hospitals

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Quincy Medical Center Closing At Year’s End

After years of struggling to balance the books, Quincy Medical Center will close at the end of the year.

Steward Health Care says it is losing nearly $20 million a year at the hospital. It just doesn’t have enough patients — on any given night there are about 40, leaving 80 percent of the beds empty.

The latest setback for Quincy began in 2011, when the large Harvard Vanguard center in Quincy cemented relations with Beth Israel Deaconess Medical Center and began referring most patients to BIDMC Milton or the main BIDMC campus in Boston

Most of the patients who still come to Quincy use the emergency room, are treated and go home without being admitted. Steward plans to open a stand-alone emergency facility and an urgent care clinic sometime next year to handle these patients.

The hospital employs 680 workers. Steward has jobs open for 80 percent of them, says Steward Hospital Group president Mark Girard, with many of those jobs in Quincy. Continue reading

‘Good Death’ Still Eludes U.S. Health System Despite Decades Of Debate

reclaimedhome/flickr

reclaimedhome/flickr

By Richard Knox

Death is back in the news again. And it should be.

Death comes to us all. And in the U.S. at least, it’s increasingly likely to be inhumane, institutional and full of misery. That’s according to a growing body of evidence, including:

•A report last month from The National Institute of Medicine called “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” It’s a 500-page indictment of U.S. end-of-life care.

•A new book by Boston writer-surgeon Atul Gawande on the subject called “Being Mortal: Medicine and What Matters in the End.”

•And recently, a must-read New York Times article — a powerful case study of how the American way of death has gone badly awry.

From these and other sources, one thing is clear: Too many Americans are still dying in hospitals and nursing homes; getting aggressive but futile care; and suffering more from the complications of treatment than from the pain of dying.

And with about 10,000 Baby Boomers turning 65 every day, it’s way past time to do something about it. “What is it going to take to ensure that patients in this country are receiving the right care at the right time in the right location, consistent with the right to choose?” Dr. Joan Teno wonders. “These are the things that keep me up at night.”

Teno, a Brown University faculty member, is among 21 authors of the recently issued Institute of Medicine report on dying in America. Continue reading

AG Deal With Partners Filed In Court: Restricts Growth, Costs

Massachusetts Attorney General Martha Coakley on Tuesday reached an agreement with Partners HealthCare that she says will alter the hospital network’s negotiating power for years to come.

The deal would resolve an antitrust investigation by the attorney general’s office and ultimately allow Partners to acquire South Shore Hospital.

“Our office was the first to shine a light on the ability of Partners to charge higher prices based on its negotiating power,” Coakley said in a statement. “Today’s resolution is the first action of its kind to directly address that market dysfunction.”

But many in the health care industry say they’re frustrated and angry about the process.

The Rev. Burns Stanfield, president of the Greater Boston Interfaith Organization, says the group is disappointed the agreement bypassed the state’s Health Policy Commission

“A proper review would need to have the agreement available before it is submitted to the judge, and for the Health Policy Commission to be invited to weigh in,” he said.

Continue reading

No Court Filing Yet In Partners Deal To Expand

WBUR’s Martha Bebinger reports that a negotiated agreement that would have let Partners HealthCare expand to include South Shore and three other hospitals is on hold.

Partners and Attorney General Martha Coakley had planned to file a deal in court Monday that the AG said would curb Partners’ market clout.

But a spokesman for the AG says “both sides are continuing to negotiate based on the agreement in principle announced last month.”

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

The deal would have capped Partners expansion through 2020 after the network, which is already the largest in Massachusetts, was allowed to add the four hospitals and 550 more physicians. Partners had agreed to limit reimbursement increases to the cost of inflation, also through 2020.

But the agreement was criticized by competing hospitals who said it would lead to higher costs. Insurers, consumer groups and employers have asked to review the details before a deal is final. The AG’s office says it expects to allow public comment, although it’s not clear how.

The parties have not set a new date for a filing a final agreement.

Partners Showdown: Hospital Coalition Wants More Scrutiny Of AG Deal

A group of Massachusetts health care providers is asking Attorney General Martha Coakley (who also happens to be running for governor) to make public details of a deal which will allow Partners HealthCare to acquire three hospitals.

