Franklin doctors to join Partners

The physicians' group for Milford Regional Medical Center is joining Partners HealthCare System Inc., giving the state's preeminent medical system a toehold in a key area of the state and enabling it to funnel more patients to its network of downtown teaching hospitals.

Tri-County Medical Associates of Franklin signed an agreement with Partners Community Healthcare Inc., the physician network for the hospital network, last month after two years of negotiations, according to people involved. A key issue in the discussions was that doctors at Tri-County didn't want to feel obligated to send their patients to Partners hospitals unless local physicians felt they needed specialized care that only those facilities could provide.

"We were concerned about losing our independence," said Philip Ciaramicoli , chief executive of Tri-County. "We had to feel comfortable that what should be done in the community hospital gets done in the community hospital."

Dr. Thomas H. Lee , chief executive of the Partners' physician organization, said the affiliation agreement doesn't require Tri- County doctors to send patients to Partners hospitals. But should they choose to send patients to Partners hospitals, referrals and medical records transfers will happen more smoothly.

"The board and the doctors asked me 20 times, 'Are we going to have to send our patients to Boston?,' " said Lee. "I told them, 'You send your patients where they need to go.' We'll get the patients who really need to come into town."

Partners Community Healthcare is the largest physicians' network in the state, with more than 4,900 physicians, up from about 4,200 in 2002.

Tri-County has about 60 doctors, including 40 primary care physicians. Primary care physicians are highly sought after by hospitals because they have the closest relationships with patients and help make decisions about where they will receive specialized treatment. Tri-County was also attractive to Partners because it serves largely affluent communities with growing populations.

Ciaramicoli said his group got to know Partners as a result of the planning for Milford Regional's new cancer center. The $25 million project, set to open in January, is being developed with Brigham and Women's Hospital, a founding member of Partners, and Dana-Farber Cancer Institute, which collaborates with Partners.

Ciaramicoli approached Partners about affiliation because he was impressed with the group's forward-thinking approach to medical management, and his existing contract with the Greater Milford Health Alliance was set to expire, he said. In particular, Tri- County was impressed with Partners' post-discharge program, which helps manage care and improve outcomes for patients with specific chronic conditions such as diabetes or heart disease when they leave the hospital.

Ultimately, the affiliation could draw patients from UMass Memorial Medical Center, the large teaching hospital in Worcester that is closest to Milford, and which has training relationships with Milford Regional. UMass Memorial is about a half-hour drive from Milford Regional. Boston hospitals are about an hour's trip. Partners includes Brigham and Women's, Massachusetts General Hospital, Newton-Wellesley Hospital, and Faulkner Hospital in Jamaica Plain.

"Not to demean UMass in any way, but we want to go with the organization that's out in front," said Ciaramicoli.

Tri-County is investing $2 million in an electronic medical records system, a Partners requirement. He said his physicians will be able to earn higher reimbursement rates from Partners if they meet goals for quality and efficiency -- a so-called pay-for-performance plan. Such plans have become popular tools in healthcare to improve quality of care while controlling costs.

Doctors affiliated with Partners also get higher reimbursement rates from major health plans such as Blue Cross and Blue Shield of Massachusetts and Harvard Pilgrim Health Care, because of its size.

The affiliation with Partners will become effective Jan. 1.

Jeffrey Krasner can be reached at krasner@globe.com.