Oregon Health & Sciences University said this week that it will seek to join forces with Legacy Health, a business move that would dramatically reshape the Portland health care market.

The proposed hospital behemoth would employ more than 32,000 people, according to OHSU, making it the largest single employer in the Portland region. Its footprint would stretch across more than 100 locations, including 10 hospitals. An approved merger would effectively shut down Legacy Health and absorb its operations under OHSU.

The impact of this transformation on patients and health care providers is likely to be profound, though details remain scant.

Here’s what know at this time:

When will the proposed merger be complete?

The two hospital systems say they plan to finalize the merger before the end of 2024 but have not offered a more detailed timeline. OHSU has reportedly committed $1 billion into the merged entity over the next decade.

What entities will review or oversee it?

Any final agreement reached between OSHU and Legacy will require regulatory approval from the Oregon Health Authority, Washington Health Department and the Federal Trade Commission. Issues they’ll consider are market share and whether a merged entity might violate antitrust law.

The Oregon Health Authority’s Health Care Market Oversight program reviews health care business deals in the state, including mergers and acquisitions, to ensure they promote health equity, lower consumer costs, increased access and better care. The program has yet to receive a proposed plan from OHSU and Legacy, spokesperson Amy Bacher said. The hospitals must do so at least 180 days before a transaction closes.

Why is this happening now?

Legacy, the largest hospital chain in Portland, lost a catastrophic $172 million in its 2023 fiscal year, raising questions about its viability.

It has faced other challenges too. Legacy alienated employees at its Legacy Mt. Hood Medical Center when it announced it was closing the facility’s birthing center. More recently, a security guard at Legacy Good Samaritan Hospital in Northwest Portland was shot and killed by a disgruntled visitor.

On Thursday, The Oregon Nurses Association said in a statement that it supported the merger.

“Over the past few years, we have seen significant failures on the part of the Legacy Health System, including, most recently, the attempted closure of the Family Birth Center at Legacy Mt. Hood, and horrific acts of violence in the workplace at Legacy Good Samaritan,” the statement said. “ONA does not have any faith in Legacy’s management, so a merger with a public institution like OHSU – which will come with more requirements related to transparency and accountability – is likely to be in the best interests of Legacy’s patients and their 13,000 staff members.”

Will Legacy rebrand or remain known as Legacy?

According to the letter of intent signed by both hospital systems, the parties “will work together in good faith to develop a strategy for appropriately branding the system as a whole and individual facilities comprising the system, including retaining the Legacy name for its existing facilities in some or all branding for at least some to-be-determined period.”

What is expected to happen to the Legacy hospital workers and administration?

Neither hospital system has provided much detail at this time. Company mergers often result in administrative or management layoffs. Per the letter of intent, physicians, advance practice providers and all other workers will remain retained by the current employer at the time the deal is finalized.

The Oregon Association of Hospitals and Health Systems on Thursday said it did not have information about how prior hospital mergers in the state have impacted system staffing levels and headcounts.

Will Legacy patients be able to continue to see their doctors?

Legacy and OHSU both will continue normal operations throughout the duration of the merger. The hospitals say they “do not expect any changes” to insurance carrier relationships once it’s complete.

What other impacts might this proposed merger have on patients and providers?

Studies have typically found that hospital mergers can often lead to increased health care costs without measurable improvements in the quality of care, according to a 2020 report by the Medicare Payment Advisory Commission. However, research published in 2021 by the American Hospital Association, an industry group, claimed they drive down costs and increase performance.