WBUR’s Dan Guzman spoke with Tufts Medical Center CEO Michael Wagner, who says the deal would have a big impact on the state’s health care marketplace. “The concern is that Partners is a system that has currently three times of the size of any system in Massachusetts,” he said. “With the proposed AG deal, this would take it to four times the size of the next largest system.”

The coalition also includes executives from Beth-Israel Deaconess Medical Center and Lahey Health. The deal, which would allow Partners to acquire three hospitals — South Shore, Melrose-Wakefield and Lawrence Memorial — in exchange for implementing certain cost-cutting measures, could go to a judge for approval as early as next week.

partners

Guzman also talked to Richard Copp, a spokesman for Partners, who said that for more than two years, there has been a process which has been transparent in the media and followed state regulations for this deal. Copp added that Partners believes the deal will result in more coordinated care and rein in cost growth for health care and that the health care system has followed the state process — there have been hearings and meetings, and Partners has followed the law.

Here’s the full press release from the coalition:

Healthcare providers across Massachusetts including Atrius Health, Beth Israel Deaconess Medical Center, Cambridge Health Alliance, Lahey Health Systems, Tufts Medical Center and other hospitals and physician groups have formed a coalition calling for a public process around the recently proposed settlement between Partners HealthCare and the Attorney General.

“Although we are competitors, we have joined together to draw attention to the threats posed to the Massachusetts healthcare system by the proposed deal between the Attorney General and Partners HealthCare,” said Howard Grant, JD, MD, president and chief executive officer of Lahey Health. “Members of the public, as well as healthcare providers, have received little information about this deal, though it will permanently transform how we deliver and receive healthcare. The proposal was crafted without the input of, or review by, the patients, doctors, nurses, caregivers, policymakers, employers, and other stakeholders who have worked so hard to reform the healthcare system.”

Coalition members yesterday delivered a letter to Attorney General Martha Coakley outlining concerns about the “significant and deleterious impacts” the proposed deal would have on the “entire Massachusetts marketplace” and raising questions about why the settlement proposal bypassed the Health Policy Commission’s Market Impact and Cost Review process. Continue reading

Report: Fewer Infections Overall At Mass. Hospitals (But Problems Remain)

(UCI Irvine/flickr)

(UCI Irvine/flickr)

For the most part, patients are contracting fewer infections inside Massachusetts hospitals — but some problem spots remain, according to numbers from the state’s Department of Public Health.

WBUR’s Martha Bebinger reports:

It’s almost impossible to compare the quality of specific hospital procedures, but you can make a few hospital system comparisons.

For instance, the latest data show lower rates for three types of hospital infections — central line and surgical site infections for hysterectomies and colon operations. On the other hand, rates for urinary tract infections from catheters have increased.

Still, required reporting is spurring change, says Patricia Noga, VP for Clinical Affairs of the Massachusetts Hospital Association.

“When there is reporting and particularly when there is public reporting, people stand up and take notice of it,” Noga says. “Sometimes more than they would otherwise.”

Here are some specifics from the state Center for Health Information and Analysis:

•Central line-associated blood stream infections in Massachusetts have declined by 47%. In Massachusetts’ Intensive Care Units and neonatal ICUs, [such infections] declined by 57% and 49%, respectively.

•Surgical site infections related to abdominal hysterectomy declined by 23% in Massachusetts hospitals. While 8% of reporting hospitals had an observed to expected ratio greater (worse) than the national ratio, overall Massachusetts’ improvement is on track with positive national trends.

•Surgical site infections related to colon surgery declined by 19%. Massachusetts’ ratio of observed to expected infections is in line with the nation’s.

•Catheter-associated urinary tract infections have increased by 45% in the Commonwealth. In Massachusetts ICUs, [these types of infections] have increased by 64%. Among reporting hospitals, 15% had an observed to expected ratio greater (worse) than the nation’s. Massachusetts significantly lags national performance on this measure.

Continue reading

Restraining Partners? Rampant Speculation On A Deal In The Works

What’s up with that Partners-South Shore deal?

