Does Partners HealthCare still need to grow?

Does Partners HealthCare still need to grow — and if so, how and where, and at what cost to Massachusetts General and Brigham and Women’s, its flagship hospitals?

That’s the important, underlying policy question, beyond what feels like a family feud between two great Harvard teaching hospitals and their parent company.

Tensions entered the public realm after Dr. David F. Torchiana unexpectedly announced he will retire at the end of April as chief executive of Partners. Two narratives about the man known as “Torch” are now making the rounds.

The first is that this brilliant but mercurial heart surgeon, who oversaw a practice of more than 2,000 physicians at Mass. General, lacked the bedside manner needed for consensus-building once he became CEO of Partners. The other is that Torchiana’s efforts to build efficiencies into the state’s largest nonprofit health care network were not welcomed by hospital leaders. Whatever the reason, he could not get them to buy into his expansion vision for Partners. So he’s leaving.

What, if anything, does that mean for the public? “I don’t think we understand all the ramifications of why the battle took place and who was on the right side,” said Dr. Stuart Altman, an economist and health care policy expert who chairs the board of the Massachusetts Health Policy Commission, an independent state agency charged with monitoring health care spending growth.

But the growth strategy the company chooses under Torchiana’s eventual replacement may matter a great deal to health care consumers, since the company exerts a huge influence on health care costs in Massachusetts and on the financial health of other providers.

Partners was launched in 1994 as an alliance between Mass. General and the Brigham. What began as a $2 billion operation has grown to a $13 billion health care delivery system, and now includes thousands of doctors, more than a dozen hospitals, and an insurance business. The alliance did not merge hospital assets, and Mass. General and the Brigham remain financially independent and competitors at heart. Still, Partners built a reputation for delivering first-rate health care.

As Partners’ market clout has grown, and its prices remained high, so has resistance to its continued expansion. The company experienced a major setback in January 2015 when a Massachusetts judge stopped Partners from acquiring three hospitals. Incoming state Attorney General Maura Healey also threatened an antitrust suit if Partners tried to push ahead.

Still, when Torchiana came on board, in March 2015, he said continued expansion was necessary to make the numbers work. If Partners couldn’t do so in Massachusetts, he said, it would look “regionally, nationally and internationally.”

In 2017, Wentworth-Douglass Hospital in New Hampshire became part of the Partners network. In 2018, Partners acquired Massachusetts Eye and Ear, but with price controls mandated by the state. Partners is currently seeking approval to acquire Care New England Health System of Providence; however, a more controversial plan pursued by Partners to also acquire the Lifespan system in Rhode Island has been suspended. Efforts to negotiate a possible takeover of Harvard Pilgrim Health Care are also on hold.

Given its control over the market, the question of whether Partners should un-partner periodically comes up. Altman said the more relevant question is “Why did they let them form in the first place?” Breaking it up now is not realistic, he said. It’s also unlikely, given that for the first time Partners has real competition after the recently approved merger of Beth Israel Deaconess Medical Center and Lahey Health.

The next Partners CEO needs to figure out how to get everyone on the same page. Maybe — just maybe — growth through acquisition should no longer be the priority. At the very least, it’s a good time to take a hiatus. Besides, shouldn’t the billion-dollar expansion of Mass. General be the most pressing concern?

In the long run, what’s important is taking care of all those patients who are walking through the door because they believe they will get access to the best health care in the world — not because they want to be part of the biggest health care empire.