The merger of the Lahey and Hitchcock physician organizations is testimony that even the most prestigious hospitals don't have a lock on bankrolling and orchestrating integrated healthcare networks.
The recently announced merger of multispecialty practices in Massachusetts and New Hampshire (Sept. 12, p. 8) creates a three-state network of tertiary and primary care that expects 1994 revenues of $567 million and is planning further expansion.
That's already half the revenue base of the blockbuster affiliation earlier this year of two Boston tertiary-care teaching-hospital giants, 1,027-bed Massachusetts General Hospital and 715-bed Brigham & Women's Hospital.
But the Lahey Hitchcock Clinic's revenues aren't tied to high-volume, high-cost hospitals-it has only one 272-bed hospital in its network.
A rapid shift in the Northeast to managed care is prompting hospitals to curb costs and reorganize their operations in hopes of stemming historically high healthcare costs (June 27, p. 102). Boston in particular has a high concentration of prestigious teaching hospitals.
Massachusetts General and Brigham & Women's last March formed the Partners Healthcare System, a common parent corporation that lists among its aims the development of a community-based physician-practice organization.
Last week, it announced the first practice affiliations in Massachusetts: a 10-physician group in Cape Ann, and a 46-physician group practicing in Brookline, Weston and at Massachusetts General.
Partners also is engineering the formation of a primary-care physician practice involving 15 to 30 members of Massachusetts Associated Physicians, a loosely knit west suburban group of practitioners, said Ellen Zane, president of the Partners network effort. The 170-physician group was first cultivated by Massachusetts General before the new system formed (Jan. 3, p. 16).
Once the primary-care practice gels, Partners will acquire its assets and include members of the original group in a separate organization with a looser affiliation, Ms. Zane said.
But the hospital-based Partners will have to compete with several other phy- sician-based organizations besides the Lahey Hitchcock Clinic that also are trying to bring generalists into the fold:
Lahey Clinic in March launched a separate partnership with Harvard Community Health Plan to sign up 150 primary-care physicians in northeastern Massachusetts. The Lahey/HCHP Partnership has signed up about 25 physicians and is in various stages of discussion with 50 others, said Steven Shufro, the unit's executive director.
Blue Cross and Blue Shield of Massachusetts has been working since February to establish a statewide group practice with a focus on primary care. The venture, called Physician Partners of New England, is discussing deals with about 400 physicians and wants to sign up 100 by year-end, said Joseph Avellone, M.D., the Blues' chief operating officer.
Competitors of the Partners Healthcare System contend that hospitals aren't the proper foundation for integrated systems because they have incentives to use their physicians as referral sources for their established inpatient business. "The doctors should drive the system, and we're doing all we can to achieve that," said Dr. Avellone.
Ms. Zane said she's fighting what she called the "conventional wisdom" surrounding the Partners system's motives for getting into primary care. "We are not in the business of building networks to fill beds," she said.
She said the tertiary care provided at the two teaching hospitals "is an important facet, but the hub is not Massachusetts General and Brigham (& Women's). The hub is the system itself."