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The $26 Million Reason To Say ‘No’ To Partners

A merger between Partners HealthCare and South Shore Hospital would increase the state’s health care costs by $23-$26 million a year, according to a report due out today.

That substantial estimate from the state’s Health Policy Commission is based on three factors: more patients funneled to expensive Partners hospitals, higher payments for South Shore Hospital and more money for its doctors.

“Given the rather strange — bizarre some would say — pricing system in Massachusetts, by this merger, South Shore and the South Shore-affiliated doctors would get an immediate increase in their rates,” Stuart Altman, the commission board chairman, said.

(401(K) 2012/flickr)

(401(K) 2012/flickr)

The commission’s estimate, according to a summary of the report, does not include the effects of increased leverage Partners and South Shore could use to demand higher payments. The impact “will be substantial if payers are unable to prevent the exercise of this leverage in future negotiations.”

The report says there is no indication that this merger would improve quality or bring new services to the area.

Partners, which expects to receive the full report today, said the South Shore merger would improve care and lower costs. The state’s largest hospital network will have a chance to respond to the commission’s findings before they are final. Continue reading

Globe Scoop: Health Commission To Advise Against Partners Expansion

Have we entered a new era of tough hospital oversight?

That’s one possible takeaway from a Boston Globe report today that says the state’s new Health Policy Commission will — in a “a rare rebuke” — advise against an ambitious expansion plan by hospital system Partners Healthcare. The proposed acquisition of South Shore Hospital by Partners would “push up patients’ costs and stifle medical care competition in the region,” the Globe reports.

More from the story, by Rob Weisman:

partners

A report by the year-old Massachusetts Health Policy Commission details what might happen if Partners is allowed to acquire the 378-bed Weymouth hospital and a Partners-owned physicians group absorbs Harbor Medical Associates, which has 65 doctors on the South Shore.

It concludes Partners’ South Shore moves would not only increase premiums for consumers and employers and weaken rival providers, but also threaten the state’s ability to hit its overall target for holding down medical spending, according to several people briefed on the findings. Those people spoke on condition of anonymity because the report is not yet public.

The commission, created under the state’s 2012 cost containment law, lacks the authority to block Partners’ moves, but its findings come at a critical time for other regulators who do have that power.

Partners spokesperson Rich Copp said his organization had not yet seen copy of the Commission report, which he stressed is “preliminary.”

But he said: “This preliminary report creates an opportunity to begin a meaningful dialogue with the Health Policy Commission around our vision to reduce health care costs.” Continue reading

Mass. Health Care Shoppers Still Choosing ‘Nieman Marcus Hospitals’

Nieman Marcus in San Francisco (sjsharktank/Flickr)

Nieman Marcus in San Francisco (sjsharktank/Flickr)

If you buy all your clothes at Nieman Marcus, rather than at Banana Republic, TJ Maxx or Target, you’re spending a lot of money. Are the shirts, jeans or navy blue blazers that much better for four times the cost?

We almost never ask ourselves these questions in health care. We go to the most expensive hospitals in Boston for everything from an X-ray to a complex cancer treatment.

That habit means “the biggest hospitals have the highest price and get all of the payments,” said Aron Boros, director of the Center for Health Information and Analysis (CHIA). The result: We spend more money than we need to on routine care with no apparent benefit. The white shirt (say, a gall bladder removal) is of the same or better quality at Land’s End (your community hospital) as at Bloomingdale’s (a big Boston teaching hospital).

Boros just released the latest figures on the gap between hospitals that get paid very well in Massachusetts and those that are (barely) scraping by.

“This is more evidence that the market isn’t changing as rapidly as one would hope,” he said.

More evidence because this is the second report to show that four out of five health care dollars in Massachusetts go to half the hospitals, the most expensive ones. Continue reading

Partners Reports $128 Million In Income For First Quarter

WBUR’s Martha Bebinger reports:

Partners HealthCare, the state’s largest health care system and largest private employer, had $128 million in income for the first quarter of the fiscal year, down from the same period last year. Income from operations was up but did not offset a dip in returns on investments. Some competitors and lawmakers wonder if Partners, despite recent concessions, still earns too much. Partners CFO Peter Markell says the question is, what should Partners stop doing?

“Do you do less in community benefits, do you trim services where you lose money, do you cut back on your research activity, etc.? We weigh those things all the time,” Markell said.

Partners saw an increased number of patients in the first quarter, in part, because it opened a new building at Mass General Hospital.

Here’s The Boston Globe’s report.

Reflections On Late Partners CEO Jim Mongan

James J. Mongan, former president of Massachusetts General Hospital and of Partners Healthcare, died last month of cancer at age 69. Today, mourners gathered at a service at Harvard to share their memories. Among those who spoke was Jack Connors, chairman of the Partners board, who kindly supplied his remarks at WBUR’s Martha Bebinger’s request.

