Sunday, May 23, 2010

Two peas in a pod

Two stories with similar themes:

Southcoast -- M.D. Anderson

The Southcoast Hospitals Group in southeastern Massachusetts recently announced an affiliation with the physicians from the M.D. Anderson Cancer Center in Texas. An excerpt:

The M. D. Anderson Physicians Network affiliation is offered selectively to qualified community hospitals and their medical staffs in the U.S. only after a rigorous and extensive evaluation process based on evidence-based treatment guidelines and quality management. This affiliation will enable patients to be treated at Southcoast with the assurance of best national practices in patient care. Because of this relationship the expert staff and physicians of Southcoast Centers for Cancer Care will be able to closely collaborate with M. D. Anderson and bring more than 100 evidence-based treatment regimens for almost every type and phase of cancer to the community.

This, if I may say so, is big news and a coup for the folks at Southcoast. No one can doubt the expertise now being brought to New England by the M.D. Anderson doctors. Another quote from the press release:

By building a strong community program with access to the nation's top-performing cancer program, we are assuring our community advanced care and clinical outcomes. We want our patients to rest assured their treatment plans are being measured against proven benchmarks with great outcomes and quality oversight.

In a previous blog post, I discussed the difference between zero-sum competition in the health care marketplace and competition that adds value for the community. Here, Southcoast has traded on the perspective and expertise offered by an out-of-region center to add benefit to its patients.

Let's note that the relationship requires no purchase or transfer of assets, nor transfer of control that undermines the local ownership or authority of the independent Southcoast system. While there are certainly business terms that require compensatory payment for services rendered, the context is one of a respectful and collaborative clinical relationship.

Anna Jaques -- BIDMC

Last week, Anna Jaques hospital in Newburyport announced a clinical affiliation with BIDMC. Here's an excerpt from Katie Farrell Lovett's story in the Daily News:

Under the affiliation, Anna Jaques will remain an independent, nonprofit hospital, but any "holes in the services" at the hospital will be filled through the new relationship with Beth Israel Deaconess, and services will be strengthened, beginning with specialty cardiovascular care and high-risk pregnancy care.

The origin of the relationship was a strategic review by Ana Jaques in which the community expressed a desire for the local hospital to supplement its service offerings by creating a partnership with an academic center.

CEO Delia O'Connor . . . stressed that the affiliation will not change the role of the Newburyport-based community hospital.

"Anna Jaques is staying Anna Jaques," she said. "This is not a business merger or change in ownership. We're not being taken over by a big Boston hospital."

As I mentioned below, our business plan is to look for community-based partners -- hospitals and physician practices -- for whom we can respectfully help to deliver coordinated care. Ownership, takeover, and reduction in local control is not our goal.

We do not foreclose the possibility that a community-based organization might seek corporate integration in addition to a service-based collaboration. But, even then, we would want an assurance, based on actual experience, that a corporate restructuring is based on a successful record of clinical integration and respectful relationships between our physicians and other staff.


Anonymous said...

A benefit to patients would be transparency in reporting of shared patients and procedures. Tracking metrics systematically and publicly allows testing that such relationships benefit community hospital patient care, not just the financials.

Anonymous said...

The MD Anderson deal makes no sense to me. It is a bizarre artifact of that hospital competing with a Dana Farber-allied hospital, and has nothing to do with how to sensibly arrange specialty care. In coverage of the deal the Globe suggests that some patients may end up going to Houston for care. That is flat-out nuts if it is more than a very few with very rare conditions (i.e., the kind of folks who might be sent from Dana Farber to MD Anderson just because of a particular expertise that exists at MD Anderson that doesn't at DFCI), and it can't be good for patients, families, care coordination, inpatient to outpatient transitions, etc. There is no reason that oncologists couldn't make alliances closer to home. And those folks needing special care could be sent to any number of tertiary care centers with oncology expertise in Massachusetts or Rhode Island, or even Connecticut or New Hampshire if you really want to go far afield, or Sloan Kettering for that matter--no reason except healthcare marketplace jockeying that has little promise of significantly improving patient care compared to what actual rational allocation of healthcare resources might accomplish.

(This is not a comment on the Anna Jaques deal which seems totally reasonable.)

Engineer on Medicare said...

What does an affiliation such as Anna Jaques with BIDMC mean with respect to referrals for specialty care. For example, Mass General and Brigham & Women's are rated more highly in the US News rankings for heart and heart surgery. (For purposes of this discussion only I shall assume that those rankings are valid indicators of probability of successful outcomes.)

If a cadiovascular patient needed a semi-urgnet referral, would the Anna Jaques cardio physician refer to BIDMC, and what influence would the patient have in that decision. If the patient said "I want to go to Brigham and Women's", how would that affect his relationship to his Anna Jaques cardio physician and would the Brigham cardio department be as receptive to the referral as would the cardio department at BIDMC?

Anonymous said...

Anon 1:54;

I confess my initial thoughts were similar to your own. However, I know several people, many being physicians, who won't go anywhere but the Mayo Clinic for treatment, and I live about 700 miles from Minnesota. Another friend went to the Cleveland Clinic for his mitral valve repair despite the presence of at least 5 local centers with (lesser) MVR experience. The Clinic had an impressive system for returning the patient to and communicating with his local physicians.

Perhaps it has something to do with the fact that the community hospital can access Anderson's undisputed expertise and not have its patients stolen. In this age of digital transmission of images and other data, there is no reason tertiary care/advice can't be administered from afar - and it might generate true price competition, which is well known to be needed in Boston.

Maybe someone should ask the hospital why they picked Anderson...

nonlocal MD

Anonymous said...


The affiliation does not and cannot require referrals to BIDMC.