SSM Health on Tuesday signed a letter-of-intent with Noble Health for the possible transfer of ownership of St. Mary’s Hospital — Audrain in Mexico.

SSM previously had tried to sell its hospitals in Jefferson City and Audrain County as a package deal to University of Missouri Health Care. Negotiations ended in December without a sale.

The sale of the the Jefferson City and Audrain County hospitals to MU Health Care would have required a regulatory waiver as MU is affiliated with Capital Regional Medical Center.

Noble Health and SSM now are in a negotiation phase for the transfer of ownership, according to a SSM news release. If successful, Noble Health, which also manages the Fulton Medical Center, would take over ownership by the end of the year. Noble Health shared its plans recently for improvements at the Fulton hospital, according to the release.

Noble Health is based in Kansas City. The health care management company became interested in the Mexico hospital after SSM’s negotiations with MU ended in December. This is about the same time Noble took over ownership of Fulton Medical Center, Executive Chariman Don Peterson said.

"We immediately identified the strategic value of hospitals that were nearby," he said. "When we understood that the Mexico-Audrain facility was available, it immediately piqued our interest."

Noble Health works under a different health care model than hospital systems like SSM out of St. Louis or St. Luke’s in Kansas City. Those organizations use a hub and spoke model, Peterson said. So, while there may be a hospital in a rural community, the services it offers are limited, and so patients end up referred to a larger hospital within the system in a metropolitan area.

"Rural is our focus," Peterson said. "We don’t do hub and spoke, we do cluster. So, our intention is to own and operate hospitals within a reasonable proximity to each other, so we can achieve economies by sharing resources across facilities."

So, a neurology doctor could do work in one hospital in the cluster a few days a week, and another the remaining days, he offered as an example.

The sale of the Mexico hospital continues a process that started in 2018, SSM Health Regional President Mike Baumgartner said in the release.

"[This is] when we began evaluating potential opportunities to ensure the long-term sustainability of quality health care in the Mid-Missouri region," he said. "We have worked closely with local leaders and community members to help shape our progress to this point. Ultimately, our goal is to ensure we do what is best for our employees, providers and the communities we serve."

Baumgartner and other SSM leaders were not available for further comment as of Thursday morning.

Progress Mexico formed a medical task force in April to address community concerns related to the hospital. SSM Health St. Mary’s Hospital — Audrain is among the top five employers in Mexico, according to the Mexico Area Chamber of Commerce.

"Rural facilities have struggled on razor thin margins," Peterson said. "Generally, they end up cutting services. We take the opposite approach. We want to add services in all the facilities we manage so we become more relevant to the community."

Noble Health leaders already have met with hospital staff and leaders this week as the announcement of the letter-of-intent was made. Noble also is holding meetings with Progress Mexico to hear community concerns and needs for the hospital, Peterson said. Those meetings were to happen Thursday and Friday.

″[We want] to ensure we have a strong hospital here in our community," Audrain County Presiding Commissioner and task force member Steve Hobbs said in April. "We are looking at what we as a community can do to make that happen."

Noble is working with Kit Bond Strategies of St. Louis to build bridges with community leaders.

"Our goal is to be a meaningful part of the community and have the community support the hospital," Peterson said.

The main concern for hospital employees is job stability, he said. The first project for Noble is stabilizing employment. Noble wants to not only maintain what is there, but to also expand and restore services, which would increase hospital employment.

One service under review is obstetrics, which had program cuts February 2019.

"I think our intention is to add back," Peterson said. "If you can’t deliver the babies, then mom has no reason to go [to that hospital], and we know mom makes 70% of health care decisions for a family. Our goal is to offer the services the community requires."

Adding services will take time, though, he added.

"We can’t do everything at once," Peterson said. "We know we can’t please all the people all the time. Our intention is to restore that hospital to a full-service facility. ... Our motto is equality, community and service. We want to operate an outstanding facility that is producing great quality outcomes."