Published in the February 17, 2016 edition
By MAUREEN DOHERTY
LYNNFIELD — Last month, the state Department of Public Health (DPH) ruled that the services provided by North Shore Medical Center’s (NSMC) Union Hospital campus in Lynn are “necessary for preserving access and health status within NSMC’s service area.”
This was viewed as good news for the town of Lynnfield as local officials and residents have actively voiced their opposition to the plan by Partners HealthCare to shutter Union Hospital within three years.
Partners and NSMC maintain that its plan to consolidate services now available at Union Hospital to its Salem Hospital campus and also by renovating and expanding the Salem campus will result in improved delivery of medical care in the region.
As a result of the Jan. 22 determination by the state DPH Bureau of Health Care Safety and Quality that Union’s services are “essential,” Partners was required to issue a written plan detailing “how access to the services provided at its Union Hospital campus will be maintained for the residents of the service area.”
Parters responded by the Feb. 5 deadline with a 13–page report outlining its essential services closure process for Union Hospital, including charts detailing all of the outpatient and inpatient services provided at Union in fiscal year 2015.
Writing on behalf of Partners/NSMC was Andrew S. Levine of the law firm of Donoghue Barrett and Singal in Boston.
Levine requested the DPH review their response “within the context of the Hospital’s and Partners HealthCare System’s commitment to continue to care for all of the NSMC’s current patients, to work with primary care and specialty physicians to ensure a smooth transition to new care delivery sites and to meet the ongoing healthcare needs of the communities it serves.”
Levine assured the DPH that “a full service Emergency Department (ED) will remain on the Union campus during the three-year construction/transition period and during this time NSMC will study new models for the delivery of urgent and emergency care in the future and work with community leaders to determine the best array of these services to meet the ongoing needs of all patients and communities.”
Alternative options in emergency care near the current Union campus after the closure of the hospital, according to Levine, could include stand alone urgent care centers run by providers or independent organizations; comprehensive urgent care centers run by providers such as hospitals or integrated MD groups; Satellite Emergency Facilities (SEF) that are not located on a hospital campus, and “new model care centers” that would be a hybrid between comprehensive urgent care centers and SEFs, but which he states are not yet licensed in Massachusetts.
“Until the planning process for emergent/urgent services is completed, it is difficult to assess potential impact on other emergency departments or first responders as the ultimate array of services remaining in the community will be of significant influence,” Levine stated.
The report failed to impress Phil Crawford, chairman of the Board of Selectmen and a vocal opponent of the closure of Union Hospital who addressed the state DPH at the Jan. 7 public hearing.
“Needless to say, I am very disappointed with their failure to address any of the issues brought forward by Lynnfield, Saugus or West Lynn,” commented Crawford after reviewing the 13-page decision. “They obviously do not have a plan to provide services to our community.”
Crawford added that Partners HealthCare officials have indicated their intent to put together “a committee this summer to study the matter. I have already requested to be on that committee as they indicated it will include community leaders.”
Questions travel time methodology
With regard to the concerns raised by Lynnfield residents and officials about the increased travel time the shifting of hospital operations from Lynn to Salem would create for both ambulances and patients, Crawford said it was “misleading” for Partners “to use Mapquest drive times as comparisons since it does not take into account traffic, road conditions, weather, etc.”
The report included several charts detailing comparisons of travel times from eight communities to the Union and Salem campuses, plus a breakdown by zip code for three sections of Lynn to Salem Hospital. It also included charts detailing travel times to other medical centers in the region from those communities. Mapquest was cited as the source of this information, with both distances traveled and estimated drive times based on the site’s “center of town to destination” definition, with an assumption of “normal traffic and legal speed limit” being observed.
Lynnfield officials and residents have repeatedly indicated their concern about increased travel times the town’s ambulances would need to get critically ill patients the care they need as well as the increased time the ambulances would remain out of service on return trips to town from Salem.
Based on the data provided by Partners, Union Hospital is 3.9 miles from Lynnfield’s town center, with a minimum travel time of 8 minutes and a maximum travel time of 11 minutes. By comparison, Salem Hospital is 9.0 miles from the town center, with a minimum travel time of 16 minutes and a maximum travel time of 19 minutes.
The same chart compares the distance, minimum travel time and maximum travel time from Lynnfield center to eight other area hospitals as follows:
• NS Urgent Care/Danvers (7.6 mi./ 10 to 11 min);
• MGH (15.9 mi./ 24 to 41 min.);
• Lahey Med Ctr./Peabody (7.0 mi./ 10 to 11 min.);
• Lahey Med Ctr./Burlington (11.5 mi./ 18 to 29 min.);
• Hallmark HS-Mel-Wak Hospital (6.7 mi./ 13-16 min.);
• Hallmark HS-Lawrence Mem. Hospital (11.4 mi./ 13-14 min.);
• Beverly Hospital (12.4 mi./ 15-17 min.);
• Winchester Hospital (9.6 mi./ 15-26 min.).
