Surprise recovery: Five years after Quincy hospital's closure, many fears go unrealized - Boston Business Journal (2024)

When Paula Ryan drives up the Whitwell Street hill near Quincy Center, her stomach still sinks.

Quincy Medical Center, with its tall white pillars, sits mostly empty, covered in vines. The activity on the site of the once-robust hospital has been whittled down to one remaining satellite ER center. It’s no longer the vibrant medical center where Ryan worked for 45 years, bustling with nurses and doctors.

The hospital was where Ryan was born in 1946, and where her two children were born as well as two of her three grandchildren. Its closure five years ago left Ryan feeling as if she didn’t know where to go anymore for health care. “I’m 73 now — when it comes time for me to have my health taken care of, I was comfortable and felt secure going to Quincy,” said Ryan, who lives in Marshfield. “That’s taken away from me.”

She wasn’t the only one who felt abandoned when Quincy Medical Center closed in December 2014. Patients worried about where they would go for care, or how expensive it would be. Employees working at one of the city’s largest employers were concerned about their jobs. And city and state officials feared there would be a hole in the center of the downtown.

But while health care in the city may never be the same, in many ways, the city has been able to avoid many of the worst catastrophes that were forecast. Community health centers expanded, and surrounding hospitals worked to accommodate the extra patients. Quincy Medical’s parent organization, Steward Health Care, was able to place hundreds of newly unemployed workers at new jobs elsewhere, and a deal to sell the hospital property helped usher in new health care services in the city.

The look back at what did — and didn’t — happen over the past five years is newly relevant as state officials consider how to address concerns over the long-term viability of community hospitals.

“In a perfect world, this would have been planned by the hospital parent, Steward, in a more methodical way. And there certainly was a gap created at that time,” said Chris Walker, chief of staff to Quincy Mayor Thomas Koch. “But I do believe, for all intents and purposes, that gap has been filled.”

Fears vs. realities

When the hospital shut all but its emergency room in December 2014, the community was fraught. Overnight, the city became the largest in Massachusetts without a hospital, and approximately 1,100 employees were left without a place to work. One of the biggest concerns was what would happen to the city’s economy.

“It’s been a number of years since Quincy closed and the folks who worked there had to get other jobs or move away — (they) couldn’t afford the housing,” said State Rep. Ronald Mariano, the House member representing Quincy then as well as now. “All the economic issues that come with losing a job. It is devastating.”

But the job losses have been at least partially mitigated. A spokesperson for union 1199SEIU said of the 370 union employees at Quincy, 100 maintained employment elsewhere in the Steward Health Care system. Another 45 stayed to work in the satellite emergency department that remained in Quincy. Likewise, the Massachusetts Nurses Association said that the hospital provided 180 available positions to the union’s 237 members.

As for concerns about the vibrancy of the downtown, Quincy Mayor Thomas Koch required developer FoxRock Properties — which bought the property in 2016 — to bring medical use development to the downtown. That deal came to fruition earlier this year, when FoxRock announced in February it would build a 200,000-square-foot medical building downtown that would be jointly operated by South Shore Health System and Brigham Health.

A new primary care practice operated by South Shore Health System also opened this month, and Beth Israel Lahey Health has indicated an interest to open clinical services.

None of those developments were apparent in the aftermath of the hospital’s closure. At the time, residents worried that even if they could find care elsewhere, that it would be expensive.

State data has shown that community hospitals spend nearly $1,500 less per inpatient stay on average — adjusted for illness severity — compared to academic medical centers. When community hospitals close, it often drives patients to more expensive options. “Striving to reach the goal of having good, low-cost treatment accessible for everyone, you’re losing a valuable asset in that fight when you lose a community hospital,” Mariano said.

But in Quincy’s case, other communityproviders were able to step up with low-cost care sites. Manet Community Health Center relocated its health practice from Quincy Medical Center to a new site in North Quincy. Of the 2,900 patients that had been served out of the QMC location, 94 percent stayed with Manet, said CEO Cynthia H. Sierra.

Manet also extended its hours of operation and added a behavioral health program. Access to more specialists and telemedicine options are also now available, thanks to a primary clinical affiliation change from Steward to Boston Medical Center. Manet plans to open an urgent care center by winter of 2020.

From 2014 to 2018, Manet has seen 17 percent growth in volume to 17,000 patients annually. Half of those patients are on Medicaid and would have been at the biggest risk of losing health care in the wake of the hospital’s closure. “It was in some ways a community crisis at the time, but a catalyst for Manet to be able to think thoughtfully about how to best respond,” Sierra said.

Nearby hospitals step up

Sierra said nearby hospitals — including Carney Hospital, South Shore Hospital, Boston Medical Center and Beth Israel Deaconess in Milton — responded to provide hospital care beyond Manet’s capabilities, including inpatient stays, OBGYN services and surgeries.

“It wasn’t immediate or without growing pains or without patient angst,” Sierra said. “But those needs were met, from our point of view, from the hospitals in the area.”

