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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

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

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?