Capsules

Sanford Fairview Merger Discontinued

The proposed merger of the Fairview and Sanford health systems has been discontinued. Sanford president Bill Gassen said, “This is the right decision for our patients and residents, our people and the communities we serve. Without support for this transaction from certain Minnesota stakeholders, we have determined it is in the best interest of Sanford Health to discontinue the merger process.” James Hereford, Fairview president and CEO, said, “While we wish the outcome were different, we know that the best thing for our patients, our people and the communities we serve is to continue our focus on delivering world class care, now and into the future.” Among Minnesota stakeholders not supporting the merger, Attorney General Keith Ellison stated, “We have done significant work to evaluate the proposed merger’s compliance with state and federal laws and whether it is in the public interest, including reviewing more than 300,000 pages of documents. The health and future of Fairview, the University of Minnesota health care facilities, and all Minnesota health systems are of vital interest to all Minnesotans.” Mary Turner, union head of the Minnesota Nurses Association, said, “Nurses are relieved at the news that the planned merger will not move forward. Additionally, this merger threatened health care in our state by putting the future of the University of Minnesota, including its medical school, into question.” The largest lack of stakeholder support came from the Minnesota legislature, which this spring passed a new law to prohibit health care system mergers from lessening marketplace competition. Furthermore, under the new law, a University of Minnesota health care facility “shall not be owned or controlled, directly or indirectly, in whole or in part, by a for-profit entity or an out-of-state entity, unless the attorney general determines that ownership … is in the public interest.” The relationship between the university and Fairview was a stumbling block in the proposed merger and remains a source of significant concern. 

Essentia Marshfield Merger Moves Forward

The next steps in the proposed merger of Essentia Health and Marshfield Clinic Health System, moving forward from the memorandum of understanding released last October, have been taken. The two groups have formally announced the signing of an “integration agreement,” to move forward with forming a new integrated regional health system. The groups say the agreement is the last step in the process, and they are on track to come together formally by the end of 2023, pending regulatory approval. “We are both physician-led organizations with an unwavering commitment to the health of rural communities,” said Essentia Health CEO Dr. David Herman, who will serve as chief executive officer of a new parent company. “Our complementary capabilities will allow us to learn and share with one another to better achieve our collective mission.” The new regional health system will include a network of 3,800 providers and 150 sites of care, including 25 hospitals with a footprint in Wisconsin, Minnesota, Michigan’s Upper Peninsula, and North Dakota. “While work remains to finalize our new relationship, this is another positive step in our journey to define the future of health care, and to fundamentally transform rural health care in America,” said Dr. Susan Turney, who previously announced plans to step down as Marshfield Clinic Health System CEO in September. The Office of Minnesota Attorney General Keith Ellison will now need to review the merger. “The attorney general’s office will review the proposed merger of Essentia and Marshfield using our existing authority under Minnesota’s nonprofit and charities laws and state and federal antitrust laws, as well as our new authority in state law to review whether the merger is in the public interest,” John Stiles, a spokesperson for the attorney general’s office, said. “The review will begin when the parties submit required documents to us, which they have not yet.” Important details around employment issues and union contracts are pending, though all parties express their commitment to working together and prioritizing patient safety while providing the highest levels of care.

New $900 Million St Mary’s Duluth Hospital Sees First Patients

After two years of concept and design work and three and a half years of construction, the brand new $900 million St. Mary’s Medical Center has opened its doors to patients. The 942,000-square foot facility represents the largest private investment in Duluth’s history. The new facility dominates the skyline on the eastern side of downtown Duluth. The glass tower stands 18 stories high with a helipad at the top. The facility has 344 rooms, all but two of them private. Dr. David Herman, Essentia Health CEO, said, “I have the deepest gratitude for my colleagues who helped to design this space, for the construction workers who made this a reality and for the community for their support during the construction.” The new building is designed to not just to cure people, but to help them heal, said Dr. Robert Erickson, physician lead on the project, dubbed Vision Northland. “It’s the light of the space that we have in the hospital, and the art that we have in the hospital, that will add to that healing. This really complements what we do in medicine.” The new building spans two city blocks on Duluth’s steep hillside. The hospital’s 28 elevators incorporate a system called “destination dispatch” designed to increase the efficiency of moving people and equipment. The new hospital is outfitted with 24 robots, which look like motorized carts that staff can program from any computer or iPad. Staff can request autonomously delivered food, trash removal, or carts of clean linens. They’ll be stationed at different chargers throughout the building. “This is a 50-plus year building, and included making sure we’ve built in the flexibility to be able to change with medicine as we move forward,” said explained facilities director Dan Cebelinski. The old St Mary’s facility will eventually be demolished.

New Health Care Communication Law Now in Effect.

