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A look at 3 systems battling housing insecurity


Housing insecurity is  a major social determinant of public health, although the problem has been too often neglected. But now some hospitals across America are trying to address it, says a report by the Root Cause Coalition. It discusses efforts by three hospital systems.

The report‘s authors note that housing issues can include homelessness and/or housing options that are too expensive. Millions of Americans face these issues, which can lead to very serious physical and mental illnesses.

Patients with housing insecurity are less likely to get needed healthcare, saving their  very scare resources for housing and food.

And so, the report says, ” hospitals like those under Partners HealthCare (based in Boston) are screening patients more closely for housing insecurity and other social determinants of health…. Patients flagged by the health system as potentially at risk for or suffering from housing concerns are connected with community organizations that offer support like short-term rental assistance, financial coaching, job training and other potentially beneficial programs.”

Consider Boston Medical Center, which has partnered with community groups to identify children in families that have high rates of emergency department use.  ER ”superusers” are a heavy burden on the industry.

BMC’s program offers housing prescriptions to patients and links them with care-coordination services to prevent or at least reduce unneeded ED visits.

In Cleveland, University Hospitals  has a local economic-stimulus program with  a housing component.

Finding stable housing for the currently homeless has been good for hospitals, too, in that it can cut the costs of care for patients  with chronic conditions who require inpatient stays.  Homeless patients are more likely to be readmitted than people with secure housing.

To read the report, please hit this link.


Boston Medical Center uses food pantry to try to improve population health



Artist’s rendition of Boston Medical Center.


The Boston Medical Center uses a food pantry demonstration project to improve local population health through addressing nutrition insecurity.

Hospitals & Health Networks reports: “Their initial work in helping to feed the community led to the establishment in 2001 of what was one of the first hospital-based food pantries in the U.S., serving not just the original target of pregnant women and undernourished children, but anyone who needed to eat. Demand has exploded ever since, and this past summer, the hospital rolled out a significantly larger version.

“With that, they now have expanded storage space to accept more donations and offer more cooking classes. Today, they distribute about 12,000 pounds of food a week, and the expansion helps BMC to meet the logistical challenges of storing and distributing food not for just the original 500 per month it was designed for, but thousands.”

“The pantry provides groceries not only for the patient, but for his or her entire household. And they are careful to meet the individual’s medical needs, such as diabetes or hypertension.”

To read the entire article, please hit this link.


Cardiac rehab gains more ground but cost and access issues remain



For Kaiser Health News


Mario Oikonomides credits a massive heart attack when he was 38 for sparking his love of exercise, which he says helped keep him out of the hospital for decades after.

While recovering, he did something that only a small percentage of patients do: He signed up for a medically supervised cardiac-rehabilitation program where he learned about exercise, diet and prescription drugs.

“I had never exercised before,” said Oikonomides, 69, who says he enjoyed it so much he stayed active after finishing the program.

Despite evidence showing such programs substantially cut the risk of dying from another cardiac problem, improve quality of life and lower costs, fewer than one-third of patients whose conditions qualify for the rehab actually participate. Various studies show women and minorities, especially African Americans, have the lowest participation rates.

“Frankly, I’m a little discouraged by the lack of attention,” said Brian Contos, who has studied the programs for the Advisory Board, a consulting firm used by hospitals and other medical providers.

Now, though, advocates say cardiac rehab may gain traction, partly because the federal health care law puts hospitals on a financial hook for penalties if patients are readmitted after cardiac problems. Studies have shown that patients’ participation in cardiac rehab cut hospital readmissions by nearly a third and saved money.

The law also creates incentives for hospitals, physicians and other medical providers to work together to better coordinate care.

Cost Undermines Participation

Oikonomides, who lives in Charlottesville, went for three decades without another heart attack after his first, but recently had bypass surgery because of blockages in his heart.

He is again rebuilding his strength at the University of Virginia Health System. “I attribute my 30 good years of life to cardiac rehab,” he said recently while pedaling on a stationary bike in a light-filled gym at one of the university’s outpatient medical centers, a heart monitor strapped to his chest.

But many patients still face hurdles.

Uninsured patients simply can’t afford cardiac rehab. And for those with some form of coverage, “the No. 1 barrier is the cost of the copayment, which is frustrating,” said Dr. Ellen Keeley, a cardiologist at UVA, who strongly encourages her patients to enroll.

Medicare and most private insurers generally cover cardiac rehab for patients who have had heart attacks, coronary bypass surgery, stents, heart failure and several other conditions. Most coverage is two or three hour-long visits per week, up to 36 sessions.

Insured patients usually must make a per visit co-pay to participate. For regular Medicare members, that runs about $20 a session, although many have private supplemental insurance that covers that cost. For patients with job-based insurance — and enrollees in the alternative to traditional Medicare called Medicare Advantage — out-of-pocket costs can range from nothing per session to more than $60 a pop.

“Some insurers say a copay for a specialty visit is $50, whether that means going to a neurosurgeon once in their life or whether that’s three times a week for cardiac rehab,” said Pat Comoss, a consultant in Harrisburg, Pa., who trains nurses to work in these programs.

More than a year ago, federal Medicare officials met with insurers after advocates voiced their concern that higher copays were keeping patients from cardiac rehab, said Karen Lui, a legislative analyst for the American Association of Cardiovascular and Pulmonary Rehabilitation, the profession’s trade group.

“To their credit, they dug in and talked with plans that had much higher copays, such as $100 per session,” said Lui. Medicare officials told insurers that a $50 copay per session is the upper limit a plan should charge,” he added.

UnitedHealth, with nearly 3 million members in Medicare Advantage plans, said patient payments for cardiac rehab vary widely. About 12 percent of members pay nothing, while 23 percent pay $50 a session. Another large insurer, Humana, has a similar range, with co-pays running up to $60 a session.

