By Liz Kowalczyk, Globe Staff | February 25, 2010
The state’s largest independent doctors group is curtailing referrals to Brigham and Women’s Hospital in Boston, a move it says is designed to better coordinate care of patients and reduce costs.
Harvard Vanguard Medical Associates said it has started sending many of its Boston patients to Beth Israel Deaconess Medical Center, unless the patients have a prior relationship with a doctor at the Brigham, where Harvard Vanguard doctors have referred nearly 100 percent of Boston patients for years.
Dr. Gene Lindsey – chief executive of Harvard Vanguard’s parent organization, Atrius Health – said he felt the organization could better coordinate care at Beth Israel Deaconess, partly because the hospital has agreed to send patients back to their primary care doctor or a specialist at Harvard Vanguard after their inpatient stay, rather than keep them in the more expensive hospital system.
Atrius, which has more than 800 doctors, is also shifting many of its new orthopedic referrals to New England Baptist Hospital from Faulkner Hospital, which is part of the Brigham. Atrius doctors did 1,000 procedures at the Baptist last year; Lindsey said he expects that number to double this year, a move driven in part by the Baptist’s success at reducing surgical infections.
Health care specialists said Atrius’s decision is a harbinger of more changes for patients in Massachusetts, as pressure grows on doctors to improve care, specifically the coordination of care, and to control soaring health care costs.
“These organizations and others like them are at the leading edge of taking up the challenge of improving care,’’ said Dr. Amy Boutwell, director of health policy strategy at the Institute for Healthcare Improvement, hospital and patient safety consultants based in Cambridge. “Our fragmented fee-for-service system is yielding high costs and poor outcomes overall.’’
The state is considering dramatically changing how providers are paid by largely scrapping the current fee-for-service system, in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit. Instead, the state would pay groups of providers a per-patient annual fee to cover all of a patient’s medical care. Adopting such a system of “global payments’’ is expected to push primary care doctors, specialists, and hospitals to form tight, efficient networks in which they are in constant communication about patients. It would be similar to the arrangement Atrius is forming with Beth Israel Deaconess.
“Relationships like this will have a lot of advantages for hospitals and medical groups,’’ said Nancy Turnbull, senior lecturer at the Harvard School of Public Health and associate dean for educational programs. “We’ll see more of this.’’
About half of Atrius patients are already covered by insurers under global payment contracts, Lindsey said, but the new policy will apply to patients with all types of coverage.
Lindsey, who has been chief executive of Atrius for two years, said the group’s overall strategy is to send patients to hospitals closest to where they live and get primary care.
For the 80,000 to 90,000 patients who have primary care doctors at Harvard Vanguard’s Post Office Square, Copley, and Kenmore centers, the Brigham and Beth Israel Deaconess are equally close.
But Lindsey said the plan is that patients at these three centers will eventually “get the bulk of their care at Beth Israel Deaconess’’ because the hospital is “focused on efficiency and collaboration . . . and recognizes their responsibility to return patients to the ambulatory environment as soon as possible,’’ he said.
Another key issue, Lindsey said, is that Beth Israel Deaconess is allowing Atrius doctors real-time access to the hospital’s medical records, meaning that doctors can follow their patients through the emergency room and inpatient units.
This ability to track patients in the hospital will help reduce unnecessary and costly duplicate testing and facilitate conversations with patients’ relatives, he said.
Beth Israel Deaconess chief executive Paul Levy said the shift of patients to his hospital will be gradual. He said the two sides agreed in a vision statement to a “primary care-focused system, as opposed to the usual way where academic medical centers consider themselves the center of the universe.’’
Lindsey stressed that Atrius “will continue to have a strong relationship’’ with the Brigham. Obstetrics patients do not fall under the new policy. And thousands of patients who see doctors at other Atrius offices will still be referred to the Brigham and the Faulkner.
The Brigham had 7,200 Atrius overnight patients in 2008, including 1,700 from the Post Office Square, Copley, and Kenmore centers, the hospital said. Patients in the latter group who have an existing relationship with a Brigham doctor will still be referred to the hospital.
“We want our patients who are affiliated with Harvard Vanguard/Atrius Health to know that there will be no change in their care; all the services that Brigham and Women’s Hospital provides will continue to be available to them, and that includes our community teaching hospital, Faulkner Hospital, where Harvard Vanguard physicians have been caring for patients for nearly a decade,’’ the Brigham said in a written statement.
“We will continue to work with Atrius Health on important patient-centered programs, including the development of a unique system that assures that critical information about our patients is transmitted precisely and promptly to their physicians, so care can be delivered in the most effective and efficient way possible,’’ the statement said. The hospital declined to address questions about referring patients back to Harvard Vanguard doctors for follow-up care.
Liz Kowalczyk can be reached at kowalczyk@globe.com.
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