"We're just asking for more sunshine on recent events that challenge the viability of our hospitals," said Donald Thieme, executive director of the council, who sent a letter to Massachusetts Attorney General Martha Coakley (PDF) on Nov. 23 requesting the meeting. "We especially want to understand the role of the attorney general in the consolidation (of healthcare providers) as a referee and a guide."
The Whittier IPA has partnered with Anna Jaques Hospital, a 123-bed community hospital in Newburyport, Mass., to form the Lower Merrimac Valley Physician Hospital Organization. Questions have been raised about a potential negative impact the proposed arrangement would have on Anna Jaques, which formed a clinical affiliation with Beth Israel Deaconess Medical Center last year, but Thieme insisted that his organization was not working at the hospital's request in this matter.
"They didn't ask for any help," Thieme said. He also cited studies that show some 50% of hospital admissions in the state take place in a teaching hospital compared with an average of 19% nationwide and that more than $1 billion is spent on secondary care at higher-cost teaching hospitals with no significant improvement in quality.
According to Thieme, it's a common healthcare business strategy in the state to promote having this care delivered at a local hospital at lower cost, but the proposed Steward-Whittier arrangement goes beyond that objective.
"This should not be interpreted as being anti-Steward, rather with so much consolidation taking place in Massachusetts at every level it is important for all to understand the 'ground rules' of integration and consolidation," Thieme added in a follow-up e-mail.
Steward spokesman Chris Murphy objected to Thieme's request to involve the attorney general as well to any insuations that Steward was acting in a predatory manner.
“The only fundamental difference in our organizations is that we pay taxes,” Murphy said. “The overall, basic point is that asking the attorney general of Massachusetts to create an unfair advantage for one community hospital over another simply because they never pay taxes and have done nothing to lower healthcare costs in the community is absurd.”
Murphy added that the agreement with Whittier IPA does not dictate where patients can receive treatment and that language was included to ensure that Anna Jaques and Beth Israel Deaconess "would not be negatively impacted." He also said that many of the Whittier physicians practice at 90-bed Merrimack Valley Hospital in Haverhill, Mass., which is a facility Steward acquired in May.
“The whole point is that the Whittier doctors work in Merrimack Valley Hospital and we want to have a relationship with the doctors that work in our hospital,” Murphy said.
In his letter to Coakley, Thieme referenced several other consolidations in the Massachusetts healthcare environment, including: the Fallon Clinic-Atrius Health affiliation and Neighborhood Health Plan joining Partners Healthcare.
"All nature of consolidation is taking place—right, wrong or indifferent," Thieme said, adding that his group has one major question for the attorney general: "If we're going to have consolidation, are we going to have limits?”
A statement from Coakley's office confirmed that a meeting will take place to discuss the council's concerns and what is already being done about them. This includes a proposal by Coakley to create an independent oversight body to review arrangements such as the one being sought by Steward and the Whittier IPA.
According to the statement from Coakley's office, "market reforms proposed by the attorney general will help address the issues raised."
Coakley talked about this in a speech (PDF) given Nov. 18 at the annual conference of the Massachusetts Association of Health Plans.
"When a provider does reach a certain level of market clout, it should trigger a market impact review to determine whether the provider's size is having a negative impact on consumer choice, access or healthy market function," Coakley said. "The agency must then have authority to restrict certain types of provider activity to protect consumers and the market. We will continue to play our traditional role of the consumer advocate in this administrative review process."