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MetroWest ends Beth Israel affiliation plan

Smaller hospitals often reluctant to lose independence

By Robert Weisman
Globe Staff / September 9, 2009

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Six months after agreeing to pursue a broad-based affiliation with Boston’s Beth Israel Deaconess Medical Center, the MetroWest Medical Center in Framingham has decided to scrap the plan.

The surprise move, which wasn’t disclosed publicly, reflects the ambivalence of some suburban hospitals about aligning with Boston’s prestigious teaching hospitals at a time of general industry consolidation. Such ties give smaller hospitals access to specialists and advanced clinical programs, but also can mean a loss of independence as large hospitals seek to impose their own practices on smaller partners.

“As is sometimes the case in the process of moving from concept to details of operation, our discussions reached the point where it became apparent we had differing views of the structure of an affiliation,’’ Andrei Soran, the president and chief executive of MetroWest, wrote in a Sept. 3 memo to physicians and staff members.

Soran declined to elaborate on any disagreements between the two parties. Judy Glasser, senior vice president at Beth Israel Deaconess, said her hospital was “disappointed’’ that MetroWest had pulled out of affiliation talks. “Sometimes, when you start negotiations, things don’t work out,’’ she said.

While both sides said they planned to continue several collaborations with each other, Soran indicated he was afraid Beth Israel Deaconess might try to retaliate for the collapse of talks on the affiliation plans. “We’re concerned that Beth Israel might make some efforts to recruit our physicians to change their affiliation in the aftermath of this,’’ he said, adding, “If they do, we will do what it takes to let the public know.’’

The poaching of doctors has been a fear of MetroWest since 1995, when Boston’s giant Partners HealthCare Systems Inc. expanded its reach in the western suburbs - MetroWest’s backyard - by affiliating with Charles River Medical Associates, a group of primary care physicians operating from Framingham to Holliston.

Beth Israel’s Glasser said she wasn’t sure what Soran was referring to in his comments about retaliation. “We have relationships with doctors in many communities, and we’re always respectful and supportive of their relationships with their local hospitals,’’ she said.

MetroWest runs Framingham Union Hospital and Leonard Morse Hospital in Natick, which together have about 300 beds and more than 740 affiliated physicians. It is owned by Vanguard Health Systems Inc., a for-profit national hospi tal system based in Nashville.

Beth Israel Deaconess, a Boston nonprofit hospital affiliated with Harvard Medical School, has several ongoing collaborations with MetroWest in what are called “service lines,’’ clinical specialties such as cardiology, radiation oncology, and vascular surgery. MetroWest has a separate agreement with another Boston teaching hospital, Tufts Medical Center, for a pediatric care collaboration between Framingham Union Hospital and Tufts Medical’s Floating Hospital for Children.

Last March, as it faced the prospect of competition from a proposed Newton-Wellesley Hospital outpatient surgical and screening center in Framingham, MetroWest opened discussions with Beth Israel about an expanded alliance. While they never worked out specifics, the idea was that physicians from the Boston hospital would work part time in Natick and Framingham, and the hospitals there would refer acute care patients to Beth Israel. There was also talk of running additional joint clinical and quality programs.

Dr. Stanley Lewis, senior vice president for network integration at Beth Israel, said at the time the hospital’s strategy would be to extend its alliances rather than build its own hospitals outside the city. The structure of those alliances range from outright ownership of a hospital in Needham to running combined clinical programs at Milton Hospital to managing a cancer program at Beverly Hospital.

Newton-Wellesley, part of the Partners HealthCare hospital system that is the state’s largest, in June withdrew its plan to build the outpatient center in Framingham. Soran and Glasser both said yesterday, however, the withdrawal played no role in the decision not to affiliate. “I don’t think that had any bearing on the discussions,’’ Glasser said.

Soran said MetroWest and Beth Israel executives worked hard to find common ground, but ultimately “decided that the business goals and the clinical goals weren’t aligned enough for this to go forward.’’

Despite the collapse of the Beth Israel-MetroWest affiliation, the broader consolidation trend is likely to continue as health care reform strains the resources of hospitals, said Needham health care consultant Marc A. Bard. He cited two examples from the Partners HealthCare network: Newton-Wellesley’s affiliation with Massachusetts General Hospital, and the alliance of Faulkner Hospital in Jamaica Plain with Brigham and Women’s Hospital in Boston.

“It allows community hospitals to upgrade their complexity, and it allows the teaching hospitals to get referrals at the upper end of that complexity,’’ said Bard, managing director of Navigant Consulting.

Robert Weisman can be reached at weisman@globe.com.