New England Baptist Hospital, a renowned hilltop institution where Boston Celtics and amateur athletes alike go for repairs of balky knees and shoulders, sits amid two of Boston’s neediest neighborhoods. Yet just a tiny fraction of its patients are poor.
State regulators say the Baptist, which specializes in orthopedic surgery, can no longer remain an outlier.
Attorney General Maura Healey’s office has reached an agreement with the hospital requiring it to work harder to attract low-income patients, who now constitute less than 3 percent of its business. Baptist executives said they will launch a major multilanguage marketing campaign this spring directed at residents with MassHealth, the state Medicaid program.
But the strategy may face logistical hurdles. Unlike most hospitals, the Baptist has no emergency room from which to admit MassHealth patients. And it must persuade the surgeons who operate there to treat more of these patients. Orthopedic surgeons nationally have one of the lowest Medicaid acceptance rates among medical specialties.
“This reflects great inequality in the access to care for many of the residents of the service area,’’ said Amy Rosenthal, executive director of Health Care For All, an advocacy group based in Boston. “People should be able to get service in their own community.’’
The imbalance among hospitals — some treat many more MassHealth recipients than others — rose to the surface last year, when Beth Israel Deaconess Medical Center in Boston and Lahey Health in Burlington struck a deal with regulators allowing them to merge more than a dozen facilities, including New England Baptist Hospital.
Beth Israel Lahey Health, as the new entity will be called, will have a far lower percent of MassHealth patients than average.
The agreement Healey reached with the new organization is part of her effort to ensure all providers do their part to treat low-income patients, rather than let the burden fall to just a handful of hospitals. MassHealth pays providers lower fees compared to private insurers and to the federal Medicare program for the elderly.
State analyses have found that just 13 to 15 percent of discharges at Beth Israel Lahey hospitals will be low-income, even though 27 percent of Massachusetts residents are insured by MassHealth. At New England Baptist Hospital, the numbers are even lower: MassHealth patients accounted for just 2.6 percent, or 3,135 of the hospital’s 122,359 total visits last year, according to the hospital — though the number of poor patients has been rising.
David Passafaro, who was appointed Baptist president in October, said the hospital is committed to making low-income residents feel welcome. “We are required to do that, and we are happy to do that,’’ he said.
The agreement with Healey requires Beth Israel Lahey Health to produce advertising targeted at low-income residents and make a good-faith effort to ensure that all doctors participate in MassHealth. And regulators specifically singled out the Baptist.
Unlike most other hospitals in the new system, the orthopedic facility is located in a low-income neighborhood, Mission Hill, and next to another, Roxbury. Founded in 1893 to provide free care to the poor, the Baptist has evolved into something quite different: a specialized institution with an acclaimed reputation in orthopedics and a celebrated sports-medicine program that includes a longstanding agreement with the Boston Celtics to treat its players.
And its market power is formidable: When it comes to the most common orthopedic procedures, the Baptist treats one-quarter of all privately-insured patients in the state — and it’s growing. Systemwide, Beth Israel Lahey hospitals will have 35 to 40 percent of the commercial orthopedic market, making it by far the most dominant provider in the state.
Passafaro said the lack of an emergency room and primary-care physician network at New England Baptist Hospital means fewer MassHealth patients are referred there. The Baptist opened an orthopedic specialty clinic three years ago, which takes all MassHealth plans and where patients don’t need a referral. The hospital, Passafaro said, wants to further promote the clinic.
But there may be another reason for the low numbers. Just 60 percent of orthopedic surgeons in the United States accept new Medicaid patients, the third-lowest among specialists after psychiatrists and dermatologists, according to a 2013 study published in the journal Health Affairs. Orthopedic surgery is also among the highest paid specialties.
New England Baptist Hospital surgeons are supposed to accept MassHealth patients who are insured by Tufts Health Plan, as part of a three-year-old agreement with the Beth Israel Deaconess Care Organization, which negotiates insurance contracts for doctors. Tufts Health insures just 273,000 of the state’s 1.86 million MassHealth members.
Passafaro said he does not know how many Baptist surgeons take other MassHealth plans. Unlike many other hospitals, it does not employ its surgeons, so it has less control over their practices, he said. Of the hospital’s roughly 140 active physicians, only about 40 are employees — mostly cardiologists, pulmonologists, and other specialists who care for patients admitted to the Baptist by other physicians and do not bring in new ones.
Employed doctors are required to accept all MassHealth plans, but surgeons are mostly in private practice.
Passafaro said he is unsure how he will get more surgeons to accept all MassHealth plans. One way would be to require that as a condition of their getting operating credentials at the Baptist, he said.
“If we bring more patients into our orthopedic specialty practice, we expect our attending physicians to take their fare share,’’ said Passafaro.
Four orthopedic surgeons who operate at the Baptist did not respond to the Globe’s request for comment.
Dr. David Halsey, president of the American Academy of Orthopedic Surgeons and a surgeon at Martha’s Vineyard Hospital, declined the Globe’s request for an interview. In a written statement, he blamed Medicaid payment rates, which “often fail to cover costs. It should also be noted that many of our surgeons regularly provide care to Medicaid patients in trauma or emergency situations, regardless of a patient or insurer’s ability to pay,” he said.
The agreement with the attorney general’s office does not hold the Baptist to a specific number of MassHealth patients, in part a recognition that patients may simply choose to go elsewhere.
The marketing plan will include advertising on public transit in English, Spanish, and Chinese. Hospital officials also will meet with community groups, public housing tenants, and health centers to inform them about the orthopedic clinic.
Several residents and advocates said the Baptist is a good neighbor that spends money on camp scholarships, buses for senior citizens, and community events. Many Mission Hill residents work there. But they have long been aware of the low number of MassHealth patients.
“They don’t get the referrals,’’ said Mary Ann Nelson, executive director of the nonprofit Mission Hill Health Movement. Patients at Whittier Street Health Center in Roxbury, for example, are more likely to be sent to Boston Medical Center for a hip replacement, she said.
Nelson recalled that when she once broke her wrist, she walked down the hill to the emergency room at Brigham and Women’s Hospital. “It never occurred to me to walk to the Baptist.’’
The Baptist is aiming to improve its relationships with health centers. But some advocates said change won’t be easy. Will the hospital have enough translators? Will parking be available and inexpensive? And will the specialty clinic provide the same level of care as privately insured patients receive?
“The pressure is on them,’’ said Jeffrey Sanchez, the former state representative for Mission Hill. “They have to make all aspects of the system open to all patients, including those in Medicaid.’’
The hospital’s plan will be overseen by the attorney general’s office and the Massachusetts Health Policy Commission, an independent state agency that tracks health care spending growth.
“They said they are going to do more,’’ said Stuart Altman, a health care policy expert who chairs the commission. “We are going to monitor them.’’Liz Kowalczyk can be reached at firstname.lastname@example.org.