Nationally, the weighted average payment now for Medicare members in private plans is just a bit more than the $20 that patients in traditional Medicare pay, said Dale Summers, director of the Center for Medicare & Medicaid Services’ division of finance and benefits.

Preventing The Next Heart Attack

Aside from cost, another big reasons so few patients participate is many are never referred to a program. Some hospitals are addressing this disconnect by building automatic referrals into their discharge system.

Patients may be reluctant to attend cardiac rehab, especially if they had not been physically active before their heart problem.

To counter that, Gary Balady, director of preventive cardiology at Boston Medical Center, stresses its importance with his patients. He tells them that about 15 percent of heart-attack patients may experience another one within a year.

“One of first things we say [in cardiac rehab] is we are here today to work together to prevent the next heart attack,” he said.

At the University of Virginia medical center, heart-attack patients are given an appointment to come back to a special clinic within 10 days of discharge. Over the course of about an hour, patients meet with an exercise physiologist, a cardiologist, a nutritionist and a pharmacist — and all in the same exam room.

At the visit, the medical professionals answer questions, go over the patient’s medications, make diet tips and recommend cardiac rehab. Kathryn Ward, manager of UVA’s cardiology clinics, says up to 100 patients a month were referred to the clinic in its first year. Of those, 71 percent enroll, she said, well over the national average.

Other Barriers

Still, patients face other barriers to this kind of care, including time constraints, or having to travel long distances to the nearest program.

And existing programs aren’t enough to accommodate all patients who are eligible. A recent study in the Journal of Cardiopulmonary Rehabilitation and Prevention surveyed 812 existing cardiac rehab programs in the U.S., finding that even if they were expanded modestly and operated at capacity, they could still only serve 47 percent of qualifying patients.

“We have patients who are an hour away from any cardiac facility and they can’t afford the gas money or the time,” said UVA cardiologist Keeley.

Take Kathryn Shiflett of Culpeper, Va. At age 33, the last thing she expected was a heart attack.

But one night in late March, she felt pain in her arm — pain that spread to her jaw — and she felt nauseated. After tests at a local hospital, she was transferred by ambulance to UVA, where cardiologists opened a blocked artery in her heart.

Shiflett, a medical worker with two children, traveled back to UVA a week later for her clinic appointment, and was encouraged to participate in cardiac rehab.

Shiflett found the program appealing because she wants to be active and prevent a repeat of her heart attack. But she lives an hour away. In addition to the distance, she isn’t sure she can make any of the sessions. Cardiac rehab classes are during working hours. The latest starts at 3 p.m.

“I’m not sure I can get there by then,” Shiflett said.

One answer for patients like Shiflett could be a home-based program, which are less common, but drawing increased interest.

“There are a whole plethora of different ways to provide cardiac rehab outside traditional center model,” said Mark Vitcenda, senior clinical exercise physiologist at the University of Wisconsin Hospital and Clinics in Madison.

At his program, patients can start in a supervised program at a center for two or three sessions, then can choose whether to continue in a home-based model, with occasional visits to the center. About 30 to 40 percent of Wisconsin program patients choose the home-based option, he said, with most being younger, working patients with lower medical risk.

“If we can lower the barriers of transportation and cost, patients are able to be more involved,” he said.

Some Boston physicians push for research without patient permission



Scan showing cerebral contusions, hemorrhage within the hemispheres, subdural hematoma and skull fractures.

The Boston Globe reports that a group of Boston doctors proposes to join research that would involve “emergency treatment for brain-injured patients without obtaining the trauma victims’ consent, arguing that they often arrive at the hospital unconscious or without family members who can speak on their behalf.”

“Federal law and the generally accepted ethics of medical research require that patients or their surrogates be told about any risks of participating in a study and have the chance to refuse enrollment. But the law allows for an exemption in certain cases involving emergency care.”

“The study team, from Boston Medical Center and Massachusetts General Hospital, wants to join a national trial looking at whether giving the hormone progesterone to patients in the hours immediately after a traumatic brain injury could prevent further neurologic damage.”






Tufts, BMC merger talks fall apart

Boston Medical Center and Tufts Medical Center have called off their merger talks aimed at what would have been the biggest alliance of two hospitals in the hospital-rich city in nearly two decades.


The Boston Globe reported that they couldn’t overcome “differences in culture, mission, and strategies for the future.”

“Culture always trumps strategy,” Ellen Lutch Bender, president of the consulting firm Bender Strategies LLC, told The Globe.

However, officials said that the two institutions remain open to future collaborations.


Will hospital mergers lead to unionization wave?



A large labor union, the Service Employees International Union Local 1199, looks at  merger negotiations between Boston Medical Center and Tufts Medical Center as a chance to increase hospital-worker union membership. Layoffs are almost inevitable in such mergers, and the union will use that fear to push unionization.

As the wave of hospital mergers continue around America, will more and more workers turn to unions for relief?


Partners to face lower-priced rival


Tufts New England Medical Center and Boston Medical Center are pushing to complete a merger this year and set up the new entity as a lower-price competitor to Partners HealthCare.

Massachusetts regulators, long concerned about Partners’ pricing power,  presumably will help move along the merger.




Boston Medical Center spending millions to shrink


The Boston Globe reports that the Boston Medical Center has expanded a ”massive redesign of its sprawling campus, boosting the estimated cost of construction and renovations to $300 million — $30 million more than originally projected.”
“The four-year endeavor, which began in 2014, is intended to shrink the medical center’s 2 million-square-foot campus by about 300,000 square feet. Hospital leaders say the redesign, which will rehabilitate some facilities and build new ones, will result in a more efficient campus that will save about $25 million a year.”

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