A brand new hospital and a brand new health care landscape


When you design, finance, and build a $40 million hospital, you might reasonably expect that the consequences of that effort will be the ones you intended. You do not expect surprises, at least not disappointing ones.

Not so, not insofar as the functioning of the new Martha’s Vineyard Hospital’s emergency department. It wasn’t about the quality of the medicine practiced there, but from the moment the spanking new gem of a medical center opened, patients complained about the ER.

As we report this morning, hospital managers, led by Dr. Jeffrey Zack, the chief of the emergency department, have made changes to improve the flow of patients through the busy ER, speed care, and keep patients better informed. The physical layout of the department had stifled communication between patients, the staff who registered the patients, and the physicians and nurses who would care for them.

As Times managing editor Nelson Sigelman writes, “The most immediate effort has been to streamline registration, a process that often contributed to the time ER visitors waited to see a doctor. A computer in the triage room now allows nurses to input basic patient information so that clinical assessment and treatment can begin immediately. New portable computers allow registration clerks to complete the registration process bedside.”

So, there’s an unexpected consequence that’s been tamed. But, timing can bring troublesome surprises too, surprises that are not susceptible to speedy, hands-on corrections.

For instance, the uncertain future of the federal health-care legislation, enacted last year as the new hospital was opening for business, is a question. The new law’s provisions, including hoped-for reductions in costs, driven by changes in patient-care protocols, and cost reductions in reimbursements to providers, are themselves under construction right now.

The design of that regulatory layer, unclear for the time being, adds significant uncertainty for hospital officials, and not just for those who are in the fortunate position of trying to get their arms around a large, new, expensive but debt-free facility operating in an economically distressed community such as this one.

Then there are the changes that will certainly be made to Massachusetts’ own health plan, in order to squeeze costs out. Remember, that plan, a Romney legacy, set out to extend health insurance coverage to all state residents, leaving the cost-control mechanisms to be worried about later.

Later is now, as the state confronts an enormous budget deficit and an even more enormous unfunded pension liability.

Gov. Deval Patrick’s $30.5 billion annual budget needs a billion dollars in savings sliced from health-care costs. Nearly 1.3 million Massachusetts residents are insured through Medicaid, also called MassHealth, with big recent increases in coverage for long-term unemployed. The state expects enrollment in MassHealth to climb nearly five percent in the fiscal year that begins July 1.

But, the governor wants to take $351 million from growing MassHealth spending through what he calls “procurement and payment strategies,” and to whittle $169 million in cost growth through “capitation cost controls.”

The goal is to keep the budget at $10.34 billion, roughly what it cost in the current fiscal year.

“Starting immediately, MassHealth plans to conduct a competitive procurement that will focus on reducing costs while providing quality care to over 800,000 members,” the governor’s plan announces. “The procurement process will promote innovative approaches to care management and delivery, as well as payments for services for this population.”

Other savings are to include $150 million in rate reductions to providers that treat Medicaid patients, $66 million in benefit reductions and co-pay increases to MassHealth recipients, and $50 million in streamlining coverage for residents eligible for both Medicare and Medicaid.

Those approaches aim at revenue sources that are important to the Martha’s Vineyard Hospital.

State hospital officials say that more than two-thirds of provider rate reductions will affect hospitals that already receive just 70 cents for every dollar of care they provide.

For our hospital, as for others in the state and across the country, the future is unpredictable and certainly more difficult.

Building a new hospital was the easy part.