Without a doubt, the prospect that Martha's Vineyard Hospital (MVH) may become an affiliate of Partners Health Care is immensely attractive. But, agreement tomorrow, as is expected from the MVH board, on a memorandum of understanding setting out in general terms the basis on which the Vineyard hospital and its counterpart on Nantucket will join the Partners system is an early step on the road to closing the deal. Now, both our hospital and Partners must diligently examine the alliance, understand all its parts, and agree on the reasonable demands each side makes and reasonable deliverables each side may expect. At the same time, although the MVH is a private, non-profit corporation, Vineyarders think it belongs to us, and, entitled or not, we must diligently consider the implications of the proposed transaction.
After all, the incentive for Partners's interest in MVH and the Nantucket Cottage Hospital is a wrinkle in the rules governing federal reimbursement for medical services that might be ironed out to Partners's multi-million dollar benefit with this deal. That's what opened the door to the discussions, begun this summer, between Partners and the two island hospitals. What's left for us and Partners, between now and the end of the year when the deal is to be consummated, is to elaborate the ways in which their interests and ours can be aligned.
As devoted as the hospital's leaders are to delivering high-quality health care, and as determined as they are to do so on a better than break-even basis, and as fortunate as they, and we, are to have such generous friends as the donors who will finance the large, new Vineyard hospital that is now in the permitting process, the discouraging truth is that the tide is running hard against them, and us.
Health-care quality requires the highest standards of performance, the sharpest personnel, deep resources, and a competitive environment in research and medical care delivery, against which to test the deployment of such prized assets. As customers and patients, we fare best when health-care services are developed and tested this way.
The diligent efforts of Martha's Vineyard Hospital leadership and staff, whose performance we enjoy, cannot be measured fairly against such a demanding health-care environment as Partners, parent to Massachusetts General Hospital (MGH), Brigham and Women's Hospital, as well as other community hospitals, health centers, and specialized providers. The historical reality is that being the Martha's Vineyard Hospital has always been a struggle, and health-care progress has always been made elsewhere, by organizations such as Partners, although with luck and time, the fruits of these advancements have made their way here. When the new hospital, albeit badly needed, is opened, the Vineyard will begin again, as it has often in the past, the inevitable accumulation of financial and medical deficits that are common to such small, rural, underfinanced, and remote institutions. Where Martha's Vineyard health care finds itself on a quality of care scale will not be where Partners and MGH find themselves.
Tim Walsh, the MVH chief, along with vice chairman Tim Sweet and members of the board's finance committee have negotiated since summer with Partners officials. Mr. Walsh describes the prospective affiliation this way: "This affiliation represents a golden opportunity to ensure that Martha's Vineyard Hospital not only survives but thrives as a community health resource. Our patients and our staff will benefit from being part of a robust system that provides a full spectrum of outstanding health care. What better way to meet our mission than to unite with one of the nation's best hospitals."
Indeed. But, this transaction is after all a sale. The MVH will become, like MGH, a subsidiary of Partners. The $40 or $50 million in assets represented by the Island hospital in its new digs a few years from now will be added to the balance sheet of Partners, a $6 billion dollar non-profit. The MVH will run its own show, but ultimately it will be a part of Partners. Which is good, of course, in fact astonishingly good. But, how will Partners extend its excellent clinical care to an affiliate such as the Vineyard hospital, smaller and more remote than any of its current collection of affiliated hospitals and health centers? How will MVH and its parent decide what services will be delivered here, and what will not, and how will it all, plus Windemere, which is expected to be a part of this deal, be financed? How will the decision-making on such questions be made?
The Island hospital's officials have promised to engage Vineyarders in a discussion of these and other questions, and we do not doubt that they will. And, it will certainly be a revealing discussion about the shape of health care on this Island in the years ahead.