The partnership between financially struggling Cambridge Health Alliance and the Boston teaching hospital Beth Israel Deaconess Medical Center could change where patients at both hospitals get care, and promises to bring more services and prominence to Whidden Memorial Hospital in Everett. The affiliation could also cost jobs in nonmedical areas.
Some Cambridge city councillors worried that the pact would force Cambridge patients to go to Boston for care, but Beth Israel patients could also face changes. The written agreement between Cambridge and Beth Israel calls for both hospitals to make Whidden a “preferred provider” of community hospital services to Beth Israel patients in Malden, Medford, Chelsea, Revere, Winthrop, Everett and “surrounding communities.” Beth Israel patients in the area would be encouraged to use Whidden for emergency care, uncomplicated inpatient services and some diagnostic procedures. Beth Israel would remain available for care, the agreement says.
The two hospitals will also consider establishing a plan for providing all levels of mental health care that makes Whidden the preferred provider of mental health services for all Beth Israel patients. Whidden might also become preferred for providing psychiatric inpatient care to Beth Israel patients living near the Everett hospital, the agreement says. Whidden has 162 licensed beds.
And both hospitals will work to increase the number of primary care doctors in the five communities around Whidden, including possibly adding office space.
As previously disclosed, Beth Israel will be the preferred provider of high-level hospital care to patients of the Alliance. The written agreement also establishes Beth Israel as the preferred hospital for frail, elderly patients in Cambridge’s Elder Service Plan, a program that provides comprehensive care for low-income seniors who would otherwise need a nursing home. A Cambridge spokesman couldn’t say immediately which hospital now cares for those patients.
Despite describing numerous possible “preferred provider” arrangements, the agreement said patients generally would remain free to get care where they wanted, and doctors wouldn’t have to refer patients to any particular hospital or specialist.
Cambridge Health Alliance includes Whidden Hospital and Somerville Hospital as well as the former Cambridge City Hospital in Cambridge. The Alliance and Beth Israel agreed to a clinical affiliation in April after months of talks. State officials did not raise any objection, and the pact should go into effect in about two months.
The Alliance provided a copy of the written agreement in response to a public records request, but deleted a number of sections. Spokesman David Cecere said in an e-mail the withheld material involved “commitments to discuss or explore various future collaborations, some of which may come to fruition, some of which may not. As such, it would be premature to disclose them.”
The Alliance is part of city government, so it is covered by the state law requiring public entities to disclose most records. Cecere said the Alliance was allowed to withhold “strategic discussions and related materials” under an exemption in the 1996 law that established the health system.
That law says the exempted material must involve information that would hurt the Alliance competitively or help a competitor.
Not surprisingly, the affiliation agreement calls for both hospitals to “collectively research opportunities to coordinate administrative duties” to reduce costs and facilitate the clinical links established by the affiliation. The agreement mentioned interpreter services and information technology as candidates for coordination; two other sections were deleted from the public copy.
Cuts and recruitment
Asked about the possibility of job cuts, Cecere said the agreement provides a “very basic and broad framework” for consideration. “It is highly speculative and premature to discuss anything specific at this point,” he said.
Some specifics for medical collaboration were disclosed: the hospitals will recruit dermatologists together, and Cambridge will have a contract to provide dermatology care to Beth Israel; both hospitals will recruit a lung specialist for the Alliance; Beth Israel or Harvard Medical School trauma surgeons will be available to Cambridge; and the hospitals will recruit cardiologists jointly.
Cambridge Health Alliance has lost money in recent years, mainly because it serves so many poor and uninsured patients. The health system sought a clinical partner so it can become part of an “accountable care organization,” an entity that provides whatever care a patient needs in return for one global payment per patient. Accountable care organizations are favored in the new federal health care law.
The law has led to more affiliations and purchases among hospitals and physicians. To provide a complete spectrum of care, teaching hospitals such as Beth Israel need community hospitals as much as community hospitals such as the Alliance need teaching hospitals. The agreement calls for the Alliance to become part of Beth Israel’s accountable care organization.