Massachusetts took a step toward a still-fuzzy vision of centralized health planning earlier this month with a widely attended public hearing on the fate of 42-bed Malden (Mass.) Medical Center.
About 600 people crammed City Hall in Malden, a Boston suburb, for a Feb. 15 hearing on the proposed closure of the Hallmark Health hospital. Malden is one of two Massachusetts hospitals that Hallmark plans to close, the second being 121-bed Whidden Memorial Hospital in Everett.
Malden would be the first hospital in Massachusetts to close since the enactment of a state law requiring state approval of closures of "essential services."
"Hallmark was the hamster in the Habitrail last night," Hallmark spokeswoman Julie Snyder said on the day after the hearing.
Malden, an inpatient psychiatric facility with urgent-care services, lost $15 million in the past two years, according to Hallmark. System officials said they want to continue providing the hospital's services to the community, but Hallmark can't do so at current reimbursement levels.
"We have the will to keep them open. We need to be provided with the way, and the way, in part, is some sort of funding from the state," Hallmark spokesman Ron Scott said.
According to the Massachusetts Hospital Association, the state's Medicaid program reimburses hospitals for 77% of their costs, and about two-thirds of hospitals in the state are losing money on operations.
The state-approved process for closing a hospital, required by Massachusetts' new patient-protection law that took effect Jan. 1, has its share of uncertainty. The state's Public Health Commission will not complete its definition of essential services until mid-March. Meanwhile, it isn't clear how and if the state would ultimately mandate that a hospital remain open if its owners want to close it.
"This is uncharted territory," said Paul Jacobsen, deputy commissioner at the Massachusetts Department of Public Health. "I would not want to speculate on what happens if."
Health department spokeswoman Ailish Wilkie said last week that the department was planning to send Hallmark a letter by last Friday requesting that Hallmark develop a plan for community members to continue to access the services the system wants to close. The department and Hallmark will then negotiate a solution.
Hallmark spokesman Scott said the system is considering several alternatives, including the possibility of relocating the psychiatric beds to Whidden Memorial, which was dependent on receiving millions of dollars in funding from public or private sources to reconfigure the facility and keep it open.
Scott said the system could accommodate patients from Malden's primary service area at the psychiatric inpatient units at the two hospitals that Hallmark plans to keep open. Also, Scott said the system could accommodate demand for urgent-care services at a Hallmark-owned clinic across the street from Malden.
Hallmark plans to close Malden on April 10 and gave the state the required 90-day notice on Jan. 9. The system doesn't plan to close its Everett hospital for nine months, so it has yet to give the state notice.