This question has come up in every conversation about hospitals in Massachusetts for the past three to four months, at least.  It’s important because the final resolution will be a benchmark for future hospital mergers, acquisitions and partnerships in Massachusetts and beyond. And it may finally address complaints that Partners Healthcare hospitals and doctors are paid more, in some cases much more, than most of their competitors.

If you’ve (understandably) lost track, here’s a recap:

partnersPartners announced plans to acquire South Shore Hospitals in June 2012.

The state’s Health Policy Commission concluded the deal would increase costs $23-$26 million a year.

Partners countered, saying that adding South Shore to its network, currently the largest in the state, would save $27 million a year.

The commission stuck to its original findings and sent a report to Attorney General Martha Coakley.  She, along with the U.S. Department of Justice, have been looking at whether Partners exploits its size and market clout to drive up health care prices and all of our premiums.

There are lots of theories about why we haven’t heard anything since Coakley acknowledged in March that she was in talks with Partners and South Shore.  Is there an impasse?  Are federal regulators clogging up the works?  What kind of pressure is Coakley (who is also running for governor) facing? I’ve heard all kinds of theories. Feel free to add yours below.

Coakley told the South Shore Chamber of Commerce last week that she expects to complete her review of the deal in a month or two.

Working with the Department of Justice, Coakley could sue to try and block Partners from bringing South Shore into its system.

But a deal that would limit Partners clout seems more likely. So what should it include?

Here’s where my random conversations with doctors, hospital executives and patients gets really interesting. The virtual water cooler chatter includes these possible scenarios:

1. Partners can add South Shore — and that’s it.  No further expansion for, say, five years or so (the time frame varies from three to 10 years). Keep in mind, Partners has already announced plans to acquire two North Shore hospitals after the South Shore deal is done.

2. Partners can add South Shore, but it must sell off another hospital of equivalent size or scope. Continue reading

Report: In Mass. Health Care, System Skewed So Rich Get Richer

A report released today by the Healthcare Equality and Affordability League (H.E.A.L.) — a partnership between the for-profit Steward Health Care System and the union, 1199 SEIU United Healthcare Workers East — finds that disparities in hospital costs and financing across the state are driving “a vicious cycle” of inequality in health care.

The result, according to this analysis, is that medical care is becoming less affordable for lower-and middle-income families in Massachusetts, and the disparities in hospital financing are “compromising the viability of community hospitals.”

The group is calling for new, and what they call more “fair” reimbursement rates so that poorer, community hospitals (with a greater proportion of Medicare and Medicaid patients compared to the higher-cost Boston teaching hospitals) can continue to serve the lower-income patients, among other financial recommendations.

David Williams, president of the Boston consulting firm Health Business Group, who was paid by H.E.A.L to research and co-author the report, says: “What hasn’t been demonstrated before is what impact these financing disparities have on communities and community hospitals.”

He notes: “The hospitals that have the highest percentage of publicly funded patients, they get paid less, but in addition to that, those hospitals also get the lowest commercial rates — because they’re not in as strong a position to negotiate — so that means that they’re doubly disadvantaged…it means that the hospitals serving middle-class and lower income communities don’t have the resources to compete effectively with those hospitals that get higher reimbursements.”

Clearly, the group’s recommendations would benefit the Steward-owned hospitals, Williams acknowledges, but, he adds: “it would also help with the state’s overall approach to cost containment.

I asked Nancy Turnbull, an associate dean at the Harvard School of Public Health, to take a look at the report and here’s what she had to say:

…This report looks to be raising critical issues regarding payment disparities. We’ve known for years, from the work of the [Attorney General], [Center for Health Information and Analysis] and others that these disparities exist and are, in many cases, getting worse. So far, we’ve done little to address them, and the effect these disparities have on lower paid providers and the patients for whom they care. However, I don’t think the solution is, in most cases, to just increase the rates of payment for poorly paid providers, although that is a needed action for some. We also need to talk about reallocation of existing payments, and about costs. I am supportive, to some extent, of giving consumers reasonable financial incentives, based on their income, to use lower cost providers—although lower paid is not the same as lower cost–but we also need approaches that are systemic. Consumers in tiered and high deductible health plans aren’t going to solve this problem without tough action by state government and other payers, including, in my opinion some regulation of rates of payment. And most tiered networks available so far are regressive — they impose higher costs on lower-and moderate-income people. They address one form of inequality by creating another.

