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With for-profit hospital system crumbling, Boston councilors also worry about impact of for-profit urgent care on non-profit neighborhood health centers

City Councilors Ed Flynn (South Boston, South End, Chinatown, downtown) and Erin Murphy (at large) yesterday sounded an alarm about a for-profit company's plans to open an urgent-care clinic less than a block away from the South Boston Community Health Center on West Broadway, warning that the new clinic could skim patients with disposable income away, threatening the health center's long-term viability and its commitment to caring for people who couldn't otherwise afford to see a doctor.

And as South Boston goes, so could other non-profit health centers across the city, they warned. "If this could happen here it could happen anywhere," Murphy said.

Although the councilors seemed shocked by the sudden incursion of a for-profit clinic in Boston, in fact, the concerns have been making inroads in the city ever since Tom Menino, who fought to keep them out, left office. Carbon Health, for example, now runs clinics both downtown and in West Roxbury.

Flynn said that unlike neighborhood health centers, the for-profits don't have to take people on MassHealth or with no way to pay for care. Should they muscle out the neighborhood centers, by reducing their income from patients with private insurance, the result would be "a devastating impact" on poor people, seniors and people with disabilities, he said.

He called the West Broadway proposal by American Family Care particularly odious given its location near the neighborhood center. "This is not a health-care desert, and there is no community need here," he said.

City Councilor Liz Breadon (Allston/Brighton) added that the end of neighborhood health centers could spark a crisis at local emergency rooms, where people without private insurance already sometimes go for care. If anything, he said, the city and hospitals should be looking at ways to treat patients with problems that don't require ER-level care in the community - for example, at neighborhood health centers.

"Community health centers are under stress and need more investment," she said.

Council President Ruthzee Louijeune sent the matter to the council's committee on public health, homelessness and recovery for a hearing.

Watch the discussion:

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Comments

Subsidizing crappy service with money from those that can choose a better option if available is not a viable long term solution to a problem. If a non-profit operation can't remain open solely on the funds from MassHealth and a for-profit operation can make enough of a profit to remain viable while offering a higher level of care and handling less clients, the issue is with the discrepancy is reimbursements between MassHealth and private insurers, not the existence of for-profit services.

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Hey Boston City Councilors.. you forgot one. Atrius Health, formerly known as Harvard Vanguard Medical Associations

yes they aren't in Roxbury or Mattapan or in Eastie.. but they have several locations within the Boston city limits that serve a ton of people.

They were bought out a few years ago by a subsidiary of United Healthcare AND went from a not-for-profit to a for profit doctors office chain now.

As a 15+ year patient, the care has gone down, services are being slashed. Every time I go in one of their locations (yes, I go to their Milk Street location) I see signs of for-profit business everywhere.. less staff, less rooms, waiting for longer appt times, reduced payment windows (used to be 120 days, now its its 30).

This is a quiet ticking time bomb... yeah we need to help community health centers but there are others that provide services (and take masshealth) that will need our help soon too.

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It’s been heartbreaking watching the precipitous decline of Atrius Health. I’ve been a patient for over ten years, since the Harvard Pilgrim days, and I can’t imagine sticking around when providers are leaving en masse, appointments are scarce, and service has become a nightmare.

But it raises another question, despite the number of world class hospitals, it’s actually quite challenging to find a PCP and get medical care even with private insurance. Medical tourism to Massachusetts is a great pride of ours, but accessibility to standard care is not.

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I was so happy going to HVMA for the first several years after I switched. It was a breath of fresh air. And to see it's decline is just sad.. I'm hoping for the better but I fear it will just become worse and worse.

I mean for a for-profit health center(s) owned by a for-profit insurance company.. its just sad. Esp when it doesn't have to be this way.

I had Kaiser Permanente when I lived in ATL and have friends who currently have it, and yes they are for-profit and you have to go to their health centers but you can have modern & well run health centers that offer a variety of services that aren't on a shoestring budget!

Its shameful the way Optum/united wants to run Atrius. They just want to suck as much $ out of it and/or make it as profitable as possible at all costs. I'm waiting for them to condense/consolidate offices.........

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I am an Atrius patient and feel the same.

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Been the mainstay of my family's healthcare since the early 1990s. They are currently swamped. Tough to deal with and few alternatives.

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Your local neighborhood health center?

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And I can vouch for all of this. I’ve been a member since the 90s, when it was still Harvard Pilgrim Heath. Getting care from specialists is now difficult. I’ve had to wait at least six months to see one because they slashed the number of doctors. They’re often located in inconvenient locations if you depend upon the T.

The quality of care, if you can get it, has gone way downhill since Optum took over.

EDIT: Fixed a sentence for clarity.

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Thank you to everyone who replied. For a while I thought it was just me, but apparently not!

