Salem hospital to end heart surgeries

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Partners HealthCare plans to stop heart surgeries at its community hospital in Salem this summer and send patients instead to Massachusetts General, saying there aren't enough cardiac patients to justify keeping the unit open.

The move appears to go against the strategy that large health systems such as Partners usually promote: to keep most medical care in lower-cost community settings, and to refer only the most complex patients to expensive teaching hospitals like Mass. General.

But Partners says the change is justified because the heart surgery program at North Shore Medical Center in Salem is underutilized. In a letter to state officials last week, Partners said the program is "no longer cost-effective or clinically necessary." More than one-quarter of patients in the Salem area already go to Mass. General for cardiac surgery, the letter states.

Partners spokesman Rich Copp said that because the number of patients coming to Salem for heart surgery is so low, it actually costs $10,000 more to do an operation there than at Mass. General.

Heart operations are lucrative procedures for hospitals, bringing in tens of thousands of dollars per case. But cardiac surgery units are also expensive to operate, and can lose money when they don't see enough patients.

"When appropriate, the goal is always to keep care in the community, but this is a situation where the practice of medicine has changed, and at the same time we have an obligation and a responsibility to do what we can to lower health care costs," Copp said.

But Partners will also get paid more for heart surgeries done at Mass. General, compared with North Shore Medical Center, Copp acknowledged. Large teaching hospitals are typically paid more than smaller community hospitals for the same medical services. The higher payments help to pay their higher costs of training doctors. But state reports have also found that teaching hospitals such as those owned by Partners also use their market power to extract higher payments from insurers.

Copp said the "vast majority" of heart surgery patients are on Medicare, which he said pays similar rates in Salem and at Mass. General. But the move is expected to bring up to $1 million more in annual revenue for Mass. General from patients with commercial insurance.

North Shore Medical Center's cardiac surgery unit was designed to perform 300 to 400 operations a year, but it has only done about 150 to 175 operations a year, according to Partners. The health care provider attributed the low numbers to broader trends. As more patients have turned to medications and nonsurgical procedures to control their heart problems, the number of open heart surgeries has been dropping nationwide.

Surgeries fell 35 percent over about a decade, before stabilizing from 2011 to 2015, according to The Advisory Board Company, a research firm.

As a result, at hospitals across the country, there is too much capacity for cardiac surgery, said Dr. Michael J. Mack, a board member at the American College of Cardiology, and a surgeon in Dallas. Last year, 14 more hospitals closed cardiac surgery units than opened them, he said.

"I would anticipate we would see more and more closings," he said. "As more hospital systems consolidate, as there's a higher focus on quality, as the margins decrease, I think all those forces together will cause more programs to close."

North Shore Medical Center plans to close its cardiac surgery unit on Aug. 17. Open heart procedures, such as coronary artery bypass operations, will no longer be performed in Salem, but less invasive angioplasty procedures, in which a tube is threaded through a blood vessel up to the heart, will continue, Partners said.

The hospital's cardiac surgery unit has 34 employees, including doctors, nurses, and other staff. Partners said those employees would have opportunities to find new positions within the Partners network.

A spokesman for the Department of Public Health said the department has received the company's notice about North Shore Medical Center and is reviewing its plans.

North Shore Medical Center has struggled financially. It lost about $21 million on operations in each of the past two fiscal years. North Shore Medical Center has two campuses, but Partners is planning to close the campus in Lynn and consolidate services in Salem as part of a $200 million project. That plan calls for adding medical beds and psychiatric beds in Salem.