IT’S CRUNCH TIME for health care in Massachusetts. Over the next week, the Legislature will decide whether to approve a new health care law and a federal bankruptcy court in Texas is likely to approve final sales of Steward Health Care hospitals in Massachusetts and announce the latest bidder for the hospital system’s physician group.
Here are my hopes for the week ahead.
With respect to Carney in Dorchester and Nashoba Valley in Ayer, the two Massachusetts hospitals Steward says it is closing, my hope is that those sites can find a variety of uses that respond to community needs—both medical and social.
It has been a pretty clear these past months that neither Carney nor Nashoba Valley was on any sort of trajectory to attract new owners who would maintain them as general acute care hospitals. Both have had dwindling numbers of medical-surgical patients for some time, yet both are also important inpatient behavioral health providers. Both admit geriatric-psych patients, and Carney has adult and adolescent inpatient units as well.
I hope and expect the state to do all that it can to find the best parties to maintain these inpatient services, and perhaps even expand them along with a robust set of outpatient behavioral health services. Free-standing urgent care— possibly even emergency services as well — with behavioral health specialists embedded in these clinical offerings should be posted at both locations. The state may need to help intervene with Medical Properties Trust and Macquarie Asset Management, the owners of the hospital properties, to get reasonable leases to help make this happen.
The state should focus on transforming the closed hospital sites into community centers providing some health care but also housing, education, and employment training. There’s a concept called “healthy villages” that would be worth exploring. State government should help facilitate this transformation effort.
My hope is that the bankruptcy court in Texas will approve local, nonprofit buyers for the remaining Steward hospitals. Some of the names being mentioned as possible buyers are Lawrence General, Southcoast Health, and Boston Medical Center. Rhode Island’s Lifespan, soon to become Brown University Health, may also be in the mix.
These buyers may need state help revising the terms of the leases owed to hospital owners and/or helping with some capital or operating expenses for a defined period. The state has already committed to spend $30 million to help these hospitals make it through the end of August, and it will likely need to spend more.
Steward was originally going to sell its physician group to the for-profit Optum, but that deal is now off the table. Getting this important asset out of for-profit hands would be a really good thing, and I hope that no matter who comes forward as the ultimate buyer, that the Health Policy Commission and Attorney General Andrea Campbell use their leverage to make sure the new owners operate the physician group in a way that responds to community health care needs and not simply profit maximization.
I applaud both branches of the Legislature for what they each have worked hard to produce; and each has similar or parallel language that mandates much greater financial transparency of hospital finances, requires special oversight of hospital owners from private equity, and gives more regulatory power to the Health Policy Commission and the attorney general.
Both bills also offer ideas to bring pharma manufacturers and pharmacy benefit managers, or PBMs, under some sort of scheme that attempts to bring greater transparency and accountability for their pricing actions and behavior.
In all these areas, the House and Senate approaches are not identical, but I sense that agreement may be reached over the course of this week.
I worry a lot more about real differences between the two bills in regard to the composition of the Health Policy Commission board, how to affordably help hospitals receiving lower commercial payments grow their revenues, and the best ways to evolve the current one-year health care cost benchmark into a multiple year examination.
Without question, I view the Senate’s approach in all of these areas far superior at the moment. Rather than detail it here, I instead point to a letter sent by a coalition of employer, insurance plan, health, consumer, and social justice advocates to the chairs of the Legislature’s Health Care Committee pressing for specific measures.
We clearly need the legislative conferees to come up with a final bill that helps to assure that our state government has all of the best policies and tools, combined with the right sort of people and agencies to provide oversight to help keep our health care system moving down a path toward affordability.
Paul A. Hattis is a senior fellow at the Lown Institute in Needham.
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