I starting to go to HVMA because I left a swamped provider. I always prided friends that I could get same day or next day appointments with my PCP or a NP. It was nice. I never waited anywhere.. eons ago they used to have signs that said "if you have not been called within 5m of your appt, to please see the person at the desk"

Now.. there's no one at the desk. Its just the rotating NPs and other support staff. The last few times I've gone to the lab its been a ghost town. I remember when they'd have 2-3 lab people, now there's just one, both checking people in and doing the draws. They used to have a dedicated desk person.

My first PCP left shortly after they became "Atrius Health".. and I ran into him a few years ago at an event and asked why he really left. He had some choice words but mostly said he feared that they were shifting away from not-for-profit healthcare with the merger and changes were coming. In a way, he was right.

Fwiw that doctor had been with HVMA since 1984. He left in 2014. He also was a leading disease researcher in his expertise. (HVMA used to have highly qualified staff... used to)

But yeah, finding a new PCP is half the battle. I don't mind traveling as long as its near the T. But many places there are wait lists for PCPs.

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I work for Atrius. Originally DMA for over 23 years and just to let everyone know, the employees are just as upset and frustrated. We deal with the brunt of the patients frustrations all day long. Well most of us who have been here long enough to remember personalized care-one secretary, one MA, for ONE PCP. Now you never know who you are going to get when you call. Days for a refill. It’s absolutely ridiculous and it’s not the higher ups that have to deal with that frustration, it’s us on the bottom of the ladder. I wish they would spend ONE day, answering phone and listening to the patients and not just “reading” comment cards because it’s a whole different ball game. My heart breaks for my elderly patients. Who depended on all of their specialists being in one building and now, they shuffle them around to save a buck and these poor people have to scramble for ride. Wait HOURS for the ride. It’s awful. I wish it would go back to patient based care and not all about the $.

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So electeds want for profit chain pharmacies open for constituents but don't want for profit urgent cares open for their constituents? How does a business know?

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Unlike community health centers, which are in almost every neighborhood (yes, I said almost - I realize West Roxbury and Hyde Park don't have one, but people there can go to the ones in Roslindale or Mattapan if they don't want to go to the hospital-based clinics each neighborhood does have), there are no non-profit pharmacies.

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It may not be truthful to say their a no non-profit pharmacies. Don't most of the non-profit community health centers have their own non-profit pharmacies? Fenway does, Whittier Street does, East Boston does as examples.

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Aren't their pharmacies nonprofit? Or are they operated under a separate entity from the healthcare programs?

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Cambridge Health Alliance has a pharmacy. Do other nonprofit hospitals?

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I'm all for government regulation to make sure health care is available and affordable to everyone.

But it feels like an oversimplification to declare that increased competition for existing health centers is bad. I would think that, in general, having more health care facilities would mean less wait for appointments, shorter travel time for more people, and (maybe even) lower prices. Of course if the new health centers are terrible, they won't help much. That's where the regulation comes in.

Especially when people are simultaneously upset about the Steward facilities possibly closing. Is it better to have more facilities, or fewer, or is the current number the perfect number and it can't ever change?

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What's happening here is that more options for people means less people choosing the community center. The community clinics can only break even if they have X amount of private insurance clients to offset the losses taken on poor clients. If another option opens for those with private insurance, there's a strong likelihood a number of them will take it - shorter waits, less administrative hassle, whatever.

So instead of the city looking at structural ways to get health care to poor people, they've been relying on the non-poor population to prop up otherwise dysfunctional systems.

It's actually not unsimilar to how the city is "solving" the housing crisis --- new fancy apartment buildings open with 5 units set aside for the poor, and the only reason that is doable is because all the other apartments are charging 4k a month. If a bunch of those 4k units are empty, and unpaid for, (because those with the ability to pay go somewhere else) then the building is now operating at a loss because the cost of providing housing is the same whether you rent the unit for 4k or for 1k. And the building may have to close because they can't cover overhead.

To stretch this analogy, what's happening here is a mixed-income building has opened on one block and currently has all the apartments filled, but the building owner tells the city council if they lose any full-price tenants they'll have to evict everyone because they'll be losing money. So then the city tells a whole different property owner across the street they aren't allowed to build a new apartment building, because some of the tenants of the mixed-income building will move and that'll cause housing for the low-income tenants.

You know, instead of like... paying for, and operating, buildings to help these people, so it's not dependent on a delicate mix of people who otherwise have nothing to do with the problem.

And the city sees this as an acceptable knife edge to walk, and a long term solution, somehow, lol.

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Government strictly regulates healthcare supply but not healthcare pricing. That's the most insane thing right now.

