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Heart surgery moves to the suburbs

Urban-suburban collaborations bring health care without the hassles


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September 1, 2007

When Children's Hospital at Waltham opened two years ago, patients expressed some trepidation about using the satellite location. "Will I have the same doctors?" "Who will be doing my surgery?" "How will the quality of care be?"

It didn't take long for patients to realize that many of the same outpatient services were available at this new Waltham facility, but without the congestion, hassle, and parking expense of visiting the Longwood campus. "It's a more accessible, convenient location," says Steve Gordon, chief administrative officer of Children's at Waltham.

Gordon adds that patients come from as far as southern New Hampshire, Rhode Island, and Connecticut, since the hospital is located at the crossroads of the Massachusetts Turnpike and Route 128.

Whether they want to visit branches of an academic medical center setting down roots in the suburbs or urban hospitals partnering with suburban facilities, consumers no longer need to make the long trek downtown for specialized treatments.

As technology has allowed treatments to become less invasive, cancer therapies, cardiac cauterization, laparoscopy, and other procedures, typically available only in fully equipped teaching hospitals, have migrated out to where the people are.

"Consumers today are more demanding and have high expectations for a better health care experience," says Donna F. Jarmusz, senior vice president at Alter+Care, a Chicago-based health care real estate consultant who helps develop facilities nationwide. "They are seeking convenient, accessible, and timely care closer to where they live and work. Just as shopping and other retail consumer experiences have become more convenient, the same phenomenon is occurring for health care services."

On the North Shore, for example, Beverly Hospital has clinical care relationships with Children's Hospital, Beth Israel Deaconess, and Lahey Clinic, sharing physicians and resources. "Our physicians are the engine that drives our delivery of health care and they are both approachable and accountable to the community they serve on a local level," says Stephen Laverty, president of Northeast Health System, which includes Beverly Hospital.

Other recent collaborations: Massachusetts General and North Shore Medical Center are planning a cancer care center in Danvers, and the Heart Center of Metrowest is joining with Beth Israel to make cardiovascular care more accessible to residents in the Framingham area.

But hospitals that hang their shingles out on the local street corner aren't the only ones changing the health care marketplace. Private, for-profit providers are offering niche clinical and specialty facilities, and even local pharmacies are adding walk-in clinics.

"This is another example of competition that both the hospitals and physicians are facing, competition that will be won or lost based on strategically located and well-designed facilities," says Jarmusz.

On a sunny autumn day at Children's Hospital Waltham, patients walk through a cheerful lobby where kaleidoscope sculptures dangle from the ceiling. Some visitors are here for the brand new outpatient care facility, where everything from tonsils to orthopedic ACL (Anterior Cruciate Ligament) repairs are done; others are visiting for the allergy, dermatology, or urology programs. Right now, the Waltham site serves almost 25 percent of the families who come to Children's for outpatient care, says administrator Gordon.

But not all procedures can be done in a community setting. Rick Wade, a spokesperson for the Washington, D.C.-based American Hospital Association (AHA), says high-risk, complicated procedures will probably always be done in an urban academic hospital setting. "There have always been medical illnesses that should be treated in a higher acuity teaching hospital, as there is certain clinical expertise that is limited or procedures so uncommon that it makes good sense to try to consolidate them," says Dr. Stan Lewis, senior vice president of network integration for Beth Israel.

In the meantime, though, Jarmusz of Alter+Care and other experts say that consumers can expect the urban-suburban partnerships to continue. Although some feel this marketing of medicine can lead to commercialization of health care and too much emphasis on the bottom line, Wade of the AHA says that as patients bear a larger portion of the cost of health care, they're looking for convenience and accessibility. "Patients no longer just go where doctors say they should go," says Wade. "They're more invested in making their own decisions about health care and having more choices."

And what do those major players, the physicians, think? "The doctors have enjoyed it," says Gordon of Children's. Lewis of Beth Israel agrees. "It builds collaboration between institutions, is helpful in coordinating care and sharing information, all of which results in safer and more efficient care. It's good medicine."

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