With the closure of the hospital, some also worried if local doctors would stay in the community. Alan Sager, a professor of health policy and management at Boston University School of Public Health said that’s common in hospital closures. “One of the things that happen when hospitals close is doctors in private practice nearby are disproportionately likely to retire or relocate,” he said.

But Joseph Weinstein, chief medical officer for Steward Health Care System, says that Steward worked to keep primary care doctorsand specialists in the city, along with access to lab services, and doctors didn’t end up leaving the community.

“We didn’t just close the door, put a lock on it and say, ‘See you’,” Weinstein said. “Even though the hospital isn’t there, people continue to get care in Quincy.”

An analysis of the health of Quincy’s residents hasn’t substantially worsened since the hospital’s closure. Premature deaths have gone down since 2014, and total deaths are the lowest they have been since 2013, though still higher than state averages.

Community differences

But while Quincy was able to avoid much of the trauma expected with the loss of a community hospital, it may play out differently in other cities. Dianne Anderson, CEO of Lawrence General Hospital, said her community hospital’s services wouldn’t be able to be replaced in the way they were in Quincy, given the hospital’s more remote geographic location.

“As far as access, there is no question it would be devastating to the entire area,” she said. She said the closure in Lawrence would affect not only local patients, but statewide costs of care, since Lawrence General performs lots of advanced procedures that would previously be done in Boston at a higher cost.

Indeed, other hospital closures have proven detrimental to the local area. In March 2014, months before Quincy’s closure, North Adams Regional Hospital shuttered after only three days notice. More than 500 jobs disappeared, as did critical health care services. While nearby Berkshire Health Systems stepped in to operate an ER in the city, community advocates are still pressing for restoration of a hospital five years after the closure.

More cities will have to confront such a reality as some community hospitals continue to struggle. According to a September Health Policy Commission report, the volume of patients that once kept community hospitals afloat is declining, with only a fifth of all inpatient and outpatient discharges in the state coming from independent community hospitals in 2017. That’s down 16 percentage points from 2010.

Anderson has banded together with several other community hospitals to demand increases in reimbursem*nt for community hospitals. The State Senate agreed such a plan was necessary last year, but the House instead wanted to tax large providers and insurers to funnel one-time money to community hospitals.

Neither proposal passed last legislative session, but both Beacon Hill and the governor have promised a renewed look at the issue this year.

Health experts agree that saving community hospitals is paramount, but many don’t believe an increase in reimbursem*nt rates is the answer. Rather, they say what’s needed is to understand which services in the community are essential and to find a way to provide them as Quincy was able to do. BU’s Sagar, for example, says that “nobody in the state has a list of the ERs or hospitals that are essential to protect the health of people, or to sustain doctors where they’re needed.”

Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said the state simply needs better planning.

“When a community hospital closes, it’s a shock to the community,” Pellegrini said. “But we need to understand capacity to take care of those folks and understand ... the resources we have and where there are needs.”

Why Quincy Hospital closed

State health care watchdogs call the struggle community hospitals face a cycle of downturn. And the death spiral played out in Quincy like a broadway show.

The 196-bed hospital, established in 1890, saw problems as far back as 1998, when the then city-owned hospital closed its maternity ward.

“Financially, the hospital took a big blow on that,” said Paula Ryan, a nurse who trained and then worked at Quincy Medical Center for her entire 45-year career. “It was a huge service that was gone.”

Fewer services were compounded by an ever-competitive market, drawing patients away from the hospital in droves.

The hospital fought back, first privatizing and signing a clinical affiliation with Boston Medical Center in 1999, then switching to a clinical affiliation with South Shore Hospital in 2009 that would only last eight months. In 2010, it forged a partnership with Tufts Medical Center.

But the affiliations weren’t enough to bring back patients, and empty beds hurt revenues. By fiscal 2009, the hospital struggled to have enough cash to satisfy a $60 million bond — taken out partly to fund hospital upgrades. The hospital was put on notice with one of its bondholders, and hired a consultant to help it change.

The hospital began looking for partners to help it compete in the broader market, and found Steward Health Care.

State regulators were optimistic about the deal, signed in September 2011. Then-Attorney General Martha Coakley wrote in a release at the time that the acquisition put the hospital “in the best position to provide Quincy's 92,000 residents with access to a full service acute care hospital and maintain key jobs.” Under the agreement, Steward would pay back up to $38 million on the debt, and invest another $44 million to $54 million in facility upgrades.

Steward ultimately pumped $43 million into the hospital, but the cycle of downturn continued. In 2013, the hospital closed a 40-bed medical-surgical unit, prompting outcry from union nurses. The closure, coupled with contract negotiations, sparked a day-long nurses strike, with nurses holding signs outside hospital front steps that called the hospital’s care unsafe. Physicians with referral partner Granite Medical Group began sending patients to nearby Beth Israel Deaconess - Milton and South Shore Hospital.

Volume continued to decline. According to a report from the Health Policy Commission, inpatient volume at Quincy Medical Center decreased 27.7 percent from 2010 to 2014. Outpatient volume dropped 24.1 percent during the same period. In November 2014, Quincy Medical Center said it would close. A month later, the hospital shut its doors for good.