If government didn't overregulate supply, then we'd see mass migration of foreign-trained doctors and healthcare providers to the USA, providing perfectly normal 1st/2nd/3rd world healthcare at 2nd world prices. Instead, we run into this "perfect enemy of the good" attitude that heavily gatekeeps healthcare. This leaves us with six-figure surgery bills, a shortage of primary care physicians, and $500 FDA-approved insulin.

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is the best name for one of these buggers that could ever be. kinda shit you can't make up.

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Do the community health centers, apart from ones like Fenway which developed a large practice around HIV care and gay men's health in general, serve a large number of patients with private insurance?

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I currently work for a CHC and they do accept private insurance (Tufts/HP, BCBS, etc.) but it's more focused on Medicare and MassHealth.

When I was unemployed six years ago, I did not want to pay the exorbitant amount of money for COBRA, so I had to go on the exchange and get bronze-level insurance (I paid through my unemployment - it was about a third of what they wanted for COBRA). That insurance wasn't accepted at Atrius, but it was at Fenway; I couldn't find anything that would accept it in the West Roxbury area.

Fenway was actually very good in their services and steps away from Back Bay Station; I was not part of their demographic but they took care of me and helped me keep up with my medicines until I got hired at the CHC.

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Not that this was your point, but the bronze exchange plan has a broader network now - the state requires any provider that takes the subsidized exchange plan to take the unsubsidized as well.

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This was more than five years ago, so I didn't know there was an update on the bronze level plan.

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And I've used Tufts, Neighborhood Health, Harvard Pilgrim, and now Blue Cross.

I remember at one time they didn't take Harvard. That was when Harvard basically made you go to one of their health centers. That they ended the practice is one thing I'll thank Charlie Baker for, as CEO of Harvard Pilgrim, not as governor.

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for a perfect example of why for-profit health care systems should be illegal.
Caritas Christi was sold to venture capitalists who changed the name and made big promises.
The only year it turned a profit, it did so by reducing pension payments - or to stick with the biblical theme, robbing Peter (retirees) to pay Paul (investors).
One year later, Steward sold all its real estate in order to pay back the VC, who then cashed out at a significantly higher rate ($800M according to Bloomberg).
But of course, hospitals need buildings to operate … so it had to lease them back. Imagine selling your car to Avis for $500 bucks then turning around and renting it back for $50/month - not exactly a smart long term plan.
Then, after multiple failed expansion attempts, we learn it has been stiffing vendors for years - so much so, medical devices were repossessed and surgeons started buying their own tools out of pocket. At least one hospital death has already been blamed and more stories are likely to come out of the woodwork.
Keep profit-seeking and privatization out of health care and you’ll save lives - ALL health care including insurance companies, nursing homes and addiction recovery.

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Typical city council approach, closing stable door after the horse has bolted

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My community health center in Dorchester hasn't been able to give us short-term appointments for flu/strep/rsv in the last few weeks and has been suggesting we go to storefront urgent cares in Quincy. So clearly there's a gap they fill.

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Urgent care should exist somewhere between an emergency room and a medical center.

The fear is that they will be treated like a medical center.

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The community health centers allegedly have same-day sick appointments, but these are typically always full, even for kids. They all say to go to the emergency department, which isn't a good use of time or resources. There are few urgent cares in the city. There's a BIDMC one on Route 9 near Wegman's that's not horrible to get to on public transit, but people report really transphobic experiences there. Cambridge has a couple of CVS Minute Clinics that aren't bad, though they have considerably fewer services than a community urgent care. BMC claims to have urgent care, but it's really more of an emergency department fast-track system, and it doesn't seem to actually be faster.

Why don't the community health centers open urgent care centers? Some of them have expanded to have in-house services like X-rays. The much-higher billing rate for urgent visits vs. standard visits seems like it would help subsidize the programs.

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Get healthy people! Because the Healthcare system is drained and so are its nurses.

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Rosie's Place, Women's Lunch Place need help from what I am experiencing first hand as a longtime volunteer for over a decade now. It has never been this out of control and crowded with hungry poor women and kids. Staff are stressed.

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It may be implemented after enough years of primary care as an industry is so absolutely impoverished that millions people refuse to accept the degradation of helping them with their health.

Primary care as an industry is well, dying. That it is an industry is part of the problem. Each profit and non-profit has to direct the organization to making money. Ultimately money is what keeps doctors, eliminates doctors, keeps nurses or doesn't.

A pervious commenter mentioned Fenway Community Health. They are closing their South End address. Will they move all doctors to the Fenway building? What staff will they lay off?

But for the single payer plan to develop there are thousands of stock holder, massive mutual funds, lots of people besides the actual companies that will fight tooth and nail to stop a single payer plan.

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They'll shuffle doctors around. They're probably pretty short of PCPs as is, it may be that consolidating locations actually allows them to be fully staffed for a short time. The lack of Primary Care providers is a huge unaddressed issue in this country... the federal government lacks the will to do anything about it.

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