the partnership between the two could create a better business environment.
The Bemidji community needs two digital mammography systems. The clinic was going to get two, but the hospital was not going to get any.
But communicating between the hospital and the clinic would be difficult with different systems, she explained. So staff re-examined the NCRH budget and decided to buy one system.
The clinic then cut its order to one system as well.
Sanford Health now has two main hubs - Sioux Falls, S.D., and Fargo, N.D.
Through the merger with NCHS, Olson said, Sanford pledged to make Bemidji a third hub.
Olson said Bemidji, in the MeritCare system, has long been thought of as a branch off of the main health care system in Fargo.
"Essentially, that's what it has been for many years," he said.
Sanford is now pledging to make Bemidji a third hub equal to those already in Sioux Falls and Fargo, he said.
"Bemidji is going to report right to corporate headquarters, just like Fargo," Olson said.
Hoody said the long-term goal is to no longer have to fly out patients to Minneapolis and Fargo for specialty health care needs.
"Bemidji, as a hub, would be able to treat more and more patients locally," he said.
Frances Kiefer, a retired NCRH nurse, said she worried about Bemidji health care getting connected to - and lost in - much larger health care corporations.
"Bemidji is a very special place. I want to make sure we don't lose that," she said. "We have to remember Bemidji."
Hanson said a main goal of Sanford's is to keep health care delivery local.
"They want to keep care close to home," he said.
Rogness said Sanford also is considering hiring a recruiter who lives and works out of Bemidji. Currently, the recruiters responsible for hiring Bemidji area physicians are headquartered in Fargo through the former MeritCare system.
"We think we can represent Bemidji better," Rogness said.
Specifically, the spokesmen were asked about recruiting for family practice physicians, which has traditionally been a difficult position to fill in Bemidji.
"It's really tough to recruit family practice these days," he said, noting that most physicians are going into more glamorous or higher-paying specialties.
Hoody noted that the clinic added 10 new physicians earlier this year.
The problem facing Bemidji is that it is neither a large metropolitan area like Minneapolis nor a small-town clinic, he said.
"We have this 'tweener' status," he said.
But he expects that joining with a larger health care system will improve recruitment opportunities.
"I think that will be very advantageous for us," he said.
Dr. Brian Livermore, a retired physician, wanted to know, honestly, what the main factor was in deciding to seek a partner.
Rogness and Hanson said NCHS wanted the ability to expand and grow its health care offerings in the future.
But NCHS did not foresee a time when it would have the financial ability to do so on its own.
Hanson showed graphs that indicated that NCHS continues to operate its long-term care facilities (i.e. WoodsEdge) at deficits.
Conversely, NCRH in 2010 is on pace to have its best operating margin since 2001, Hanson said.
The problem, he said, is sustainability.
Rogness said NCHS decided to seek a partner that would help the Bemidji health care system expand.
He said, as Will previously stated, that the Bemidji community has wanted Bemidji to offer cardiology services, but has never been able to do so.
"Sanford said there was no question they could help us grow cardiology," he said.
NCHS talked with seven health care systems, Rogness said. That list was narrowed to three and then to one.
"Sanford was the strongest one," he said.
Rogness addressed rumors about the NCHS Foundation by saying it would remain in local control. In fact, $5 million of the $75 million that Sanford will invest in Bemidji will be given to the Foundation
"We're very proud of that development," he said.
Another potential benefit of joining with the Sanford system is the commitment it has to American Indian tribes, Rogness said.
In South Dakota, Sanford Health is working with the Indian tribes there to improve health care, he noted.
"One of their goals is to eradicate Type 1 diabetes," Rogness said, adding that Sanford Health is excited about the prospect of working with this region's area tribes.
Rogness said Sanford has a "huge research bent" and has an expansive research facility in Sioux Falls and is developing a new research site in Fargo.
"I wouldn't doubt we would have something similar here in the future," he said, noting that the Sioux Falls facility is twice the size of the Bemidji Regional Event Center.
Hanson said the $75 million from Sanford is a minimum amount just for health care; investments in research and innovation would be beyond that amount.
Rogness said Sanford also is "very excited" about the potential partnerships with Bemidji State University.
Since the announcement of the merger was made, NCHS has hosted four public forums and five meetings for its employees.
Johnson said that more information about the merger and any potential impacts on patients will be included in the December issue of "Pulsations," NCHS' newsletter, which is expected to be released in January.