New Caritas chief puts an end to old practice

By Jeffrey Krasner
http://www.boston.com

Ralph de la Torre became Caritas Christi's CEO in May.Caritas Christi Health Care is dropping a longstanding strategy in which doctors at its five community hospitals have been pressured to refer as many patients as possible to St. Elizabeth’s Medical Center, the flagship of the six-hospital chain owned by the Archdiocese of Boston, according to its new chief executive, Dr. Ralph de la Torre.

Doctors will have more freedom to refer patients to whichever institution will provide low-cost, high-quality care, de la Torre said. That will enable the community hospitals to keep more high-paying procedures. Until now, community hospital referrals have acted to subsidize St. Elizabeth’s.

Sending patients from suburban hospitals to a larger central hospital with high levels of medical expertise – a strategy known as “hub and spoke” – no longer works, de la Torre said in an interview.

“In the past, the effort to drive that hub-and-spoke network hurt the relationship among the local doctors, local hospitals, and the patients,” he said.

The move is driven in part by an acknowledgement of St. Elizabeth’s capabilities, said de la Torre. “We’re not going to be the full-blown, academic research hospital,” he said.

The change was applauded by some hospital executives. “As somebody who lived within the system for many years in two different strong and needed hospitals, I fervently hope the hub-and-spoke model is dead,” said Delia O’Connor, chief executive of Anna Jaques Hospital in Newburyport. She worked at Caritas Christi for more than 15 years and was chief executive of Caritas Norwood Hospital. “That will be best for the communities served by the hospitals.”

Ellen Zane, chief executive of Tufts Medical Center, said, “I think this is a great move. Referrals to tertiary centers can never be forced; they must be earned.”

Tertiary-care hospitals have advanced equipment and many specialized physicians and can handle complex medical cases that are beyond the scope of many community hospitals. Many also serve as teaching sites for medical schools and conduct extensive scientific research.

Though St. Elizabeth’s is a teaching hospital for Tufts University School of Medicine and it has some research programs, it has never reached the level of advanced medical expertise across many specialties that Massachusetts General Hospital or hospitals in Boston’s Longwood Medical Area boast.

Caritas Christi is one of the few free-standing Catholic healthcare systems in the United States. It also includes Caritas Holy Family Hospital in Methuen, Good Samaritan Medical Center in Brockton, Caritas Carney Hospital in Dorchester, and St. Anne’s Hospital in Fall River.

After two unsuccessful attempts to sell the chain last year, the archdiocese renewed its search for a new chief executive for the system and hired de la Torre in May. The archdiocese also revamped the system’s board of trustees so it could operate independently of the church, except in matters of medical ethics or sale of assets.

Already, de la Torre has made some bold proclamations:

He said Carney Hospital would stay open as a community hospital, despite large operating losses in recent years.

He unveiled plans for an $18 million upgrade to operating rooms at St. Anne’s.

He said he was considering turning Good Samaritan’s emergency department into a Level One trauma center – one that is able to treat catastrophic injuries, such as gunshot wounds.

But it’s unclear how Caritas Christi will pay for the improvements. De la Torre said the Carney plan is contingent on receiving $20 million to $30 million from the state, foundations, or private donors. With that money, he said, Carney could invest in deferred maintenance and other improvements. He said that after recent cost-cutting, the hospital is now breaking even, without state subsidies or additional cash from Caritas Christi.

The improvements at St. Anne’s were planned by Robert Guyon Jr., that hospital’s chief executive, long before de la Torre joined Caritas Christi, he said. Money for the job will come from a planned refinance of Caritas Christi’s $250 million in bonds this summer, he said. Even though interest rates are up, de la Torre said the hospital will be able to lower its debt service payments by having steady payments over the life of the loan. The current finance package is “front-loaded,” so payments are higher in early years and then decline.

De la Torre acknowledged that operating a Level One trauma center is expensive and often doesn’t bring in enough money to cover the expenses of having round-the-clock staffing by highly trained physicians.

“We’re looking at it,” he said. “It’s 50-50. Everything we’re looking at has to meet three criteria: Does it make fiscal sense? Is there a need for the service? And can we do it well?”

Jeffrey Krasner can be reached at krasner@globe.com.

© Copyright 2008 Globe Newspaper Company.

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