A few excerpts follow. Readers are welcome to add thoughts in the comments below.

Jim and I became partners with a small “p” and what a privilege that was. The trust and mutual respect were very special.

When Jim became CEO of Partners in January of ’03, he had two major goals: Increasing the number of people with access to health insurance and improving the quality of care within the Partners system. He succeeded at both.

Jim was an inspirational leader and folks loved working for and with him. His leadership, his quiet example and his passion for excellence literally changed the culture of how physicians in the Partners system practice medicine.

He had no interest in making Partners bigger. His focus – always – was to make us better. He felt strongly that if we concentrated on better in every aspect of care design and delivery, bigger would follow and once again he was right. Continue reading

Amidst Political Turmoil And Cost-Cutting Pressures, Partners Hires New Lobbyist

Joe Alviani, Partners' new lobbyist

The state’s most powerful hospital system hires a new lobbyist. Here’s the memo from Partners HealthCare President and CEO Dr. Gary Gottlieb:

Dear Colleagues,
Please join me in welcoming Joe Alviani to Partners HealthCare as our Vice-President for Government Affairs (GA). He begins on November 22nd. Joe’s broad and rich portfolio in the public sector will be an invaluable resource and addition to the skills and talents of our GA team. His role will be a crucial one as we build on our strategic plans with a focus on strengthening our relationships with all the key stakeholders in the health care discourse at the state and federal level. Joe will be joining a strong external affairs team that includes Partners Community Health and Public Affairs. These leaders and their teams will work together with the Chief of Staff to coordinate our efforts in highlighting the contributions we make to the communities we serve.

Many of you will be familiar with Joe in his role as Executive Director of the Employers Action Coalition of Healthcare (EACH), an initiative of employers, providers and health plans working together to reduce significantly the rate of increase in Massachusetts commercial health care spending by improving the value of health care services. Partners HealthCare is a founding member of EACH. Joe is president of Alviani and Associates, a Boston firm with a specific focus on strategic counsel to non-profit organizations, government and business. Joe’s group has represented the Massachusetts Life Sciences Collaborative, the New England Healthcare Institute and the John Adams Innovation Institute of the Massachusetts Technology Collaborative to name a few. Prior to establishing his own practice, Joe was senior vice president of Government Affairs at ML Strategies, a subsidiary of the law firm Mintz Levin.

Joe’s ties to Capitol Hill and Beacon Hill run deep. Continue reading

Daily Rounds: Partners Cutting Costs; The Liberal Gene; Vanishing Money And Alzheimer’s; Free Birth Control Under Health Reform

Partners planning reduction of costs – The Boston Globe The state’s largest health care system says it will redesign care for thousands of patients and reduce administrative costs as part of a major new initiative intended in part to make treatment at its teaching hospitals more affordable. (Boston Globe)

Can a 'liberal gene' determine political stance? Researchers say it's so – Los Angeles Times (articles.latimes.com) “[Researchers] reported that ‘it is the crucial interaction of two factors – the genetic predisposition and the environmental condition of having many friends in adolescence – that is associated with being more liberal.’

Alzheimer’s Warning Sign – Money Problems – Vanishing Mind – NYTimes.com New research shows that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements. (The New York Times)

Health Overhaul May Bring Free Birth Control : NPR Fifty years after the pill, another birth control revolution may be on the horizon: free contraception for women in the U.S., thanks to the new health care law…A panel of experts advising the government meets in November to begin considering what kind of preventive care for women should be covered at no cost to the patient, as required under President Barack Obama's overhaul. (npr.org)

Do You Really Need A Doctor F2F?


Dr. Joseph Kvedar wants to talk about Emotional Automation, and I second the motion.

He’s a telemedicine expert and director of the Center for Connected Health at Partners. I’m a regular person who would be thrilled if I could just Skype any checkup that requires no laying-on of hands. But I seem to be atypical. As Dr. Kvedar contemplates why the health care system is so slow to adopt alternatives to costly face-to-face doctor-patient office visits, he writes in a new blog post:

I now think that the primary roadblock is a psychological one. Providers, and to a lesser extent consumers, intuitively believe that quality care means meeting one’s doctor face to face. The main reason for this belief, by both parties, is that a trusting, caring relationship with a provider is thought of as a cornerstone of effective care. While it it undoubtedly true that trust is critical for an effective relationship and that effective relationships with providers lead to improved care (the likely best explanation for the placebo effect), I want to call into question the assertion that these relationships have to be human-to-human or face-to-face.

In fact, he writes, his center’s work has shown that alternatives can be highly effective:

In our own [Congestive Heart Failure] telemonitoring program at Partners Healthcare, we have cared for more than 3,000 patients with CHF using in-home monitoring of weight, blood pressure, heart rate and oximetry. Using this approach, we have seen readmissions drop by 44% and we are able to care for a daily census of 250 patients with 3-4 nurses. Considering that those same nurses, in a certified homecare agency model, would be caring for 4-6 patients daily, the impact of telemonitoring on extending the reach of providers to larger populations of patients becomes evident.

