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Lahey Health Reexamines the Appropriate Care Model

John Commins, for HealthLeaders Media, March 12, 2014

This nonprofit, three-hospital health system in eastern Massachusetts has prioritized directing care to the most appropriate setting, which often means admitting patients to the community hospitals closest to their homes.


Nesto

Richard W. Nesto, MD
executive vice president of Lahey Hospital

Community hospital leaders often express anxiety about the loss of independence and control that comes when their hospital is acquired by a larger health system. In many health systems the smaller hospitals are used as feeders to ship patients to the flagship hospitals.

That's not the way they do business at Burlington, MA-based Lahey Health. For the past two years the nonprofit, three-hospital health system has prioritized directing care to the most appropriate setting, which often means admitting patients to the community hospitals closest to their homes.

The arrangement appears to be working. Richard W. Nesto, MD, chief medical officer of Lahey Hospital & Medical Center, says Lahey Health, which will soon include the 229-bed Winchester Hospital, has thrived with its emphasis on appropriate care settings. Inpatient volumes are up at Lahey Hospital & Medical Center, Beverly Hospital, and Addison Gilbert Hospital, even though inpatient admissions are down in the rest of the Bay State.

The medical center is seeing fewer low-acuity patients because they've been redirected toward Beverly and Addison Gilbert, which can provide care at a lower cost and with greater convenience for the patients being treated closer to home.

At the same time, with fewer low-acuity patients, Lahey has freed beds to treat more complex patients who historically would have headed 20 miles south to get their care at Boston's prestigious academic teaching hospitals.

Nesto spoke with me recently about Lahey Health's appropriate care model. The following is an edited transcript.

HLM: Why the emphasis on appropriate care settings?

Nesto: We have deployed our specialists in as many as 10 community hospital settings as far away as 60 miles from here in an effort to delivery Lahey quality and expertise locally in community hospital settings. We've been doing this for 15 years or so in a number of specialties, always by invitation and never with the interest in stealing or absorbing patients back into Lahey. We want them treated in the appropriate location and returned to the appropriate primary care doctors in those settings.

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