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Rival assails state waiver for Steward Health Care

Each would have unit in Fall River

Steward has offered a top job to state health chief John Polanowicz.Josh Reynolds/Associated Press

Hoping to avoid a medical arms race, state health officials six years ago barred hospitals from opening new cardiac catheterization units within 30 minutes of similar services. But this summer, regulators approved an exception to that ban that appears to benefit a particular health system: Steward Health Care.

The policy change has paved the way for Steward to transfer its catheterization unit from Quincy Medical Center, which is closing, to Saint Anne’s Hospital in Fall River, which the company says will allow it to offer its patients seamless care within its own network at lower cost.

But Steward’s competitor in the region, Southcoast Health System, has cried foul, contending that Steward was influential enough to win support for a service that is not needed and will siphon patients from Southcoast’s longstanding catheterization program, which has a location in Fall River, just 2 miles from Saint Anne’s.


The secretary of Health and Human Services, John Polanowicz, is a former Steward executive and was recently offered a top job there.

The Department of Public Health, after initially rejecting Steward’s request to open a catheterization unit at Saint Anne’s last year, created a waiver and recommended approval last month “after careful consideration of the comments submitted by Southcoast.” The Public Health Council plans to vote on the recommendation Wednesday.

Southcoast executives question why state regulators approved the exception allowing Steward to open the Saint Anne’s unit, given that the use of cardiac catheterization generally is dropping because of better alternative therapies. Some evidence suggests hospitals and cardiologists need to perform enough cases each year to keep skills sharp.

But Steward argues that Fall River and New Bedford need more services because their residents have a higher-than-average rate of coronary heart disease. Public health officials’ analysis agreed, finding that the rate of hospital stays for cardiac disease in the Southcoast region is 74 percent higher than the state average.


The dispute highlights some of the uncertainty about exactly how to achieve Massachusetts’ goal of holding down medical costs while improving patient care. Under new models of care that Steward has embraced, which involve being paid a budgeted amount to provide all of a patient’s care, the company argues that it can better manage costs and quality if patients get treatment in-house.

Steward has been trying to open a cardiac catheterization unit at Saint Anne’s since at least August 2013. Public health department staff turned down its original request two months later because of a 2008 moratorium on new units within 30 minutes by ambulance from an existing 24-hour service that does both diagnostic and interventional catheterization.

Catheterization, which involves inserting a long narrow tube into the blood vessels and injecting an X-ray-sensitive dye into the tube, can be used both to check for blockages and clear them using various devices.

The moratorium was intended in part to prevent hospitals from starting so many profit-making services that individual programs did not have enough cases to develop expertise.

In June, eight months after health officials tabled Steward’s plan, associate commissioner Dr. Madeleine Biondolillo told a cardiac advisory committee that the policy was being changed to include an exception. During a meeting, she told the group that so-called Accountable Care Organizations — large health systems that coordinate a patient’s medical care — would be allowed to transfer poorly performing cardiac catheterization units within their systems in certain cases. There are about 20 ACOs in Massachusetts, including Steward.


In August, Steward mailed a formal request for approval to transfer its catheterization unit to Saint Anne’s. Quincy did just 47 procedures in 2013, while Steward expects the new service to do 379 diagnostic catheterizations the first year. Steward says those patients would come mostly from Boston and Providence hospitals, but Southcoast worries they would come from its procedure rooms.

Linda Bodenmann, chief operating officer at Southcoast, complained that there was no public hearing about the policy amendment.

“The approval of this request by DPH is inconsistent with the goals and mandates of DPH, which is to set policy and ensure the distribution of services by focusing on patient need and not the influence of large systems,” she said.

The state would not comment about how the exception to the catheterization rules came about, but acknowledged that Polanowicz “was not precluded from involvement’’ in that broad policy change.

David Kibbe, an HHS spokesman, said the secretary later “recused himself from the staff recommendation and decision’’ on the specific Saint Anne’s Hospital proposal due to a potential employment opportunity at Steward. On Aug. 19, a Steward executive asked Polanowicz if he would consider returning to the company as president of its hospital division, his disclosure statement shows.

“This employment opportunity was presented well after guidance on cardiac catheterization services had been issued,’’ Kibbe said.

Dr. Mark Girard, president of Steward Hospitals, said he did not advocate for the policy change with state officials but said he does not know about other Steward executives.


“We talk about ACOs all the time to the [DPH] commissioner and the secretary,’’ he said. “This marketplace is rapidly evolving on the ACO front based on the extensive number of providers and patients in the ACO model. The exception was put in there to enable ACOs to take care of their patients.’’

This fall, the dispute between the hospitals turned derogatory. In an Oct. 10 letter to public health officials, John Jurczyk, a Saint Anne’s vice president, said cardiologists had lost confidence in Southcoast because several members of the heart surgery team had left. Southcoast President Keith Hovan shot back in a letter a month later that those comments were “misleading and patently false’’ and that the hospital had recruited two new surgeons.

The Saint Anne’s catheterization lab would be the final stage of a new $29 million three-story wing.

Southcoast offers cardiac catheterization at St. Luke’s Hospital in New Bedford and Charlton Memorial Hospital in Fall River, both of which are operating at less than 50 percent capacity, Southcoast executives said.

Charlton has the larger program, providing 2,512 diagnostic and interventional procedures this year. St. Luke’s does only diagnostic catheterizations, and the number has fallen to about 460 annually. The state requires diagnostic programs to do 300 procedures a year in order to keep skills sharp, and Southcoast fears falling below that minimum.

More coverage:


Steward lagging on new facilities

Coakley seeks to negotiate over hospital closure

Physicians group sues Steward over payments

Liz Kowalczyk can be reached at kowalczyk@globe.com.