More than three months after Tufts Medicine abruptly announced plans to shut its children’s hospital, the health system is revealing long-awaited details about the fate of dozens of doctors and nurses as well as thousands of patients, many of whom are on Medicaid and live with complex medical conditions.
The details include employment opportunities for all physicians and a pledge to keep open a unique rheumatology clinic at Tufts, which several families had feared would close.
“We’ve been working very closely with all of our physicians ... to make sure we’re coming up with the right model of care,” Michael Dandorph, CEO of Tufts Medicine, the parent organization of Tufts Medical Center, said in an interview.
Tufts announced in January that it would close 41 inpatient pediatric beds by July, citing a need for more adult inpatient beds and waning demand for pediatric beds. Children in need of inpatient care would be referred 2.7 miles down the street to Boston Children’s, it said, which will open 50 beds by mid-July as part of the first opening phase of a new clinical building.
Outpatient pediatric care will remain at Tufts, including pediatric primary care, day surgeries, its pediatric emergency room, and newborn intensive care unit.
News of the closure prompted a backlash from doctors, patient families, and staff. Parents of Tufts patients expressed anxiety over switching doctors and paying more for care at Children’s, the most expensive and largest pediatric hospital in the state. Physicians, concerned about having to give up caring for the sicker and more complex patients who require overnight stays, discussed leaving Tufts altogether, which threatened the hospital’s ability to staff its outpatient pediatric clinics. More than 60,000 people signed a petition to keep the hospital open.
Now, according to details that Tufts shared with the Globe, Boston Children’s will create a foundation for current Tufts doctors.The doctors will have privileges at Children’s, but Tufts would lease back and pay for the doctors’ time. Unlike other doctors at Boston Children’s who have Harvard affiliations, the Tufts doctors will be professors and faculty of Tufts University School of Medicine, which many preferred, according to Tufts.
While many of the specifics for surgeons are still being discussed, non-surgical specialists, who may have previously helped manage their patients’ care upon admission to Tufts, now will mainly refer inpatient care to doctors at Children’s.
Some doctors still feel their skills won’t be fully utilized by caring for less sick patients that primarily require outpatient care.
The hospital said three-quarters of its 140 physicians have decided to join the foundation or continue to work for the hospital; officials declined to specify how many doctors’ decisions remain outstanding. Doctors are required to give 90-days notice if they decide to leave.
This type of structure isn’t new for Children’s, and many Children’s doctors are part of separate foundations, Children’s said, creating the nonprofit equivalent of a private practice.
One doctor who will join the foundation is Dr. Yujuan Zhang, a pediatric rheumatologist, Tufts said. Her presence is critical for the institution, as her work includes caring for children with Pediatric Acute-onset Neuropsychiatric Syndrome, or “PANS,” and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or “PANDAS.” Tufts said the disorders, which include a subset of conditions that straddle the specialties of mental health and rheumatology, are not widely recognized by other health institutions. Children’s declined to comment.
Tufts will also stop providing pediatric inpatient chemotherapy, and has communicated that with the 35 families affected. While chemotherapy is typically provided on an outpatient basis for adults, Tufts said chemotherapy for children is often an inpatient experience and would be performed at Boston Children’s. Outpatient oncology care will still take place at Tufts.
Other clinics will be considered on a case-by-case basis. Tufts expects to have enough doctors to maintain most specialty outpatient services, but questions linger about how many patients the remaining doctors can take on. It’s possible that Boston Children’s doctors will be needed to fill in while Tufts hires more, or that some services will need to be transitioned to Children’s entirely.
At a Department of Public Health hearing on the closure held April 28, Boston Children’s Hospital CEO Kevin Churchwell said the hospital is adding ambulances between the hospitals and is creating a portal to allow clinicians to share medical records.
Tufts doctors reacted to the new details with mixed emotions.
Dr. Daniel Rauch, chief of pediatric hospital medicine, said he would join the new foundation but laments the loss of Tufts Children’s. He said he was particularly worried about losing the ability to provide complex care for hospitalized patients. “The type of job offered for most of the faculty [is] substantially different from our current positions,” he said. “Not better or worse, but different and, for many, the change did not align with their choice of practice or career path.”
Dr. Sylvia Yoo, interim director of pediatric ophthalmology at Tufts, said she decided against joining the foundation, because she mainly provides outpatient care. She said she wasn’t sure if there was a benefit to joining or not joining the foundation but wanted to remain close with colleagues in ophthalmology at Tufts, with whom she works closely.
“We are working with our counterparts at [Boston Children’s] regarding any children we see who do need admission to the hospital,” she said.
Tufts said when a patient is cared for in its clinics, even if by a physician with the Children’s foundation, the patient will pay the rates Tufts has negotiated with their insurer. Patients will pay Children’s rates for services at Children’s.
The two hospitals have also been working through issues with insurance coverage. There were five health insurance products that Tufts Children’s patients had that were not accepted by Boston Children’s. Boston Children’s is now accepting the largest one, a Medicaid Fallon/Tufts Medicine plan that covers 26,000 of the children seen at Tufts. Tufts said 13 families were associated with the remaining plans that used inpatient services at the hospital in 2021, and that Children’s would work with each family to accommodate them. Children’s declined to elaborate.
All of Tufts’s 95 affected nurses have found jobs elsewhere at Tufts or with other organizations, either Boston Children’s or another area hospital, Tufts said. Four affected nurses have taken early retirements. All of the moves are effective July 1, Tufts said.
The closure will require final approval from the Department of Public Health, which has 15 days to respond to the public hearing and present any conditions to the closure.
Tufts will also file its plans with the Health Policy Commission, the state’s health care watchdog agency, this month. HPC staff will review the cost implications of the plans. The agency has the right to request a more in-depth review and could weigh in on how Tufts structures its plans with Children’s.
Tufts has argued that total spending would decrease if they open more low-cost inpatient beds for adults. But pediatric care costs may go up — according to data the state Center for Health Information and Analysis compiled at the Globe’s request, pediatric care is 25 percent more expensive at Boston Children’s than at Tufts for patients insured by Blue Cross Blue Shield of Massachusetts, the state’s largest insurer.
The hospital’s pediatric closure may occur even before the commission completes its cost review, a Tufts spokesperson said.