Time for a second opinion

THE RECENT series of Globe Spotlight articles detailing the way Partners Healthcare uses its market power to exact high reimbursement rates from insurers - and to fund expansion into the suburbs - could simply be a Harvard Business School case study were the impact on the cost of healthcare not so great. But this is more than a case of men and women in white jackets putting one over on the suits at Blue Cross Blue Shield of Massachusetts and the other insurers. Especially now that the state is committed to health coverage for all its residents, anything that pushes up overall costs is the state's business.

That is why it is encouraging that Governor Patrick called for a meeting today of top state officials to explore the role of past and present contracts between Partners and the insurers in the rising cost of healthcare in the state. Due to the recession, the state is hemorrhaging revenues at the same time it wants to continue subsidizing the insurance of many lower-income residents.

It is unclear just what the state's options are. As one of the Spotlight articles noted, the state recently strengthened its regulatory oversight of the need for new satellite outpatient facilities, but - as Harvard Pilgrim CEO Charles Baker put it - "The horse may be pretty much out of the barn."

Partners points out that it is not the only Boston teaching hospital network that has expanded in the suburbs and that in some cases it has acted in partnership, not competition, with community hospitals. Overall, it sees its efforts to boost its operating margins - which are lower than those of some major teaching hospitals in other states - as an effort to stay nationally competitive for top-flight medical and research talent.

Still, the higher rates that Partners-affiliated institutions outside of Boston generally get from insurers push up the state's overall health bill each time a suburban resident has a procedure done at a Partners facility and not at a lower-cost community hospital.

In the long term, rate-setting should move away from the private contracts that providers and insurers carve out together to ones based more on performance, with the state setting an allowable range for each procedure. In the best of all worlds, such rates would be universal - covering Medicare and Medicaid as well as privately insured patients - and would thus end the systematic underpayment of hospitals like Boston Medical Center and Cambridge Health Alliance that serve more low-income patients.

Whatever solutions officials devise, the state has to make sure that it is helping to maintain the viability of lower-cost community hospitals that are in competition with the satellite facilities of Partners. The future of universal healthcare access is riding on it.