Expanding ties between the state’s two largest medical care providers, fast-growing Steward Health Care System has struck a deal with Partners HealthCare System to send its most severely injured patients from emergency rooms at Steward’s 10 community hospitals to Partners-owned Massachusetts General and Brigham and Women’s hospitals in Boston.
Steward employees learned of the plan in a letter from Dr. Michael Callum, president of Steward Medical Group, which represents about 700 doctors employed by the for-profit hospital chain. Under the arrangement, Callum said, Partners physicians will help several Steward hospitals establish trauma centers to handle less critical cases.
The alliance could shift patients from competing Boston teaching hospitals such as Beth Israel Deaconess Medical Center, Boston Medical Center, and Tufts Medical Center, which now accept some urgent care referrals from Steward. It also could put rival community hospitals at a competitive disadvantage if Steward builds up its own trauma centers. Such care, while not a big moneymaker, is considered a crucial measure of a hospital’s skills and competence.
Steward is “trying to develop a full-service system so they have the capability to provide things in the medical area that anyone would want,” said Stuart H. Altman, professor of health policy at Brandeis University. “And to the extent that they can’t provide the services, they’re trying to show that their brand is developing ties and has access to high-end institutions.”
Each year, Steward hospitals send about 1,000 severely injured patients — mostly victims of car crashes or gunshot wounds — to the five so-called Level 1 trauma centers in Boston, which are certified to treat the most critically hurt patients, or to similar sites in Worcester and Providence. Referral decisions are typically made by Steward emergency room doctors based on their own relationships with other hospitals, which trauma center is closest, and which has available beds.
Under the arrangement with Partners, the largest hospital and doctors organization in Massachusetts, all Steward patients will now be sent to Mass. General or Brigham and Women’s except in cases where patients have other preferences or EMTs take a patient directly from an accident or crime scene to the nearest trauma center.
“This trauma care partnership is an exciting new relationship,” Callum wrote to Steward employees. “It will create a new level of communication between our organizations, including direct links between emergency physicians in our community hospitals and trauma physicians at Massachusetts General Hospital and Brigham and Women’s Hospital.”
The alliance isn’t the first between Partners hospitals — which have been cited by state Attorney General Martha Coakley as among the most expensive in Massachusetts — and two-year-old Steward, which many in the state health care industry welcomed as a lower-cost alternative.
Last year, Steward teamed with Tufts Health Plan to offer small employers less expensive health insurance that restricted patients to Steward hospitals for routine care. At the same time, it agreed to refer more complicated adult care to MGH and the Brigham and complex children’s procedures to Mass. General’s pediatric branch, MGH for Children.
Coakley’s office, which has been working with the Justice Department on an antitrust investigation of Partners' contracting and other practices, more recently has been scrutinizing a Partners bid to acquire South Shore Hospital.
Brad Puffer, a Coakley spokesman, said the state is aware of the Partners-Steward deal. “Our office has been informed of the agreement, but we will not comment further until we’ve had the chance to review the details,” he said.
Competing academic medical centers were also weighing the agreement’s impact.
“Boston Medical Center has a longstanding history as a major regional trauma center, with over 2,000 trauma cases per year,” said Jennifer Watson, the hospital’s chief of staff. “We expect to continue to play this critical role in the health care system and to provide exceptional care to our trauma patients.”
Beth Israel Deaconess senior vice president Judy Glasser declined to comment on the deal. Tufts Medical Center, which was designated a Level 1 trauma center last February, doesn’t receive many patients from Steward hospitals, and “we don’t see it having an impact on our trauma service,” said Brooke Tyson Hynes, a Tufts vice president.
Callum, in an interview, said Steward chose Partners because it operates two Level 1 trauma centers — at Harvard-affiliated Mass. General and Brigham and Women’s — and Steward hospitals generated too much volume for a single center.
Callum said Mass. General will handle trauma referrals from St. Elizabeth’s Medical Center in Brighton, Carney Hospital in Dorchester, Quincy Medical Center, Holy Family Hospital in Methuen, Merrimack Valley Hospital in Haverhill, and Nashoba Valley Medical Center in Ayer.
Brigham and Women’s will handle referrals from Steward’s Norwood Hospital, Morton Hospital in Taunton, Good Samaritan Medical Center in Brockton, and Saint Anne’s Hospital in Fall River, he said.
The Partners hospitals will sometimes shift cases depending on available resources, Callum said.
Other plans call for Partners doctors to share their clinical expertise in running a trauma center and helping their Steward counterparts through the process of gaining Level 3 certification to take on less acute trauma cases at Holy Family, Good Samaritan, and Morton hospitals. St. Elizabeth’s will also send surgical residents to Mass. General for trauma care training, rather than to Bay State Medical Center in Springfield, where they now go. And Partners and Steward will merge emergency department clinical records and imaging scans to speed up care and avoid duplication.
“Trauma is a thing where every second counts,” Callum said. “So we want to do this in a coordinated fashion. This will be the first truly integrated trauma program in Massachusetts.”
Ann Prestipino, a senior vice president at Mass. General, said Steward approached Partners about the partnership. Both Mass. General and Brigham and Women’s now treat about 2,000 trauma cases a year, she said.
“If this plays out, both the Brigham and the Mass. General should see a marked increase in their number of trauma patients,” Prestipino said. “This provides us an opportunity to be altruistic in sharing our knowledge about treating some of the most critically sick and injured patients. And we’re developing a relationship with a group of community hospitals that need our help.”
She noted that critical emergency care is usually labor- and technology-intensive, and that many patients don’t have commercial insurance.
“Trauma is not a profit center for either the Brigham or the Mass. General,” Prestipino said. “We’re not doing this for economic gain.”