Public comments filed on a proposed merger and acquisition pact in Massachusetts reflect the breadth of consolidation debates raging across the country.
Is bigger always better?
That question has triggered an avalanche of controversy in Massachusetts, where the largest health system in the state is seeking to get larger.
Partners HealthCare, which is the top private employer in The Bay State with about 60,000 workers and a dozen hospitals in its provider network, is a not-for-profit health system based in Boston. It was founded 20 years ago by two of the most prestigious academic medical centers in the country: Massachusetts General Hospital and Brigham and Women's Hospital.
Partners' quest to acquire three more suburban hospitals has drawn fire from insurers and other critics, who are pressuring Massachusetts Attorney General Martha Coakley to toughen an anti-trust settlement deal she cut with the health system in May.
The pact includes price caps and growth limits on Partners for several years. On Sept. 25, the AG filed a revised version of the pact in Suffolk Superior Court, and Judge Janet Sanders set an Oct. 21 deadline for the public to file comments with Coakley's office.
Former CMS Administrator Donald Berwick, MD, made his view of the deal public in an opinion piece published by the Boston Globe Oct. 19: "You don't have to be an antitrust lawyer to predict the consequences of even more market power: higher prices, less competition, and the squeezing out of smaller players." Coakley, a Democrat, is in a tight race for Governor of Massachusetts. Berwick challenged her in the primary for the party's nomination.
The public comments provide a snapshot of the arguments for and against Partners' consolidation effort, which features the acquisition of South Shore Hospital in South Weymouth as well as Hallmark Health System's hospitals in Medford and Melrose. The public comments also reflect themes common to debates over health system consolidation efforts across the country, with supporters highlighting benefits such as financial stability and detractors raising alarm over higher healthcare costs and monopoly risks.
Settlement Supporters
Mark Haas, director of health information management at South Shore Hospital, makes a spirited defense of the settlement deal. The IT expert, who also teaches budgeting and management as a member of the Tufts University School of Medicine, wrote that he had recently joined the South Shore Hospital staff after working for eight years at Mass General.
"There is a significant need for deep investment in the infrastructure—information systems in particular," he wrote. "SSH would benefit significantly from the advanced electronic health record technologies in place at Partners and be better able to keep up with the newest technology opportunities. If SSH could begin to utilize the electronic health record system in place at Partners, the coordination of care can occur with far fewer resources being utilized."
Hass contends that the merger would reduce healthcare costs at South Shore Hospital. "I have grown to appreciate how vital primary care is to keeping costs down in the US healthcare system. The SSH community desperately needs access to a network of community primary care physicians that can seamlessly communicate with the specialists in the area as well as the hospital and emergency room."
State Sen. Jason Lewis, (D-Winchester), chairman of the Joint Committee on Public Service, wrote that the settlement deal would help ensure the financial future of Hallmark Health and its hospitals.
"The proposed merger of Hallmark Health and Partners HealthCare is an excellent opportunity for Hallmark Health to remain a viable provider of quality health care in its core communities," he wrote. "Specifically, Partners HealthCare will be able to provide primary and secondary healthcare in Melrose, Stoneham and Medford at more affordable sites… than in Boston; and the volume of patients from Partners HealthCare will help Hallmark Health achieve operational sustainability in a lower-cost health care environment."
In an email exchange with HealthLeaders, Lewis said state officials are determined to make sure Partners does not gain monopolistic advantages over its competitors and healthcare payers. "That could be a risk, but there are mechanisms in the settlement agreement as well as other tools the state has to prevent that from happening," he said.
Melinda Matthews, VP of clinical services at Lexington-based Eliot Community Human Services Inc., defended Partners' plan to consolidate mental health services in the North Shore region of the state. The mental health consolidation plan, which is included in the settlement pact, includes boosting mental health services at North Shore Medical Center Union Hospital and moving acute care services at the Lynn facility to North Shore Medical Center Salem Hospital. The hospitals in Lynn and Salem are already part of the Partners family.
"Eliot often collaborates with (Partners HealthCare) and affiliates to coordinate care and improve service delivery," she wrote. "Eliot believes that the proposed agreement to create a Center of Excellence in Psychiatry and Behavioral Health at Union Hospital along with maintaining current service levels is a crucial and important commitment that is necessary to preserve and enhance treatment and services for individuals living in the North Shore area."
Consolidation Critics
Morton Heafitz, MD, a retired physician who served as president of a Medford-based surgical practice, wrote that advocates of the Partners settlement are overstating the deal's financial benefits.
"All of us were accredited cardio-thoracic surgeons by appropriate medical societies that served as consultants 24/7 at more than 20 hospitals… We cared for patients in their communities for a fraction of the cost of (Boston-based) hospitals. True, we did not do transplants, but did participate in resident training and research—the supposed reason for high-cost surgery—but the results were just as good if not better than utilizing these institutions as way stations for inaccessible [Boston-based] monopolies."
Heafitz calls on Judge Sanders to take a stand for community-based care: "I urge you now as someone who appreciates community needs to deny Partners this unnecessary monopoly and monetary waste."
Katerina Panagiotakis Koudanis is the founder and leader of Union Hospital Advocates, a community group that opposes Partners' plan to convert NSMC Union Hospital to a psychiatric facility. She says the group has about 100 active members who live in Lynn, Lynnfield and Saugus.
"We're devastated at the decision," she said of Partners' plan for NSMC Union Hospital. "We've had a community hospital in Lynn since the 1800s."
Koudanis filed two public comment letters at Coakley's office this month. One letter challenges determination of need proceedings related to NSMC Union Hospital.
The second letter contends that the relocation of acute care services to NSMC Salem Hospital places a potentially dangerous and costly burden on Lynn residents, namely an increased reliance on ambulance service.
"It will be tragic," she said in an interview this week. "To access Salem Hospital, it's almost impossible to reach the hospital during rush hour."
Koudanis says many Lynn residents cannot afford to take an ambulance to Salem Hospital and will choose to drive themselves, even in an emergency. "The median family income is $44,000. A lot of people don't have insurance," she said.
Koudanis said she has embraced the underdog role in a David versus Goliath struggle: "I'm not afraid of saying what's right."
Representatives for both Partners and Coakley declined to comment for this story, stating that their stands on the settlement deal are in documents filed at Suffolk Superior Court.
"Representatives for both Partners and Coakley declined to comment for this story, stating that their stands on the settlement deal are in documents filed at Suffolk Superior Court."
Christopher Cheney is the CMO editor at HealthLeaders.