Patient visits to Cambridge Health Alliance are below expectations so far this year, officials at the institution say.

Patient visits to Cambridge Health Alliance are below expectations so far this year, officials at the institution say.

While Cambridge Health Alliance works toward earning a profit after years of operating losses, it still isn’t meeting goals for increasing the number of patients it serves, a hospital official said last week.

Volume, especially outpatient visits to alliance doctors, plunged last month, Chief Financial Officer Gordon Boudrow said at a Tuesday meeting of the board of trustees’ finance committee. The number of doctors’ visits for the month was lower than any monthly total in the past four years, hospital spokesman David Cecere said. Inpatient volume was also lower than the alliance’s forecast for February, Boudrow said.

What Boudrow described as a “disappointing month” came after better-than-expected volume in January. But the hospital and its doctors have not met volume goals in six of the eight months since the alliance’s current fiscal year began July 1, he said.

“This is concerning,” Boudrow told the trustees. The Feb. 9 blizzard probably caused some of the falloff in volume, but “we’ll be drilling down asking for some explanations” from alliance doctors and staff.

Cecere said in an e-mail: “Given that the month just ended, we are still evaluating the potential causes for the lower volume in February. A variety of factors can influence volume, and it’s not completely predictable.” He also cited the January figures, saying that month was “one of our strongest performances of the year.”

The alliance is also contending with more patients without health insurance than it expected, Boudrow said at the meeting. This trend is increasing the amount of hospital and doctor bills it can’t collect, he said. However, the hospital is still losing less money than it projected.

Strategies

CHA already serves more uninsured and low-income Medicaid patients than most other Massachusetts hospitals. The Cambridge-based system, which includes the former Cambridge City Hospital, Somerville Hospital and Whidden Memorial Hospital in Everett; and Boston Medical Center are the top “safety-net” hospitals in the state.

To survive and thrive in today’s health care environment, the alliance is trying to reorganize itself to coordinate all the medical care its patients need, including complicated procedures that must be performed at other hospitals. Such systems, called “accountable care organizations” because they are accountable for a patient’s complete care, can save money and earn bonuses from the government and insurers. Accountable care organizations often include community hospitals such as the alliance as well as hospitals that perform more specialized procedures, such as a Boston teaching hospital.

In January the alliance enrolled in a Medicare program for hospitals that want to be accountable care organizations. The alliance will coordinate complete medical care for at least 500 Medicare patients who are seeing or have seen an alliance primary care doctor. The alliance can get a bonus from Medicare if it can care for these patients at a lower cost than if the patients were not in the program. The task is challenging because the patients can continue seeing any specialist and using any hospital in the Medicare program, not just alliance doctors and hospitals.

The alliance has also been in talks with Beth Israel Deaconess Medical Center about a “clinical partnership.” Such a partnership could help the alliance and Beth Israel serve as accountable care organizations. Beth Israel already is one, and it owns or has affiliations with several community hospitals, including Mount Auburn Hospital in Cambridge.

This story  was updated March 12, 2013, to correct that the board met the previous Tuesday.