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Changes resisted
at Caritas Carney
(May
2008 Issue)
By Nan Shnitzler
A report commissioned by the Massachusetts Attorney General has
recommended that Caritas Carney Hospital in Dorchester reposition
itself from an acute care hospital to a mental health center. Carney
has been the weak fiscal link in the six-hospital Caritas Christi
healthcare system, owned by the Catholic Archdiocese of Boston,
and has depended on legislative subsidies to stay afloat.
The Attorney General's office is the public watchdog over the Commonwealth's
non-profit charitable hospitals and Caritas has been of particular
concern. Operating margins are too slim to support capital improvements
and it failed to partner with either of two suitors last year. The
report is a way to pinpoint why, says AG spokesman Harry Pierre.
The report, prepared by Philadelphia-based Health Strategies &
Solutions, Inc., also recommended that Caritas St. Elizabeth's Medical
Center in Brighton transition to a community teaching hospital
and that the archdiocese relinquish system control to an independent
board with healthcare operations expertise. The report suggested
that Carney could restore its viability if it cut underutilized
services and beefed up specialty ones. Carney's medical-surgical
market share declined between 2004 and 2006 in favor of Boston Medical
Center and Quincy Hospital, but some community health centers cite
Carney's behavioral health services as the reason they send patients
there. "Carney should consider the feasibility of transitioning
to a behavioral health services facility while retaining selected
primary care, urgent care and diagnostic services," the report states.
Pierre says the report was advisory and it would be up to Carney
and the Caritas system to evaluate all the inputs and take action.
To that end, Caritas hired Wellspring Partners to take a more in-depth
look at Carney. The results were due at the end of April.
Carney officials are acutely aware of the problems. At the end
of March, they cut 55 jobs at the 197-bed hospital.
"We looked at the report and said tell us something we don't know,"
says Carney spokeswoman Margaret Carr.
Carr characterizes the layoffs as a smart business move to align
staffing levels with patient volumes and says that no direct care
personnel were let go in psychiatric services. She denies that
Carney continues to be a financial drain on the Caritas system and
says it recently posted a profit.
"We're actually moving in the right direction," she says. Carney
provides mental health and substance abuse services in 44 beds and
on an outpatient basis. It's one of the few Boston providers with
an adolescent unit, Carr says. The hospital is looking closely at
psychiatric services as well as its other offerings to see what
makes sense in the current health care climate, but certain changes
are off the table.
"Our initial reaction is we don't think it makes sense for psychiatric
services only," Carr says. "The community has a need for an acute
care hospital and we will remain an acute care community hospital."
The report points out at least one thing everyone can agree with,
that psychiatric services are extraordinarily important, says Bill
Walczak, chief executive officer of Codman Square Health Center.
But he thinks the report missed Carney's significance to its constituency
of several hundred thousand residents as a low cost alternative
to downtown teaching hospitals.
"These 115 beds occupied on any given day are vitally important
to our corner of the city," Walczak says.
Despite the market equation, that medical-surgical beds are abundant
and psychiatric beds are scarce, Walczak doesn't think Carney can
sustain itself on psychiatric beds alone.
The broader debate, Walczak says, has been whether Carney should
stay in business at all. So while the AG report did not recommend
closure, community health advocates still take every opportunity
to trumpet the importance of their neighborhood hospital.
"We're saying we have to look at the system as a whole rather than
this market based ideology," Walczak says. "We need the government
to step in to make sure a system of care serves our region of Boston.
We think a rational system of care would include a full-service
Carney Hospital."
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