Boston Medical Center and Tufts Medical Center Eye Partnership

With more than 870,000 patient visits last year and more than 4,500 full-time staff, Boston Medical Center is the largest safety-net hospital in New England. Photo by Kalman Zabarsky

Boston Medical Center, Boston’s “safety-net hospital” and the primary teaching hospital for the BU School of Medicine, is discussing a strategic partnership, including a potential merger, with Tufts Medical Center, the primary teaching hospital for Tufts University Medical and Dental Schools.

Karen Antman, dean of the School of Medicine and provost of the Medical Campus, stressed that any partnership or merger would not include the medical schools, which are parts of their respective universities.

Robert A. Brown, president of Boston University, says it is imperative that any partnership or merger maintain Boston Medical Center (BMC) as a premier academic medical center and as a safety-net hospital, fulfilling the hospital’s mission to provide exceptional care to the city’s vulnerable populations, regardless of insurance status or ability to pay. “BMC is a superb academic medical center and the city’s most important safety-net hospital,” Brown says. “If a partnership or merger can ensure that BMC continues to play both these roles in a stronger, sustainable way in the future, it is worth pursuing.”

Kate Walsh, president and CEO of Boston Medical Center, echoed Brown’s commitment to continuing to provide first-rate medical care for all. Walsh says conversations to date suggest that a strategic partnership may strengthen the missions of both medical centers and that “an affiliation that secures a long, bright future of continuing to provide exceptional care without exception would be of great interest to us.”

She says a partnership with Tufts Medical Center could have great potential benefits, including new options to serve patients, greater financial resources, and a larger referral network to attract new patients and better payments from insurers.

“Tufts Medical Center is our neighbor,” says Walsh. “We know them, we respect them, we share a common geography and a commitment to providing high-quality care to all patients. We also share a mutual commitment to our academic missions of teaching and research.”

Over the last 20 years, changes in health care models have made hospital partnerships and mergers a virtual requirement for a sustainable health care business, particularly in the Boston area. In 1994, Massachusetts General and Brigham and Women’s teaching hospitals teamed up to form Partners Health Care, which has since brought in several community hospitals around Boston. In a rival venture, Steward Health Care has, in the past few years, taken over 10 community hospitals as well at St. Elizabeth’s and Carney hospitals. Earlier this year, Beth Israel Deaconess Medical Center took control of Jordan Hospital in Plymouth and formed a joint venture with New England Baptist Hospital. Antman says many observers of Boston’s crowded health care arena consider a merger involving Boston Medical Center to be long overdue.

Similarly, changes in health care payments combined with cuts in research funding have hit academic medical centers particularly hard. An alliance between Tufts and BMC could produce efficiencies of scale, Antman says.

Walsh cautioned that while the two medical centers have much in common, “there is more work we need to do before we will know whether a partnership is the best option for our employees, and most importantly, our patients.”

A combination of the two medical centers could result in significant change for clinical faculty at both schools of medicine. Boston Medical Center currently has 724 physicians, including the clinical faculty at the BU School of Medicine, and Tufts Medical Center employs 500. BMC officials say any partnership involving the two hospitals would take years to accomplish, and that the medical center would continue to offer a full range of services.

“We do not underestimate the anxiety that this will create among our clinical faculty,” Brown says. “We also understand that the hospitals, and not the universities, control the outcome of any discussion. We will do all we can to provide support and advocacy on behalf of our clinical faculty during what will be a period of uncertainty.”

If the two hospitals merge, the two medical schools would remain separate, each with its own faculty, curriculum, and rotations, called clerkships. The merger would have no impact on the number of students enrolled at the BU Medical School or on the size of the medical sciences faculty who teach at the school. However, the consolidation may result in fewer hospital beds, which might reduce the number of clerkships and residency slots available to BU and Tufts Medical students in the consolidated hospital. Currently, 45 percent of BU medical students do their clerkships at BMC while 35 percent of Tufts medical students do theirs at Tufts Medical Center.

Antman says she does not foresee a shortage of clerkship opportunities for BU medical students. “We are affiliated with 20 other hospitals in the area,” she says, “and we have a program in place to identify even more clerkship and residency opportunities in Boston, and around the country.”

With more than 870,000 patient visits last year and more than 4,500 full-time staff, Boston Medical Center is the largest safety-net hospital in New England. Approximately 70 percent of BMC patient visits come from come from people who rely on government payers such as Medicaid, the Health Safety Net, and Medicare for their coverage.

Boston Medical Center struggled with changes to the health care business for years and only recently, under the leadership of CEO Kate Walsh, has it approached financial stability. In 2012, the hospital reversed three years of losses and posted a small but meaningful financial gain. At the same time, Moody’s Investor Service and Standard & Poor’s bumped up their ratings of the hospital from negative to stable.

“Kate Walsh’s excellent track record as our hospital leader gives us added assurance that any change is likely to be in the best interests of the hospital, the underserved, and those medical students and clinical faculty associated with the facility in the future,” Brown says.

Antman says she sees hope in successful mergers such as the 1998 partnership of New York Hospital and the Presbyterian Hospital, which created the 2,500-bed New York Presbyterian Hospital. That hospital, which has two distinct medical centers, Columbia University Medical Center and Weill Cornell Medical Center, serves as the primary teaching hospital for Columbia University’s College of Physicians and Surgeons and the Weill Cornell Medical College.

“In these initial discussions we are all looking forward to finding a new way to educate medical students in Massachusetts,” says Antman. “There is no reason we can’t work with our partners to create a better educational experience for our students.”