Boston Medical Center plans to shut down its 12-bed acute-injury rehabilitation unit and outpatient clinic, which will lead to layoffs for about 30 nurses and therapists and the dismantling of its training program for young doctors entering the field.
After the program closes July 1, the hospital will send patients who need rehabilitation for severe brain and spinal cord injuries to large, specialized facilities, including Spaulding Rehabilitation Hospital and Braintree Rehabilitation Hospital, said Dr. Ravin Davidoff, chief medical officer at BMC.
The decision was not motivated by immediate financial concerns, he said, noting that the program does not lose money. Instead, the hospital began reevaluating its program after the rehabilitation department's longtime chairman, Dr. Steve R. Williams, recently left for a job in Kentucky.
BMC is the only hospital in Boston that still has an inpatient rehabilitation unit for acutely ill patients, who usually stay about a month, Davidoff said. And although hospital officials believe the patients get very good care, he said the program is not as cost-effective as the large rehabilitation hospitals.
"We are too small to do this on an economically efficient scale,'' he said. "We asked if this is the way we want to spend a defined pool of dollars.''
The hospital in part is trying to prepare for expected changes in how medical providers are paid.
Typically, providers have billed insurance companies and government payers for each service provided to patients, including office exams, imaging tests, and hospital admissions - with few limits on the number of services.
But many insurers and government programs are shifting to so-called global payments, which limit how much physicians and hospitals can spend in caring for groups of patients. In the future, it probably will be cheaper for BMC to buy rehabilitation services for its patients at an outside facility that can provide care for less money.
Boston Medical Center has about 200 admissions annually to its rehabilitation unit and 2,300 outpatient visits to its clinic. The hospital will continue to provide inpatient and outpatient physical, occupational, and speech therapy
The hospital is working to find other programs where its 12 rehabilitation medicine residents can complete their training.
Williams is going to the University of Louisville, where he will be chief of spinal cord medicine and director of translational research in the Division of Physical Medicine and Rehabilitation, and chief medical officer of Frazier Rehab and Neuroscience Center.
Liz Kowalczyk can be reached at firstname.lastname@example.org.