he Avera signs were already up at the ACMC clinic on Carlson Street in Marshall when Avera Marshall and Carris Health Marshall held a press conference a week ago to announce and explain the merger between the two southwest Minnesota health care providers.

On Tuesday, I attended the Marshall Noon Rotary Club meeting at Shay’s restaurant. And the guests of honor were Avera Marshall CEO Mary Maertens and Dr. Steven Meister, who is vice president of clinical support services for Carris Health.

Just a couple years ago, putting those two in the same room would appear by most in Marshall to be awkward. That’s because in 2010, ACMC sued Avera Marshall for allegedly steering patients away from ACMC.

So after Maertens and Dr. Meister ended their opening statements, the same big question was probably on everybodys mind. Rotarian Chuck Lindemann asked it.

“What came of that lawsuit?” Lindemann asked.

“Let me start that,” Dr. Meister quickly said.

After a long statement that describing a culture experience session that he and Maertens participated in and a golf outing, he finally got to the answer everybody was waiting for.

“The lawsuit is under the bridge,” he said. In fact, Meister said in hindsight, different decisions might have been made.

“Personally, I hated it,” Dr. Meister said of the lawsuit. “It gave me a lot of grey hair.”

The next question, however, was probably the most important.

“Dr. Meister’s fees are excessive,” Rotarian Dallas Dammen said. “I want to know why a joint merger that takes away competition, his fees won’t go any higher?”

And that question strikes to heart of what affects most people when it comes to health care. Most people believe health costs are out of control. People are going bankrupt and premiums are too high.

Several comments under the Independent Facebook posting of the Avera Marshall/Carris Health merger article involved the concern of no competition.

“This is a terrible idea,” one of the comments read. “Patients no longer have a choice. This does not benefit all of us.”

And another comment: “Let’s just keep merging. Eliminating competition only means more money in a few people’s pockets.”

The concern is real. According to xtelligent Healthcare Media, 115 mergers and acquisition transactions were executed in 2017. That number was expected to increase in 2018. According to xtelligent Healthcare Media, the intent of these mergers is to give their systems greater scale to reduce costs, offer additional care services and create a larger footprint in the local market.

So getting back to Dammen’s question, Dr. Meister said his fees are not set by him.

“They are set by your insurance. If you are 65 of age, this gets into government reimbursement. In rural America, in Marshall specifically, rural Minnesota and rural Lyon County, we have 55 percent of payers — patients — are government payers,” Meister said. “If my cost is $100 and I want to charge a $110, Medicare comes up and they say, ‘you get $49, take it or leave it.’ So if it costs me $100, I lose money at the get go. So that money has to be made up somewhere.”

Maertens supported Dr. Meister’s explanation.

“Dallas, to your question, first I would first note that a little addition to Steve’s point, we do have an agreement with the state of Minnesota and with the attorney general, that people who are self-paid, we must give the same discount we give our most favored non-government payer. So you don’t actually pay the full dollar if you are self-insured. Avera Marshall also provides about $3 million a year in charity care so that (medical bills) are not bad debts for people who cannot pay.”

Maertens also said Avera is committed to the community and certainly to those closest to the patient.

This integration will not raise prices,” Maertens said. “We largely have the same clinic fee schedules before, and that continues going forward and we actually probably have better insurance contracts or relationships with payers giving people better opportunities.”

Maertens also said Avera is working with the federal government and the state of Minnesota to add value to both Medicare, Medicaid in terms of outcomes.

“We are working very hard on the topic of affordability and long-term sustainability for you as a patient too. Avera has a saying, ‘we don’t want to put people in a position of bankruptcy due to their medical bills.’ “

Besides the affordability factor, both Dr. Meister and Maertens stressed the merger will help in the recruiting of needed specialists that rural America often times has difficulty attracting.

We needed to partner with somebody like Avera that gives us a chance to recruit better quality … to give our local area the best health care we can have.”

So the bottom line, both Dr. Master and Martens promise more quality and affordability. Only time will tell.

Like President Donald Trump said in 2017: Nobody knew health care could be so complicated.”

I think we are all learning day by day how complicated it really is.