THE TIME IS NOW TO TALK OF HOSPITAL MERGERS

In the past, hospital officials in Cape Girardeau have avoided the "M" word. In their minds, "merger" was somehow a signal of financial troubles.

But in today's climate of managed care and health reform, more hospitals are opting to combine operations and streamline as a way to keep costs down.

It is an idea whose time has come in Cape Girardeau.

Southeast Missouri Hospital board members are favorable to the concept of merger. St. Francis Medical Center officials are resistant, pointing to antitrust obstacles and a belief that competition is ultimately best for the consumer. They also point to the sizable debt of Southeast, with its new Clinical Services Building, and the fact that St. Francis is relatively debt-free.

It is true the issue of antitrust could be a stumbling block. But shouldn't stand in the way of preliminary discussions. The concept deserves meaningful study.

A joint hospital merger committee, which quit meeting early last year, should be reactivated. Exploration of a merger about seven years ago stalled when a small group of doctors threatened an antitrust lawsuit.

Moreover, St. Francis Hospital's recent request to add another cardiac catheterization lab shouldn't be linked any renewed merger effort. A merger would take time to achieve, and St. Francis needs this upgraded equipment.

The new cardiac catheterization lab would augment an aging lab installed in 1986. It would also provide more advanced equipment than a mere upgrade, which is critical when seconds count.

This second cardiac catheterization lab doesn't fall into the category of senseless duplication of services -- such as two open-heart surgery programs or two helicopters. The Missouri Health Facilities Review Committee, which must issues a certificate of need for St. Francis, should endorse this expansion.

But the committee should also take a hard line against any future requests that are clearly duplication.

If antitrust laws are so rigid, why are more and more hospitals merging?

It is hard to ignore a growing number of mergers in St. Louis and other areas. Even hospitals in Carbondale and Marion, Ill., are exploring the possibilities. And consider the case of Danville, Ill., population 40,000, where two not-for-profit hospitals merged.

Richard Livengood, president of the Marion Memorial Hospital, said antitrust laws shouldn't be viewed as insurmountable in today's health care climate.

Charles Hutson, president of Southeast's board of trustees, thinks there has been a softening in the Justice Department when it comes to dealing with hospital mergers.

While competition may drive down costs in many businesses, it often produces the opposite effect in hospitals. The days of unbridled building and blank-check technology are gone. Managed care will bring discounted prices to the consumer. To accomplish this, hospitals must tighten their belts.

The issue of competition isn't limited to Southeast Missouri.

If costs are too high here, more and more patients will go to St. Louis or Memphis where managed care is well established. Both hospitals are losing patients from a dwindling pool.

While both Cape Girardeau hospitals may be financially secure, they don't operate efficiently. On any given day, they utilize between 50 and 60 percent of their beds. And many programs -- such as open heart surgery -- operate well below capacity.

And who is to say financial security today will remain in the wake of health reform? In the past 10 years, the cost pressures of managed care, coupled with too many hospital beds, have forced 500 hospitals to close nationwide.

Both Cape hospitals have cooperated on a number of levels in recent years. And both are leading a push for the region's first physician hospital organization, which should bring more competitive pricing.

Southeast and St. Francis have walked hand-in-hand to the dance floor but can't seem to tango.

Let the music begin.

It is time to judiciously explore a merger of Cape Girardeau's two not-for-profit hospitals.