Hospital Merger Raises Questions

BOSTON--As top officials hail the merger of two of Harvard's leading teaching hospitals, the hospitals' rank and file are quietly grumbling that amid the euphoria over cost-efficiency and claims of improved service, they are being overlooked.

Administrators at Brigham and Women's and Massachusetts General Hospital (MGH) have not said anything about whether cutting costs will mean cutting jobs at the two hospitals, nor have they said much else to their nearly 19,000 employees, according to employees interviewed at the hospitals yesterday.

The two hospitals this week took what may be the first step toward consolidating the five main Harvard Medical School teaching hospitals, hoping to reduce costs and improve care. Further, officials see the merger as a shift toward becoming a primary care network that will allow them to better cope with what appear to be imminent changes in the American health care system.

In part, administrators sought a merger with an eye to cutting $240 million in costs from the two hospi- tals' combined operating budgets of $1.2billion.

But for all the good that officials say thehospitals' consolidation will do the Bostoncommunity, employees say they have beenunderinformed and are frightened at the prospectof losing their jobs.

While employees assume that some of them willbe laid off, the full effects on staff andservices have yet to be announced.

Employees say they have stayed informed aboutthe merger mostly from newspaper accounts, insteadof from the hospitals in which they work.

"We really don't know what's going on," one MGHemployee says. "Most of what I'm gathering I'mgetting from The [Boston] Herald."

"They haven't said a word about it and to methat means...people are going to be laid off,"says another MGH employee, who refused to give hisname for fear of losing his job.

At Beth Israel Hospital, which along withChildren's and the Deaconess may eventually jointhe conglomeration, electrical staff worker DavidFitzgerald says the merger may serve the good ofthe communities, but not the employees.

"It's probably good for the hospitals, but notfor us," Fitzgerald says.

Apart from employee concerns about their jobs,there is also the possibility that the merger maycause the loss of some top physicians who may besqueezed out of their departments.

"A merger of all the hospitals would definitelymake them more efficient and cut costs," says Dr.Daveed Frazier of Beth Israel. "Right now, Bostonhas one of the biggest concentrations of topdoctors in the country and a merger might causethe loss of top talent. From an academic and acare-provided point of view, the result of amerger won't be as good."

Hospital staff said in interviews yesterdaythey thought the part of the merger mostattractive to the administration was its potentialto save money.

Administrators at the two hospitals, however,say they view the merger as a way to better theinstitutions' original purposes of "servingwhoever comes through the door," said H. RichardNesson, president and CEO of Brigham and Women'sHospital, at the press conference Wednesdayannouncing the move.

"The merger isn't primarily about costreduction. It's about how to better serve thecommunity and carry out our mission," he said.

Administrators also touted the move in a memodated yesterday to the employees of Brigham andWomen's Hospital and MGH--the first suchcommunication to staff about the merger.

"Through this merger, we have combined ourstrengths to better prepare ourselves to meet therevolution in managed care," read the memo fromMGH General Director J. Robert Buchanan andNesson.

"By merging, we believe we will be able tooffer the best resources for patient care,research, and teaching through an efficient,cost-effective delivery system," Buchanan andNesson wrote.

Cost-effectiveness also seemed to be on themind of Medical School Dean Daniel C. Tosteson '44at the Wednesday press conference. He called themerger a "momentous step" that he hopes will allowthe two hospitals to provide "the highest qualityof health care at an affordable cost to thelargest possible population in the greater Bostonarea."

Several doctors and nurses agree the merger isa good idea.

Dr. Joseph Rhatigan of Brigham and Women's saysone of the merger's greatest effects would come inthe form of financial savings.

"I don't think there will be any differences interms of services, but there probably will befinancial savings," he says. "For example, rightnow there are duplicate services provided by thetwo hospitals, such as transplants, that will bestopped."

Dr. Eugene Braunwald, chair of Brigham andWomen's department of medicine, said at the pressconference the merger will lower costs by trimmingredundant services and reducing the hospitals'excess capacities.

"I think it can eliminate the duplication ofservices, reduce costs and improve care,"Braunwald said.

Nurse Kevin J. Flinn of Beth Israel ambulatoryservices says he hopes the other hospitals willjoin Brigham and Women's and MGH in theconsolidation.

"I think Beth Israel being part of the mergerof Harvard teaching hospitals would make sense,"Flinn says. "I don't think it would compromiseservices and costs would probably be reduced. Theywould have to save money on central administrationcosts and the added purchasing power wouldprobably lead to better prices on medical items."

Though it appears the five hospitals have theultimate goal of joining forces, for now the threehospitals not included in the merger are moreconcerned with the effects the current move willhave on them.

Beth Israel's Dr. Joshua Bloomstone says hethinks his hospital can benefit from the merger.

"I think the merger is potentially good forBeth Israel because Mass General and the Brighammight now form their own HMO [health maintenanceorganization] and then [Harvard Community HealthPlan] will pull out. And if that happens theymight come here," he says. "This merger gives usthe possibility of merging with Deaconess to forman Ob-Gyn center."

The merger has national implications beyond thehighly-concentrated population of health careworkers in the Boston area, as the Clintonadministration pushes for reforms in health care.

One key player in the merger, Business SchoolDean John H. McArthur, cited the changing natureof health care as a major factor in the hospitals'move, calling the merger "just a small step in thereordering of health care."