Ah, the academic-style understatement. Yes, the impact of telemonitoring “becomes evident” — as a potentially huge saver of labor and money. He points to another example of a “computerized relational agent” — a virtual nurse who speaks to hospital patients from a bedside screen for discharge planning. Patients “preferred the agent to a health care provider, because she did not talk down to them, was not in a hurry and allowed them to ask the same question multiple times.”
He concludes with a call to action:

Lets call this phenomenon Emotional Automation. Lets start a dialogue about it. Is it far fetched to think that we could parse provider work flow into those actions that truly require a real-time interaction with a provider and delegate others to technology? Can we set up systems that are extensions of our providers that will allow patients to feel cared for by their doctor but be interacting with a piece of software or a robot? How many examples can you come up with? What are the pros and cons of this approach?

Readers, what do you think?

Daily Rounds: Drug Co. Money Flows To Docs; Recalled Walmart Peas May Contain Glass; How To Live To 100; Organizing Boston Hospitals

Docs on Pharma Payroll Have Blemished Records, Limited Credentials – ProPublica “Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs. But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.” (ProPublica)

And here’s another, related story:

Mass. doctors earn drug firms’ dollars – The Boston Globe “While some doctors who gave speeches once or twice during 2009 and 2010 earned $2,000 to $3,000, more than two dozen Massachusetts psychiatrists, endocrinologists, and other specialists who gave frequent talks brought in $40,000 to $100,000 and, in a few cases, more. Dr. Lawrence DuBuske, an allergy specialist, earned the most: $219,775. The Globe reported earlier this year that he resigned from Brigham and Women’s Hospital largely because of its new speaking ban.” (Boston Globe)

Frozen Vegetables Sold at Kroger and Walmart Recalled – Parenting.com “PR Newswire reported that the Pictsweet Company announced a voluntary recall of certain codes of store brand products containing frozen green peas after the company learned that some of the packages may contain glass fragments, which may cause injury if ingested. Products subject to this recall were distributed only to Kroger stores in the Southeast United States and Walmart stores throughout the United States.” (parenting.com)

Personal Health – Three R’s for Extreme Longevity – NYTimes.com Esther Tuttle is pushing age 100. "Her memoir and replies to (a reporter's) queries revealed three critical attributes that might be dubbed longevity’s version of the three R’s: resolution, resourcefulness and resilience. Throughout her long life, she’s taken hardships in stride, traipsed blithely over obstacles and converted many into building blocks. And she has adhered to a regimen of a careful diet, hard work, regular exercise and a very long list of community service, all while raising three children." (The New York Times)

Running a hospital: Tactical update on SEIU Paul Levy on union organizing at Beth Israel Deaconess Medical Center: “There has been a theory circulating around town that this tactical decision to avoid MGH and Brigham and Women's Hospital might have its origins in the personal relationship between the former head of the SEIU and the Chief Operating Officer of PHS [Partners Health System], who served as an Deputy Secretary of Labor under President Clinton. Will SEIU's reluctance to take on the PHS hospitals be put aside now that Mr. Stern has left the SEIU and the COO [Tom Glynn] is leaving Partners?” (Running A Hospital)

Key Executive At Partners HealthCare Steps Down, Heads To Harvard

Tom Glynn is stepping down as Partners COO

Tom Glynn, the longtime chief operating officer at the state’s dominant health care network, Partners HealthCare, will step down at the end of the year to teach at Harvard’s Kennedy School of Government, according to a letter from Partners president and CEO Gary Gottlieb. In addition to his main job as COO, Mr. Glynn, who has been with the organization since 1996, has also acted as an important strategist on political and other critical matters.

Here’s the letter from Dr. Gottlieb, announcing the departure:

Dear Colleagues,

Last year at this time when Partners HealthCare was preparing for the CEO transition, Tom Glynn, our Chief Operating Officer, shared with me his aspiration to return to his greatest passions, public service and higher education. Given the tumultuous environment we faced, I prevailed upon him to stay and help our leadership team through the organizational change ahead.

Now as we move forward with our strategic plans, and as we enter a new fiscal year, Tom has informed me that he is ready to step into the next phase of his career; he will leave his fulltime responsibilities at the end of the year, using the time until then to help with the transition. Tom will be teaching at the Kennedy School of Government at Harvard University and serving as a Senior Fellow for Health Care Delivery Reform at the Center for American Progress in Washington, DC.

Over the last nearly fifteen years, Tom has been a remarkable leader and partner to all four Partners’ CEOs as well as the leaders of all of our member organizations. Continue reading