And while much of the Steward saga is known among hospital establishment insiders, a few fresh details emerge here. The piece begins this way:

CHRIS HOPEY, THE president of Merrimack College, brought an intriguing proposal late last year to his board of trustees: Steward Health Care, the upstart, for-profit hospital chain that is challenging some of the biggest players in the Massachusetts health care industry, wanted to transfer Carney Hospital in Dorchester to the North Andover school.
Three sources familiar with the hush-hush discussions say Hopey told the board members that Steward was looking to unload Carney and Laboure College, a nursing school attached to the hospital that is also owned by Steward. Merrimack was seen as a potential match for the hospital and the nursing school because the college is interested in getting into the health care education field. Merrimack is also Catholic, making it a good fit for a hospital that formerly was part of the Boston Arch­diocese’s Caritas Christi hospital chain.

But Steward’s overture to Merrimack raised a lot of questions. Why did Steward want to unload Carney, a hospital it acquired only a year before? Was Steward’s focus on community-centric health care unraveling? And could Steward legally transfer Carney to someone else? When Steward purchased the Caritas chain of six Massachusetts hospitals in October 2010, the Boston-based company agreed not to close, sell, or transfer a majority ownership interest in any of the hospitals for at least three years. Would a transfer to a third party be a violation of the agreement?

The deal with Merrimack never happened, reports Bruce Mohl. But as the piece makes clear, despite some recent glitches — like the tense, controversial departure of Carney’s president, Bill Walczak, after he served in the post for just over one year — Steward is forging ahead with a multi-faceted plan toward profitability, as well as dominance in the region.

Mohl writes:

Steward is also running full-page newspaper advertisements trumpeting the savings available with its limited network health plan. The ads emphasize the Steward name rather than the names of the company’s individual hospitals and represent an attempt to build a new brand associated with savings and quality care.

To steer more patients to its hospitals, Steward is aggressively adding doctors to its physician network, in several instances wooing them away from the networks run by Boston’s big teaching hospitals. “The number one driver of where a person goes for care is the recommendation of their physician,” Murphy says. To attract more patients, Steward is adding doctors to its physician network, wooing them away from the big teaching hospitals.Dr. Mark Girard, president of the Steward physician network, say his stable of doctors has grown 150 percent since January 2010, rising from 1,000 (400 directly em ployed by Steward) to 2,500 today (600 directly employed by Steward). Officials at other hospitals, some of whom have lost doctors to Steward, say the company is offering a myriad of financial incentives to physicians, including income guarantees and, in some cases, lavish salaries. But concrete examples could not be documented, and Girard says such tales are overblown.

Girard says doctors are joining with Steward because the company offers them a number of ways to keep care in their local communities and improve their profit margins. A Steward-owned medical malpractice insurer offers lower rates. Grant and infrastructure money provided by Steward allows doctors to install electronic medical record systems at virtually no cost, Girard says. A Steward call center can handle appointments, scheduling, and other grunt work that previously was handled by workers in a doctor’s office.

The Whittier Independent Practice Association in New buryport, a group of 150 North Shore doctors, dropped its affiliation with Beth Israel Deaconess and joined Steward late last year. Whittier was followed a month later by the 90 doctors of Compass Medical, which operates practices on the South Shore and had been associated with Partners. Sources say a key factor in their defections was a global payment contract Steward had signed with Blue Cross Blue Shield of Massachusetts.

The Blue Cross contract capped what Steward would receive for providing care to patients, but the cap initially included a hefty growth factor, meaning Steward would receive more money for its care than it did the previous year.

A note on the illustration above, used by permission: You can see more of artist Yuta Onoda’s work here.

If the sale of Caritas Christi’s six hospitals to a private equity firm goes through it will trigger major changes in the hospital marketplace in Massachusetts as we’ve reported here. Paul Levy at Beth Israel Deaconess Medical Center (and other hospital executives who will be affected) are scrutinizing quotes as they speculate about possible changes. Levy wonders, for example, if there are signs that Caritas might seek an affiliation with Partners, the state’s largest hospital network and if Partners is signaling interest.

Caritas’ CEO Ralph de la Torre says the Accountable Care Organization (ACO) he plans to create will need to refer some patients to one of Boston’s tertiary hospitals. A few hospital administrators say de la Torre could press to add the brand name Partners’ hospitals to his ACO and that Partners could be tempted to negotiate deep discounts for Caritas.

As Levy points out, an affiliation between the state’s two largest hospital networks would take dominance to a new level; which is why some hospital consultants say it could not happen. The state Attorney General’s office has told Partners that any new affiliations would receive more than the usual scrutiny (notice the standoff approach to overtures from Cambridge Health Alliance). And Partners has to be rattled by the federal lawsuit filed Monday in Michigan.

The Caritas/tertiary affiliation decision, whenever it happens, will say a lot about the network’s priorities: will it go with the best value or the best brand.

Some Caritas supporters are frustrated by warnings that, if the sale goes through, the network will use Cerberus’ cash to prey on competing hospitals and physician groups. They point out that Partners or Beth Israel or both already have physician practices in the Caritas hospital communities and this deal would just give Caritas a chance to compete.

A coalition of community hospitals and a few Catholic groups continue to question (PDF) the merits of the Caritas-Cerberus deal, but it is expected to win approval from the Supreme Judicial Court in the coming weeks.