Rival hospitals face off on North Shore

The Daily ItemSALEM ? Competition between Boston-based Partners HealthCare, which includes Salem Hospital, and Northeast Health System, which owns Beverly Hospital, is likely to intensify over the next three years.A change in the regional healthcare business climate was brought on by Partners which, in a purported effort to increase its overall performance rating, is pressuring physicians to keep their patients inside the organization’s network of medical facilities.Partners executives claim that referrals outside the network are not easy to monitor and, hence, make it more difficult to improve the organization’s overall healthcare. They also maintain that outside referrals create obstacles to smooth medical electronic data collection, an asset shared by Partners doctors.Not everyone agrees with that assessment.Paul Levy, chief executive at Beth Israel Deaconess, quoted by the Boston Globe, said Partners simply doesn’t want to lose business to the rival Northeast Health System.Beth Israel Deaconess Hospital in Boston and the Lahey Clinic in Burlington have clinical relationships with Northeast Health through which they accept patient referrals. Northeast Health operates the 227-bed Beverly Hospital, the Addison Gilbert Hospital in Gloucester and other clinical facilities in the region.Earlier this week, about 300 doctors practicing with Northeast Health System on the North Shore and abutting communities found themselves squeezed by the ramped-up competition. The doctors were dropped from the Partners network, apparently for not fully participating in the Partners system.Rather than forge an alliance with another physician group, the Northeast doctors negotiated directly with the region’s three largest insurance companies to ensure the same level of reimbursement received by Partners doctors.Partners physicians are members of Partners Community Health Care Inc. (PCHI), a much larger doctors group of about 1,000 primary care physicians and 3,000 specialists that was formed to negotiate favorable rates with the largest health insurance companies n Tufts, Harvard Pilgrim, and Blue Cross Blue Shield.When the Northeast doctors were told of the changes, they feared the insurance companies would attempt to reimburse them at a lower rate than their Partners colleagues. As Stephen Laverty, chief executive of Northeast Health System put it, “Just because we went from wearing a read hat to a blue hat, why would you pay us less?”Laverty elicited support from North Shore legislators to pressure the insurance companies. The result was a three-year pact with the insurers that gives the Northeast doctors similar reimbursement rates.”This whole issue is purely about payment and has nothing to do with referrals,” said Petra Langer, director of communications at Partners.According to Langer, the healthcare industry is changing and facilities will soon be held more accountable for their performance. “Pay-for-performance contracts are becoming more common,” she said. “We only get paid for the entire reimbursement if we reach certain clinical goals, and part of that is made possible by having electronic medical records.”Langer said all PCHI doctors have access to the electronic medical records and other Partners-standardized clinical systems. “Once a patient goes outside the system, they are harder to track,” she said, explaining that it becomes more difficult to assess the quality of care.Responding to suggestions that Partners is acting out of a quest for increased profits more than enhanced health care, Langer said, “Honestly, Mass General is full most days and there is a long waiting list for people to get in. And North Shore Medical Center has a high rate of occupancy.”Langer said new healthcare reform legislation will create a more competitive atmosphere since providers will be paid based on the quality of the care provided, a measure set by government regulatory agencies.”Even Medicare on the federal level is moving toward a pay-for-performan

More Stories In News