Boston Medical Center is weighing a plan to close an aging part of its sprawling campus and eliminate about 85 of its 496 beds, as it braces for state and federal budget cuts and intensified pressure to shift more care to outpatient settings.
Hospital executives stressed that it was premature to estimate how many, if any, of their 4,500 jobs would be shed as part of the plan to shutter the East Newton Street campus, site of the former University Hospital. That hospital merged with neighboring Boston City Hospital in 1996 to create Boston Medical.
Both hospitals had a history of service to poor residents of Boston, and Boston Medical has continued that mission, pledging “exceptional care without exception.” Hospital officials say their plan would allow them to retain their mission by treating more patients in neighborhoods and moving about 60 medical surgical beds — and many workers — to floors in the Yawkey Center and Menino Pavilion at the hospital’s main campus in the South End.
“Boston Medical Center is looking at every way we can to make our hospital efficient,” said chief executive Kate Walsh. “Beds are the most expensive part of our operation. Going from 500 beds to 400 beds is a big decision for our hospital, and we have not made it yet. But we’re evaluating it as part of health care reform, which is going to require fewer patients in beds.”
The plan, which would take place over the next four to five years, would require the approval of the hospital’s board and the Boston Redevelopment Authority.
Hospital executives have begun to brief employees and leaders of labor unions representing workers at Boston Medical, the largest of the state’s so-called safety net hospitals serving disproportionate numbers of low-income patients. They met with representatives of three unions in separate meetings last month, and earlier hosted a town hall-style forum with more than 200 employees.
Walsh said the hospital’s goal is to treat more residents at outpatient settings such as the city’s neighborhood health centers that refer patients needing more complex care to Boston Medical. She said the hospital currently spends about $2 million a year transporting patients two blocks by ambulance from one campus to another. Shortly after Walsh took the helm in 2010, the hospital shut down the emergency department at the East Newton campus.
But the plan to close the entire campus, including medical surgical beds, would have a far greater impact and is certain to draw intense scrutiny from union and city officials.
Leaders of the Massachusetts Nurses Association, which represents registered nurses at the East Newton campus, would ask Boston city officials to intervene if they felt the health care of the community was being compromised by the move, said union spokesman David Schildmeier.
“We have concerns that the plan they’re moving towards is going to displace more than 400 nurses eventually from the old University Hospital,” said Schildmeier. “That’s a pool of talent and experience we’re concerned about preserving. So we’re going to be watching this closely to make sure that this is in the best interest of the city and the best interest of the workforce.”
Boston Medical, a teaching affiliate of the Boston University School of Medicine, currently has about 142 medical surgical beds and 28 intensive care unit beds at the East Newton campus, which sits between Albany Street and Harrison Avenue.
Most of the hospital’s renovations and newer buildings — including the Shapiro Ambulatory Care Center — are clustered at the main campus near the intersection of Massachusetts Avenue and Albany Street. BU’s medical school, which sends its medical residents to work at both campuses, is sandwiched between the two.
Ellen Lutch Bender, president of health care consultant Bender Strategies in Newton, said the move may be a harbinger of things to come at other Massachusetts hospitals.
“Boston Medical Center is doing what it needs to do to stay financially solvent in this challenging health care environment,” Bender said. “Hospitals are under huge financial pressure to do what they have done but do it with less resources. We’re going to see at many hospitals the possibility of moving beds and the possibility of staff reductions.”
After losing money for several years, Boston Medical posted a profit of $8.8 million in 2012, according to figures released last week by the Massachusetts Center for Health Information and Analysis.
But because it derives about three-quarters of its revenue from Medicaid and Medicare — the government insurance programs for low-income and older patients — the hospital is vulnerable to the deep federal and state budget cuts projected in coming years.
The state and federal health care overhaul laws in recent years also create incentives for Boston Medical and other Massachusetts hospitals to develop specializations, coordinate care with one another, and treat more patients in less costly community settings.
“In some instances, service relocations within Boston Medical Center will make sense, but of course the larger concern of health care workers will be with any potential reduction in services to patients or the community,” said Jeff Hall, spokesman for Local 1199 of the Service Employees International Union, one of the labor groups that met with hospital officials.
Hospital officials also met last month with representatives of the Massachusetts Nurses Association and the American Federation of State, County and Municipal Employees.
“As is the case whenever there’s a downsizing or cutback, we’ll be monitoring the process very closely and making sure our members are treated fairly and equitably and in accordance with our collective bargaining agreement,” said Jim Durkin, spokesman for AFSCME Council 93.