In its assessment of whether the additional travel time and distance to Salem Hospital will influence whether patients will opt to seek their care elsewhere after Union Hospital closes, the report states:
“While the hospital hopes and expects that many patients with NSMC physicians will not find the additional travel time an issue, NSMC recognizes that there are other community providers who may be more convenient. Last year, Lynnfield residents accounted for 291 inpatient admissions and 1,151 emergency department visits at NSMC with about a third of both going to the Salem campus.”
The report further stated: “Less than a third of Lynnfield residents and less than a quarter of Saugus residents chose NSMC for their care and other providers already serve many residents of these communities.” The report cites its source for these statistics as “NSMC Data Warehouse.”
“They use numbers from 2015 to rationalize their move, but those numbers are also misleading since they have already moved entire floors of services out of Union,” Crawford said.
Over 138,000 patients went to Union in FY15
The DPH required Partners to provide information on the utilization of services provided to patients prior to the proposed closure of Union. A summary of services delivered to patients in fiscal year 2015 was provided indicating that during this time frame there were 71,562 “unique patient” outpatient visits to Union, with a total of 138,785 “patient encounters,” meaning the same patient returned to Union more than once to obtain a particular service during that year.
The outpatient services provided by category below lists the “total unique patient encounters” followed by “total patient encounters” in parenthesis:
Imaging Services: 22,826 (36,773); Laboratory/Blood Bank: 17,466 (50,525); Emergency: 15,706 (24,156 – includes 20,405 outpatients and 4,111 inpatients); Cardiology Services: 11,214 (18,953); Operating Room: 1,663 (1,813); Infusion Clinic: 821 (2,470); Pain Clinic 785 (1,854); Cardiac, Pulmonary Rehab, Wellness: 715 (1,870); Neurodiagnostic Services: 366 (371).
In FY’15, 28,463 “total patient days” were provided to inpatients at Union Hospital. The inpatients beds provided by type were as follows: Adult Medical/Surgical: 14,917; Geriatric Psychiatry: 6,204; Pediatric Psychiatry: 5,145; and ICU: 2,197.
In addition, diagnostic imaging services at Union Hospital were received by 30,296 unique patients in FY’15 with a total of 36,773 patient encounters.
The types of diagnostic imaging provided by category below lists the “total unique patient encounters” followed by “total patient encounters” in parenthesis: Diagnostic Radiology: 12,847 (17,156); CT Scan: 6,036 (7,084); General Ultrasound: 4,764 (5,321); Mammography: 4,745 (4,762); Interventional Radiology: 868 (1,329); Vascular Radiology: 705 (774); Nuclear Medicine: 331 (347).
According to Levine’s report, Partners believes it will have the capacity to provide the same services currently available to patients at NSMC Union at alternative sites when the transition is completed. The eight types of services analyzed were: Inpatient Medical/Surgical Care; Inpatient Critical Care; Inpatient Psychiatry; Surgical Services; Emergency Services; Primary Stroke Services; Ambulatory Care Clinics and Diagnostic Imaging.
Inpatient Medical/Surgical Care: With 48 new private patient rooms at NSMC Salem, the report states capacity exists to care for all Union campus patients and to meet the needs of the hospital’s service area. This is based on current occupancy rates and new construction enabling Salem to provide 20,552 additional patient days, which will more than accommodate the current 14,917 patient days from the NSMC Union campus.
Inpatient Critical Care: With the current 20-bed ICU and 8-bed CCU, critical care capacity exists at NSMC Salem for an additional 2,287 patient days. Partners states this will enable Salem to care for all Union patients (2,197 patient days) and also meet the demand in the service area while the new facility configuration will support “more efficient management of step-down patients” of which there were 549 at Union in FY’15.
Inpatient Psychiatry: Capacity for Pediatric, Geriatric and Adult psychiatry patients will increase by 56 licensed beds with the relocation from Union to Salem. Partners states this will increase overall capacity by 87 percent, which is more than double current adult beds, and allow for an additional 1,730 annual admissions by 2020.
Surgical Services: Partners states Salem has the existing capacity to accommodate both the current surgical volume at Union and meet the demand of the service area. Combined, the two campuses require 13 operating rooms and Salem currently has 16. Partners also has additional outpatient surgery capacity available at MGH/North Shore in Danvers.
Emergency Services: Partners states its new, larger state-of-the-art ED at Salem, with 65 bays, will have the capacity to care for “high acuity and emergent patients” in the service area. Changes include: improved space for behavioral health patients and an additional capacity for 33,773 annual visits. Those requiring inpatient admission or surgery would be sent to Salem while “low acuity cases will continue to shift to physician offices, existing or newly established urgent care centers or other new care models with in the community.”
Primary Stroke Services: Partners maintains the Salem campus has sufficient capacity to meet the needs of stroke patients in the service area.
Ambulatory Care Clinics: New construction at Salem will provide the capacity to care for all infusion, cardiac, pulmonary rehab, wellness and phlebotomy services currently offered at Union while Partners states it already has sufficient capacity to meet the needs of all other ambulatory services currently offered at Union.
Diagnostic Imaging: Partners states sufficient capacity currently exists at either the Salem campus or at any of its affiliated sites in Peabody, Danvers, Gloucester, Swampscott, the Lynn Community Health Center and MGH North Shore Danvers to meet the full array of diagnostic imaging services currently provided at Union Hospital.