Boston is not the first city to attempt amerger of this kind. Other cities--most recently,Minneapolis--have responded similarly to thehospitals' growing size and to the growing numberof HMOs, says one health care expert who requestedanonymity.

The implication of such recent moves, then, isthat "consolidation"--one of the corporate buzzwords of the '90s--has arrived in health care. Forstaff at those hospitals, as they know all toowell, "consolidation" may mean "unemployment."CrimsonHaibin Jiu

But for all the good that officials say thehospitals' consolidation will do the Bostoncommunity, employees say they have beenunderinformed and are frightened at the prospectof losing their jobs.

While employees assume that some of them willbe laid off, the full effects on staff andservices have yet to be announced.

Employees say they have stayed informed aboutthe merger mostly from newspaper accounts, insteadof from the hospitals in which they work.

"We really don't know what's going on," one MGHemployee says. "Most of what I'm gathering I'mgetting from The [Boston] Herald."

"They haven't said a word about it and to methat means...people are going to be laid off,"says another MGH employee, who refused to give hisname for fear of losing his job.

At Beth Israel Hospital, which along withChildren's and the Deaconess may eventually jointhe conglomeration, electrical staff worker DavidFitzgerald says the merger may serve the good ofthe communities, but not the employees.

"It's probably good for the hospitals, but notfor us," Fitzgerald says.

Apart from employee concerns about their jobs,there is also the possibility that the merger maycause the loss of some top physicians who may besqueezed out of their departments.

"A merger of all the hospitals would definitelymake them more efficient and cut costs," says Dr.Daveed Frazier of Beth Israel. "Right now, Bostonhas one of the biggest concentrations of topdoctors in the country and a merger might causethe loss of top talent. From an academic and acare-provided point of view, the result of amerger won't be as good."

Hospital staff said in interviews yesterdaythey thought the part of the merger mostattractive to the administration was its potentialto save money.

Administrators at the two hospitals, however,say they view the merger as a way to better theinstitutions' original purposes of "servingwhoever comes through the door," said H. RichardNesson, president and CEO of Brigham and Women'sHospital, at the press conference Wednesdayannouncing the move.

"The merger isn't primarily about costreduction. It's about how to better serve thecommunity and carry out our mission," he said.

Administrators also touted the move in a memodated yesterday to the employees of Brigham andWomen's Hospital and MGH--the first suchcommunication to staff about the merger.

"Through this merger, we have combined ourstrengths to better prepare ourselves to meet therevolution in managed care," read the memo fromMGH General Director J. Robert Buchanan andNesson.

"By merging, we believe we will be able tooffer the best resources for patient care,research, and teaching through an efficient,cost-effective delivery system," Buchanan andNesson wrote.

Cost-effectiveness also seemed to be on themind of Medical School Dean Daniel C. Tosteson '44at the Wednesday press conference. He called themerger a "momentous step" that he hopes will allowthe two hospitals to provide "the highest qualityof health care at an affordable cost to thelargest possible population in the greater Bostonarea."

Several doctors and nurses agree the merger isa good idea.

Dr. Joseph Rhatigan of Brigham and Women's saysone of the merger's greatest effects would come inthe form of financial savings.

"I don't think there will be any differences interms of services, but there probably will befinancial savings," he says. "For example, rightnow there are duplicate services provided by thetwo hospitals, such as transplants, that will bestopped."

Dr. Eugene Braunwald, chair of Brigham andWomen's department of medicine, said at the pressconference the merger will lower costs by trimmingredundant services and reducing the hospitals'excess capacities.

"I think it can eliminate the duplication ofservices, reduce costs and improve care,"Braunwald said.

Nurse Kevin J. Flinn of Beth Israel ambulatoryservices says he hopes the other hospitals willjoin Brigham and Women's and MGH in theconsolidation.

"I think Beth Israel being part of the mergerof Harvard teaching hospitals would make sense,"Flinn says. "I don't think it would compromiseservices and costs would probably be reduced. Theywould have to save money on central administrationcosts and the added purchasing power wouldprobably lead to better prices on medical items."

Though it appears the five hospitals have theultimate goal of joining forces, for now the threehospitals not included in the merger are moreconcerned with the effects the current move willhave on them.

Beth Israel's Dr. Joshua Bloomstone says hethinks his hospital can benefit from the merger.

"I think the merger is potentially good forBeth Israel because Mass General and the Brighammight now form their own HMO [health maintenanceorganization] and then [Harvard Community HealthPlan] will pull out. And if that happens theymight come here," he says. "This merger gives usthe possibility of merging with Deaconess to forman Ob-Gyn center."

The merger has national implications beyond thehighly-concentrated population of health careworkers in the Boston area, as the Clintonadministration pushes for reforms in health care.

One key player in the merger, Business SchoolDean John H. McArthur, cited the changing natureof health care as a major factor in the hospitals'move, calling the merger "just a small step in thereordering of health care."

Boston is not the first city to attempt amerger of this kind. Other cities--most recently,Minneapolis--have responded similarly to thehospitals' growing size and to the growing numberof HMOs, says one health care expert who requestedanonymity.

The implication of such recent moves, then, isthat "consolidation"--one of the corporate buzzwords of the '90s--has arrived in health care. Forstaff at those hospitals, as they know all toowell, "consolidation" may mean "unemployment."CrimsonHaibin Jiu