Cape Cod Healthcare ‘affiliates’ without ‘merging’ – why, and what that means

Plus, recalling just how far we’ve come in terms of care, and attitudes

Cape Cod Healthcare, with flagships Cape Cod and Falmouth Hospitals, is entering into a “clinical affiliation” with Beth Israel/Deaconess/Lahey, and that is a big deal for this peninsula.

Careful language making it clear that this is not a “merger” or “acquisition,” and Cape Cod will continue to exercise local decision-making, was meant to reassure those wondering whether big-market healthcare giants can appreciate nuances and priorities in this smaller, more insular place.

But major, seismic forces remain, and Cape Cod Healthcare President and CEO Mike Lauf faces undeniable facts:

*Community hospitals like Cape Cod and Falmouth need affiliations to survive. Even more, they need doctors, an increasing challenge. Creating a pipeline with Beth Israel/Deaconess/Lahey is one way to do that. The goal: Bring 10 new physicians onto the Cape in the next two years.

*Cape Cod Healthcare’s strongest calling cards are its profitable cardiac unit, and a strong Emergency Room backed up by inpatient capacity. That’s attractive in Boston. Cardiac referrals for more complicated cases will now be directed toward BI/Lahey (though that can’t be a patient requirement). Cardiac and ER also create important hands-on venues for docs emerging out of teaching hospitals.

*Traditional profit centers for 24-7 hospitals have fallen away. Doc-in-boxes for non-emergencies and day-surgery suites draw many patients who once created revenue to offset steep critical care costs. Gone are the days when you went to the hospital to get a colonoscopy, blood test, X-ray. Diagnostics and lab work are processed on freestanding islands. You can find a doc in a CVS and get a prescription. Low-overhead telemedicine is about to become an industry standard, with the blessing of insurance companies fixed on bottom lines. Community urgent care centers in Harwich, Chatham, soon Orleans, are CCHC decentralizing and capitalizing on the changing market. Yet high-tech, bullseye, brick-and-mortar hospitals must continue to serve vital, lifesaving functions. Hence partnerships, affiliations, attempted synergies.

*Cape Cod has a huge percentage of Medicaid and Medicare patients, especially Medicare. If reimbursements don’t include a decent margin, the squeeze is on. If Cape Cod Hospital had not qualified long ago for what’s known as federal sole source community provider status, which creates a serious bump in Medicare rates, there would be deep crisis right now rather than a chess game of shifting partnerships and alliances.

*Aligning with Beth Israel/Lahey means that a relationship with Brigham and Women’s/PartnersHealth (now Mass General Brigham) is superceded. Jordan Hospital in Plymouth, long a Cape competitor for services like obstetrics, already has merged and changed its name to Beth Israel-Deaconess in Plymouth. Extending down the highway seems to make sense from a Boston vantage, but Cape Cod Health Care’s model (at least for now) is fundamentally different from the deal struck in Plymouth.

The importance of independence, a local board and administrators, certainly has appeal around here, and not just in health care. But shifting plate tectonics ramming health care into consolidated masses suggests that before long we may be looking at as few as six to eight institutions managing care in Massachusetts. Already, Beth Israel-Deaconess-Lahey counts more than 4800 physicians and 36,000 employees under the logo, and that’s not even the biggest entity in the state.

Does this matter?

What really matters is quality and outcome; there’s no consolation or comfort if it’s a local person or team who makes a bad diagnosis or botches a procedure. And there’s no guarantee that local decision makers are more beholden to community (or subjective) wishes; closing inpatient maternity and pediatric care at Falmouth Hospital, after years of declining census, could be seen as one sign of that.

But this latest announcement reveals that Cape Cod Health Care believes it can remain freestanding while taking advantage of proximity to some of the world’s best health care systems – a goal Lauf has articulated for years. If that’s true, then this is not necessarily a stride down the inevitable merger road; it may be a tactic, even national model, that allows health care delivery to remain at least somewhat diversified, and of high quality.

It’s easy to take for granted standards now commonplace at Cape Cod Health Care, but for those with longevity (who can still remember stuff), this announcement highlights a key fact: As these hospitals have become first-rate, attractive to the Beth Israels of the world, we have witnessed a profound improvement in one of the most important aspects of quality of life on the peninsula.

As proof I take us back to the 1970s. Cape Cod Hospital’s reputation was terrible; prevailing wisdom was that unless you were going to die within 90 minutes, it made no sense to go there versus racing down Route 3 for Boston. There also was a bitter, divisive campaign to unionize staff, creating all kinds of bad feeling about hospital management.

This young reporter heard what seemed like an impossible rumor: Obstetrics and gynecology docs had a policy that no soon-to-be dads were allowed in delivery rooms to witness (let alone support, celebrate, or participate in) the birth of their babies.

I tracked down the head of the OB/GYN department who confirmed that this was indeed true. When I asked why, he looked at me with mixture of disdain, condescension, and amusement, then answered my question with a question:

If your wife needed to have her appendix removed, why would you want to be in the operating room?

That’s how far we’ve come. Here’s hoping this new “affiliation” can take us even farther.

Haven’t subscribed yet? Here’s how to keep seeing a Voice:

https://sethrolbein.substack.com/welcome