Following a nationwide trend, the Minnesota legislature has enacted a new law, which went into effect Aug. 1, 2023. In efforts to protect health care providers and facilities from civil liabilities around adverse outcomes, utilizing a process known as CANDOR (Communication and Optimal Resolution) is now a requirement. Details of the bill are here included in SF NO.2909 (statute for the Minnnesota Candor Act). Known as the Communication and Resolution After a Health Care Adverse Incident legislation, the CANDOR process is a patient-centered approach that emphasizes early disclosure of adverse events and a proactive method to achieve an amicable and fair resolution for the patient/family involved. It includes communication with the patient throughout the entire investigation and resolution. Many states have found using the CANDOR process has improved patient safety, better supported health care team members and lowered malpractice claims. The process was developed by the Agency for Healthcare Research and Quality (AHRQ) using a $25 million Patient Safety and Medical Liability (PSML) Grant, the largest federal investment ever in research to improve patient safety and reduce medical liability claims The initiative was launched in 2009 and utilized input from experts and key stakeholders. AHRQ commissioned the Health Research & Educational Trust, in partnership with the American Hospital Association, to develop a customizable toolkit for national distribution to guide hospitals in implementing a communication and resolution process in their institutions. The traditional approach when unexpected harm occurred often followed a “deny-and-defend” strategy, providing limited information to patients and families and avoiding admission of fault. The CANDOR initiative was made possible by many individuals and organizations joining to advance the implementation of a transparent and just response to an adverse medical event. The process represents a synthesis of best practices in the field, as informed by those most affected, including patients and families themselves. Absent this process, for patients who experienced an adverse event the inability to get answers was frustrating and compounded the harm they experienced. Furthermore, many health care facilities and providers were hesitant to enter into frank conversations with the patient and/or family members due to fear of liability.

FDA Fastracks Francis Medical Cancer Breakthrough

Francis Medical, Inc., a privately held medical device company that is developing an innovative and proprietary water vapor ablation therapy for the treatment of prostate, kidney and bladder cancer, recently announced that the U.S. Food and Drug Administration (FDA) has granted Breakthrough Device Designation for its Vanquish minimally invasive water vapor ablation therapy. Breakthrough Device Designation expedites the review of innovative technologies that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions. To qualify for a Breakthrough Device Designation, a device technology must show that it has the potential to provide more effective treatment than current standards of care. The goal of the program is to help patients have more timely access to these medical devices by expediting their development, assessment and review. Prostate cancer is the second most common cancer in U.S. men and the American Cancer Society estimates one in eight American men will receive that diagnosis during their lifetime. Prostate cancer is a serious disease often treated with therapies that cause complications, such as urinary incontinence and erectile dysfunction. Francis Medical’s Vanquish water vapor technology applies the thermal energy stored in a few drops of sterile water to deliver targeted treatments to the cancerous tissue through a simple transurethral procedure. The therapy is designed to ablate cancer cells while protecting surrounding structures, lessening the likelihood of life-altering side effects common with other prostate cancer treatments. “The goal of Francis Medical is to become the first line therapy of choice for patients with prostate cancer,” said Michael Kujak, Francis Medical president and chief executive officer. “We are excited that the FDA has recognized the potential of our technology to be a breakthrough for patients who today face the difficult choice between addressing their cancer and avoiding the debilitating morbidities often associated with current standards of care.” 

Physicians at Allina Primary Care and Urgent Care Clinics File for Union

A group of Advanced Practice Providers (APPs) and physicians at Allina Health Primary Care and Urgent Care clinics recently announced their intention to file for a union election with Doctors Council SEIU, Local 10MD. The decision comes after months of discussions and organizing efforts to address concerns related to patient and provider safety, moral injury and their eroding professional voices and agency. The group, which includes nurse practitioners, physician assistants and physicians, is concerned about the impact of the current working conditions on patient care, professional practice and personal well-being. They have cited several reasons for seeking union representation, including but not limited to:

• Patient safety concerns due to understaffing and inadequate resources
• Limited input and decision-making power in matters affecting patient care, provider safety and professional autonomy
• The erosion of the clinician-led model of care and the threat of corporate influence on medical decision making
• The moral injury caused by the pressure to prioritize productivity and profit over patient needs and values and from a lack of support and resources to provide high-quality care

“As healthcare providers, we are committed to delivering the highest quality care to our patients, but we cannot do that when we are overworked, understaffed and unsupported,” said Dr. Matt Hoffman, a physician at Allina Health Primary Care. “By forming a union with Doctors Council SEIU, we can better advocate for the resources and support we need to provide safe, effective and compassionate care to our patients.” “Voting to unionize gives us in primary and urgent care the opportunity to, en bloc, work collaboratively with Allina leadership to re-center our patients as the focus of our work. It would give us a seat at the table where practice-changing decisions are made so we can properly advocate for the needs of our patients,” says Dr. Katherine Oyster. “It gives us an opportunity to decrease provider burnout/moral injury with the ultimate goal of keeping us happily providing care with Allina for many years to come.” This historic union election is expected to take place in the coming weeks. If successful, these physicians and APPs will be the country’s largest private-sector union of clinicians.

Minneapolis VA Opens New Specialty Care Center

The Minneapolis Veterans Administration Health Care System is now seeing patients in a new 15,000-square-foot specialty medicine facility. The new clinic opened Aug. 3 and is located adjacent to the main medical center on the main campus. It features 28 exam rooms, two procedure rooms a blood lab and an EKG/cardiac room. The new building will allow veterans to access more services at one convenient location. Although attached to the main hospital, the new building has its own dedicated entrance and drop-off area so veterans have an easier and more convenient way of getting care. Services offered in this new location include allergy, cardiology, endocrine, nephology, pulmonary, rheumatology, infectious disease, sleep medicine and select nutrition and pharmacy. Ancillary service expansion in this location includes lab, ECG and cardiac device monitoring, immunotherapy, diabetes education and pulmonary function testing. This is just one step in the Minneapolis VA’s goal to expand services for the veteran population. Some of the services now offered in the new facility had been provided in the hospital. By moving them to the new on-campus facility, that space can be converted into expanded hospital capacity. As part of the overall strategy to meet the needs of the greatest number of veterans in history, specialty care services have also been expanding in all of the Minneapolis VA’s 13 regional community-based clinics located throughout Minnesota and western Wisconsin.