Partners doesn’t need more hospitals

There is something extraordinary about the elephant that tries so hard to convince you it’s just not big enough.

This particular elephant is Partners HealthCare, the huge medical system of hospitals and doctors that wants to grow even bigger by acquiring three additional hospitals in Greater Boston and leave the door open for a fourth merger later. A review of those plans by a judge — leading to a thumbs-up-or-down decision — is coming to a conclusion soon.

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Attorney General Martha Coakley wants Superior Court Judge Janet L. Sanders to agree that the mergers — combined with concessions negotiated with the state — are in the public interest.

More than 130 people wrote in when the judge invited public comments. Coakley’s office will deliver the correspondence and its response to those submissions by Thursday. Sanders is scheduled to hold a hearing next week, though no one seems to expect an immediate decision.

The expansion plan at Partners — it owns Massachusetts General and Brigham and Women’s, among other hospitals — is front and center in the debate over the cost of our health care system in Massachusetts.

Critics, who until recently included Coakley, have long complained that Partners used its size and marketing clout to drive prices too high.

I never liked the idea of Partners merging with South Shore Hospital in Weymouth. I put the Partners plan to acquire Hallmark Health System’s hospitals in Medford and Melrose in the same category. I have plenty of company among some of those people who wrote to the judge.

My basic beef: The original combination of Mass. General and the Brigham created a huge distortion in the health care market 20 years ago. It was presented as a big cost-saver at the time, but it worked out very differently.

All that is history now. But it should make everyone think hard about another round of Partners expansion on the scale being proposed.

There are two kinds of arguments advanced by Partners and Coakley to support the plan, one about the negotiated restrictions and another about the health care market of the future.

The attorney general insists those restrictions — price caps and other kinds of limits for much of the next decade — are a better alternative than an antitrust lawsuit to try to stop the deals. Coakley’s people say they made the best real-world deal available. The critics, including antitrust lawyers and economists, disagree.

The Partners pitch for managing in
the health care market of tomorrow is an argument for the bigger elephant. It’s about complex and expensive plans that need huge scale to succeed.

Partners promotes its merger proposals as part of a larger strategy to limit rising costs while improving care. A key part of that process is something called population health management — a way to keep track of patients in detail to make sure they are getting care at the right time and in the right place.

That’s expensive, Partners points out. The company estimates it’s spending $1 billion on computer systems to manage the process.

So here are the questions:

How large do we really want Partners to become?

And can Partners accomplish a lot of its medical management goals without buying up more facilities?

True, other hospitals in Eastern Massachusetts have been merging and consolidating at a rapid rate in recent years. It remains to be seen what that means for patients and all of us who pay for health insurance.

Growth at Partners falls into an entirely different category. The deal with the attorney general would limit the company’s expansion for a while. But Partners would eventually enjoy greater market clout, relative to other providers, and that won’t be a good thing for its competitors or for us.

Partners doesn’t need to own more hospitals, even if care at other kinds of settings makes medical and financial sense. Major academic medical centers have managed just fine for many years in more informal relationships with community or specialized facilities. Besides, Partners already owns lots of other care providers.

There are many dedicated people at Partners performing life-saving work every day. But the organization carries a lot of economic baggage of its own making over the past two decades.

The elephant of Massachusetts health care is big enough already.

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