Baker pushes health care competition

DPH commissioner helping to lead the way

THE BAKER ADMINISTRATION is showing signs that it wants to get more aggressive about encouraging greater competition between health care providers.

Monica Bharel, the commissioner of the Department of Public Health, is sending the strongest signals. Her agency is preparing to issue new regulations next week that will spell out how the state will handle approvals of hospital expansions and mergers and the introduction of new services. Insiders say the so-called determination-of-need process has tended in the past to protect incumbent players, but the overarching goal of the new regulations, according to those who have been briefed, is to encourage competition and innovative health delivery methods.

Bharel’s desire for greater competition has also surfaced in a contentious fight over a cardiac catheterization facility in Fall River. With cardiac catheterization, a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, groin, or neck and threaded to the heart where it is used for diagnostic purposes or to deliver treatment.

In 2008, the Department of Public Health instituted a policy barring any cardiac catheterization facility from opening within a 30-minute drive by ambulance from an existing cardiac catheterization facility. The policy was designed to avoid duplication of services and to make sure cardiac cath facilities conducted a minimum of procedures each year so staff skills would remain sharp.

Steward Health Care in 2013 began lobbying hard for an exception to the 2008 rule that would allow it to open a cardiac catheterization facility at its St. Anne’s Hospital in Fall River, which is located a short distance from two hospitals offering the same services in Fall River and New Bedford. Both of those hospitals are owned by Southcoast Hospital Group.

Bharel approved the exception in April 2015 over the objection of many staffers at the Department of Public Health. The approval prompted Southcoast to sue the agency, alleging Steward had improperly used its influence with key officials to get its way.

As part of that lawsuit, Southcoast recently completed a deposition of a former DPH staffer who strongly opposed the change in policy. Deborah Allwes, the head of the agency’s Bureau of Health Care Safety and Quality, claimed Steward enticed the Patrick administration to set the policy change in motion and then convinced the Baker administration to carry it out. Allwes said John Polanowicz, the secretary of health and human services under Gov. Deval Patrick, set the process in motion in 2014 to help Steward, where he worked prior to joining the administration and where he took a top job after he left. Allwes said Bharel also did favors for Steward, suppressing negative information in a mandated state review of the company’s operations.

But Allwes said Bharel’s support for the policy change on cardiac catheterization reflected the commissioner’s overall philosophy about health care. In her deposition, Allwes described how she and the commissioner tangled on the issue.

Allwes said she repeatedly warned Bharel that opening another cardiac catheterization facility so close to existing facilities that were operating at less than 50 percent capacity would mean fewer procedures overall would be performed, which could lead to lower quality care. She noted that many of her colleagues and independent experts supported her position.

“I tried to explain that our job as regulators was different than the business side of health care,” Allwes said, according to the deposition. “The business side of health care was really for them to stay profitable, whereas our side of health care was to make sure they put patient safety and quality of care first. And she didn’t agree with that.”

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Bruce Mohl

Editor, CommonWealth

About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

Allwes said Bharel favored greater competition. “She said to me that it was her opinion that we just give [Steward] the license and see whoever does better,” Allwes said. “I said to her, but that goes against what the Department of Public Health is supposed to do. She said that she didn’t feel that it was her job to say who could or who couldn’t be in business. She further said that in her opinion whoever did a better job would be the one that would stay in business.”

Allwes said she was forced to resign by Bharel. Allwes indicated her departure was precipitated by her concerns over the treatment of Steward, but another deposition by another aide to Bharel suggests Allwes was let go because of poor performance. A spokesman for Bharel’s office did not return phone calls. Allwes’s attorney, whose client was subpoenaed to testify in the case, declined comment.