ROCHESTER, Minn. — On the books, the rescue-buyer that is MercyOne North Iowa plants its flag in Albert Lea, Minn., next year as part of a health system twice the size of nearby Mayo Clinic.

That's not a typo.

At 120,000 employees, the 93-hospital, Michigan-based Trinity Health system that owns Albert Lea's new medical suitor carries almost double the 63,000 employees who draw a paycheck from Mayo Clinic.

And that's not counting the 159,000 employees and 139 hospitals belonging to the Chicago-based CommonSpirit Health, the other operating parent for Albert Lea's newest medical facility. At $28 billion in revenues, CommonSpirit is the largest nonprofit health system in the country.

Though it's hard to imagine the word "nonprofit" in quite the same way, considering the branding expertise it must have required for the higher-ups at CommonSpirit to pick through 1,200 possible re-branding names, as the system formerly known as Catholic Health Initiatives did following their mega-merger last year with Dignity Health of Arizona and California.

Welcome to the age of hospital consolidation.

You can try to follow along with all of the mergers, acquisitions, spin-off units and logo changes that have accompanied the arrival of the latest health care brand for Albert Lea here in the waning days of small town hospitals, but it gets complicated, fast. MercyOne, the parent of MercyOne North Iowa, Albert Lea's new clinic, was until last January known as Mercy Health. As a result of that branding reboot, the company estimates it will need two years just to change all the signage in Iowa.

"They are one of the two largest systems in Iowa, along with Unity Point," says Allan Baumgarten, an independent health care analyst based in the Twin Cities and author of the annual report Minnesota Health Market Review. "Unity Point is merging with Sanford Health," he adds, confusing an already confusing picture, "and that's creating something of a six-state regional system."

Officially, the arrival of MercyOne in Minnesota is less of a raid on fresh territory than the byproduct of consolidation and a plea for help. As bigger players seek out efficiencies in scale, hospital systems are absorbing smaller clinics, closing departments and shifting staff to address redundancies and labor shortages.

That was the process that led Mayo Clinic to shift many of its services out of Albert Lea, angering locals in the process. It laid the groundwork for the invitation by Albert Lea business and civic leaders asking their neighbor system to the south to open a new clinic in town.

The provider said yes. At the announcement last week, MercyOne released a joint statement with the Albert Lea Healthcare Coalition, a group described as seeking to "regain control of local health care options and reduce costs of health insurance in southern Minnesota." It described the move as a chance for Albert Lea to gain more specialists and lower costs of care.

"MercyOne North Iowa Medical Center was invited to submit a proposal by the Save Our Healthcare Coalition from Albert Lea," said company president Rod Schlader in an email to Forum News Service. "As a system, MercyOne supported our proposal. As providers of health care in rural settings, we believe MercyOne is a good fit for the Albert Lea/Freeborn County area."

Just as with finance and tech, with health care you are going to see fewer players and bigger players over time, says Baumgarten.

"You're also going to see players that are crossing state lines and regional lines. ... Everybody's crossing state boundaries, and everyone wants to have a larger system with more patients, services, facilities and points of presence."

All that being said, the issue remains that MercyOne is starting small and testing the waters. It will open a primary care clinic "with enough space for visiting specialists and extended hours for urgent care, including weekends," according to a press statement. If patient goals are achieved, an imaging center and an ambulatory surgery center are also possible.

Should MercyOne seek out specialists for Albert Lea, it will draw from the same tight labor market that Mayo Clinic Health System has faced. On the website for MercyOne Northeast Iowa, the large employer is currently offering loan assistance, relocation costs and signing bonuses to medical specialists in 17 specialties.

"I'm not sure I understand the enthusiasm that this is generating," says Baumgarten. "I saw the editorial in the Albert Lea Tribune. They're saying this is a historic moment. (But) they're not bringing inpatient care back to Albert Lea, and it seems to me that is what Albert Lea is missing now."

Then there are the logistics of our increasingly specialist-driven care model.

"Presumably once they get this clinic launched they are going to have to be referring patients out for specialty care or hospitalizations," says Baumgarten. "Are they proposing to admit them to the closest MercyOne hospital, which I think is Mason City, 50 miles away, not 30 miles away (like the Mayo hospital in Austin). Will the population of Albert Lea think they're getting as good care if they are going to Mason City to the MercyOne system, that they could get if they go to (Mayo Clinic) in Austin or Rochester?"

Another question still to be answered, given the recent announcement that Mayo Clinic Health System will end labor and delivery services in Albert Lea next month, is whether MercyOne will offer a facility for expecting mothers. "At this time," says MercyOne North Iowa's Schlader, "there are not plans to build a labor and delivery center in Albert Lea."

"I think it's great that consumers in the Albert Lea area will have more choices of providers, and maybe additional lines of service that they didn't have close to home before," says Baumgarten. "But I'm not sure that I see this as such a historic moment."