Among the findings, according to the H.E.A.L press release:

“The rich get richer as highest cost hospitals attract a greater proportion of patients with commercial insurance, which have higher reimbursement rates than Medicare and Medicaid.”

(H.E.A.L report)

(H.E.A.L report)

–“Patient migration for routine care from community hospitals to high cost Boston teaching hospitals increases total medical costs and contributes to higher premiums for all individuals and families with commercial insurance (non-Medicare nor Medicaid). Additionally, low-income patients, forced to travel greater distances to receive routine care are more likely to forgo treatment until conditions become acute and require more expensive interventions.”  Continue reading

New Home Birth Data: Numbers Rise A Bit, Controversy Remains Unchanged

A new CDC analysis of trends in out-of-hospital births from 1990-2012 found that home births are on the rise — but only a tiny bit.

The federal agency reports that 1.36 percent of U.S. births occurred outside a hospital in 2012, up
from 1.26 percent in 2011. Those new numbers mark the highest level of non-hospital births since 1975, according to the CDC.

In terms of actual births, that means 53,635 births in the U.S. took place out of a hospital in 2012, including 35,184 home births and 15,577 birthing center births, the CDC says.

(Source: CDC)

(Source: CDC)

Here are some more findings from the CDC news release:

• In 2012, 1 in 49 births to non-Hispanic white women were out-of-hospital births;

•The percentage of out-of-hospital births was generally higher in the northwestern United States and lower in the southeastern United States;

•Out-of-hospital births generally had a lower risk profile than hospital births.

Continue reading

Responding To Relman: ‘Spaulding Gave Charlie His Recovery’

Yesterday we linked to Dr. Arnold Relman’s gripping near-death story of breaking his neck last summer, and the medical odyssey that followed. In it, Relman, the former editor of The New England Journal of Medicine, lavished superlatively high praise on Massachusetts General Hospital, where he was initially treated, but was much more critical of Spaulding Rehabilitation Hospital in Cambridge, where he spent about a month recovering.

That critique left some Spaulding patients (and their families) feeling perplexed and a bit slighted. Jeanette Atkinson, the wife of former Spaulding patient Charlie Atkinson, asked for space to offer another perspective.

Charlie Atkinson, 78, at home, is still recovering from West Nile Virus. (Courtesy)

Charlie Atkinson, 78, at home, is still recovering from West Nile Virus. (Courtesy)

Charlie was the subject of a recent CommonHealth post: West Nile Story: 400 Days In Hospital, A New View Of Health Care (And Life)

Jeanette submitted this “rebuttal” after reading Relman’s piece:

My husband, Charlie Atkinson, and I are in a particularly good position to respond to Dr. Arnold Relman’s article, “On Breaking One’s Neck,” since Charlie recently spent five weeks at Massachusetts General Hospital and thirteen months at Spaulding Long Term Acute Care Hospital in Cambridge and received spectacular care at both.

MGH saved his life. As Charlie (age 76 at the time) fell into a deep coma in August, 2012, doctors there inserted a breathing tube, started a ventilator, administered oxygen and drugs, inserted catheters, ordered tests, and worked around the clock to diagnosis his illness – which turned out to be West Nile virus of the most devastating kind.

After three weeks in Mass General’s intensive care unit and two in the respiratory acute care unit, he was stable enough to be discharged – but to where? He was tethered to respiratory machinery; he was almost completely paralyzed; he knew his name, but not where he was; and he would never have been able to maintain the rigorous physical therapy schedule at a place such as Spaulding Rehabilitation in Boston. He was still far too sick to be admitted to a regular nursing home/rehabilitation facility.

Spaulding Hospital, Cambridge, gave him his recovery. We’d never even known of the existence of “LTAC’s,” or Long Term Acute Care hospitals. Their range of services is much more limited (and far less expensive) than those of full service hospitals such as MGH, and much more focused on helping patients achieve a maximum quality of life while treating their on-going medical problems. Spaulding, Cambridge does that superbly. Continue reading