Lahey Health Reexamines the Appropriate Care Model

John Commins, for HealthLeaders Media , March 12, 2014

Because we have two community hospitals locally and a third one to come on line, Winchester Hospital, we now have hospital partners and we can be much more nimble.

Some examples: We have patients now who come to our emergency department at the tertiary medical center in Burlington who reside in communities where our other partner hospitals are located. If those patients have a condition that can be treated just as well in a community hospital setting, we actually transfer them back to the community hospital.

This is a very novel idea because most academic teaching hospitals want to take on as many patients as they can to fill their beds. What we are doing is reversing the transfer process and patients are getting great care within our system at a lower cost to the plans and the patients and the Commonwealth of Massachusetts.

We are also actively telling our primary care practices surrounding the tertiary medical center to use local consultants and specialists who are on the medical staffs of our system community hospitals to keep care local. Before, we would encourage those primary care doctors to send their patients to the mother ship because we didn't have partner community hospitals.

HLM: How can you tell if your efforts are successful?

Nesto: The end result is that our community hospitals have the highest censuses they've had in years because of this redirection of care.

Community hospitals, particularly in a highly competitive market like eastern Massachusetts, unless they keep their census up are going to wither. That is counter-productive because then more and more care will go to Boston, where it is much more expensive.

I worked 25 years at Boston and Harvard teaching hospitals and at any one time probably 30% of the patients have conditions that can be treated just as well in a community hospital setting and the patient can stay close to the home.

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