This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.
Basically what you have inside of Partners is two distinct provider systems with Mass General owning the markets north and west of Boston while Brigham & Women's dominates the markets south of Boston and Cape Cod. The system as a whole is not "clinically integrated" and they really only act together in terms of keeping overhead low, information systems and of course contracting with insurers. Very bold move given that South Shore is still under review.
It looks like this is, at least partially, disigned to hurt Lahey Health and its network specifically Beverly and Winchester hospitals. Investing $200 million in Salem Hospital, puts pressure on Beverly Hospital which is nearby. The upgrade to Hallmark - $300 million - pressures winchester, and Lahey Hospital itself. Even more nefarious, while behaviorial dependence and chemical abuse hospital beds are in short supply, one of the few areas to have such a hospital is Lynn, where Partners proposed to convert Union Hospital into a behaviorial and chemical abuse site. BayRidge Hospital (part of Lahey Health and Beverly hospital) provides substance abuse and mental health treatment. So all parts - Salem ($200 million), Hallmark ($300 million) and Union conversion (430 to 40 million) of Partners investment puts financial pressure on lahey in greatly increase investment. How does an investment "arms race" lower cost of consumers? Lahey, Beverly, winchester invest, so other neighbors must compete - if they can!What happens to Cambridge Health Alliance(and specifically Whidden, Lowell General, Lawrence General etc. More likely they realize they can not compete and a number of them go under. To evaluate impacts we can't just look at Hallmark, but it's neigbors. Personally, I am concerned!
There is another aspect of this not stated in any of the news stories I have seen.In Massachusetts academic medical centers like MGH, can no longer invest large amounts in areas outside of boston or their "main campus". [I think the limit is or was $30 million but don't hold me to it, could be a little higher or lower.]This was an important part of MGH's strategy in the past with large outpatient centers in Waltham, Chelsea, a partnership with North Shore Med Center in Danvers, and the Partners Center in Foxboro. Now it looks like MGH gets to build two more huge outpatient centers in "prime locations" at the former Union Hospital site, the confluence of Rt 128 and Rt 1 and at the Hallmark Medford site near Rt 93. Now MGH gets to build two more huge sites north of Boston by calling it "conversion" of a hospital rather suburban expansion by an academic medical center. These investments in the suburbs should be subject to the same regulatory review as if MGH suggested new outpatient centers - which they are. MGH is planning to invest over $500 million in on the north shore, a significant portion for these outpatient centers, surely more than the current limit. The state passed to law to protect suburban hospitals from poaching by prestigious academic medical centers. If they let this Hallmark purchase happen along with the rest of MGH's north shore plan, they will have abdicated this responsibility.
If MGH/Partners converts two of its hospitals to outpatient centers - at in Lynn and Medford - (which generally aren't counted when Hospital networks are evaluated, but if they large outpatient centers can serve a similar service for academic medical centers - they control the patient who is eventually funneled more patients into Boston for tertiary care. ) Does that make it easier for Partnters to gobble up other community hospitals like Emerson or Milford etc, where Partners controls large physician groups?This needs serious review by the authorities!
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