Boston Top Doctors: Community Hospitals

Image by Nicholas Veasey

SAY YOU DISCOVER a suspicious lump, find out you’re pregnant, or injure your shoulder. Should you head to a Boston hospital?

Not necessarily. These days, Longwood Avenue isn’t the only place to get top-notch care. As competition for patients and healthcare dollars heats up, community hospitals have become increasingly sophisticated, says David Ball, a Newton-based healthcare consultant. Most have a network of “affiliations” — arrangements under which major academic medical centers (the Beth Israels and Mass Generals of the world) send their specialists out to the ’burbs to see patients and cover shifts. Children’s Hospital pediatricians, for instance, treat the kids who end up in Winchester Hospital’s emergency room; physicians from Dana-Farber and Brigham and Women’s help guide South Shore Hospital’s oncology care. The upshot? Simply by seeing these docs at your local hospital rather than downtown, you’ll often pay less. Teaching hospitals collected, on average, 38 percent more than community hospitals for comparable cases, according to a 2010 report from the Massachusetts Council of Community Hospitals. Specifically, rates for routine care delivered at MGH or Brigham and Women’s ran 66 percent higher, says Edward Moscovitch, who authored the study. (Investigate for yourself at Massachusetts Healthcare Quality and Cost Council.)

If your condition is rare and serious, going downtown might remain your best bet. But for most of us needing relatively common procedures, chances are a community hospital can do things better, because patient care is its only focus. “The major academic centers also have to juggle a research and teaching mission–sometimes that helps with care, but not always,” notes Sara Singer, assistant professor of healthcare management and policy at the Harvard School of Public Health. Another benefit? Staying close to home can alleviate stress and increase the likelihood you’ll get timely follow-up care. Here are eight facilities that deliver the same exceptional medical care found in Boston.

METROWEST

Beth Israel Deaconess Hospital–Needham
Needham
Beds  | 58
Specialties  | Emergency care, orthopedics, urology
Since becoming a suburban outpost of Beth Israel in 2002, the former Glover Hospital has the diagnostic muscle of the big boys — without the gridlock. “Because we’re small and used to working together, communication flows easily,” says chief nursing officer Penny Greenberg, who moved from the Boston flagship five years ago and now runs Needham’s nursing staff. Daily rounds are a group affair: Nurses, plus a social worker, physical therapist, nutritionist, and spiritual adviser all weigh in. In a new wing of all-private rooms, call buttons ring to nurses’ cell phones. As a result, the hospital has a near-zero rate of patients developing bedsores, an indicator of care quality. The facility, once cash-strapped, has been upgraded in ways that make tapping the expertise and resources of the downtown Beth Israel even easier. The new million-dollar MRI, CAT, and digital mammography suite, for instance, is electronically linked to the main campus, allowing specialists to give a second opinion. And Needham’s state-of-the-art emergency department has 19 treatment bays, ER docs from downtown, and a layout that puts crucial equipment (like ventilators) near the ambulance entrance. It also has stabilization and rapid-transit procedures for getting critical cases to Boston.

Emerson Hospital
Concord
Beds | 179
Specialties | Oncology, emergency care, maternity care
As the story goes, it grieved Charles Emerson each time he took his ailing wife, Theresa, to Brookline by horse and buggy to have her cough treated. Shortly after Theresa’s death in 1910, the nephew of author Ralph Waldo granted 40 acres and $20,000 to build a hospital that to this day serves a grateful swath of MetroWest from Wayland to Groton. In fact, the hospital is so popular with neighbors that there’s actually a waitlist to be a candy striper. A wellness and education center, offering everything from nutrition counseling to support groups for caregivers, is set to open this spring. Of course, people get sick, and when they do, Emerson has experts at hand: neuro-surgeons from the Lahey Clinic, perinatologists from Brigham and Women’s (for high-risk pregnancies), and radiation oncologists from Mass General. The hospital’s Bethke Cancer Center has a state-of-the-art linear accelerator, which better targets cancerous cells with less collateral damage to healthy tissue. The center also offers complementary therapies, including massage, acupuncture, and Reiki. Another patient benefit? Along with handmade hats for newborns and bears for sick kids, the volunteer auxiliary here stitches quilts for those undergoing chemo and radiation.

Newton-Wellesley Hospital
Newton
Beds  | 307
Specialties  | Oncology, disease screening, orthopedics, bariatric surgery
The Newton-Wellesley area has a hospital to match its premium schools and real estate values. A member of Partners HealthCare, the hospital shares physicians and technology with sister institutions Mass General and Brigham and Women’s. If you arrive unresponsive at the ER in Newton, your entire computerized medical history can be pulled up onscreen instantly (results, images, physician notes — even if they were done years ago at MGH or Brigham). Another system tracks every drug order, flagging potential interactions, errors, and duplications. Each patient — and every pill — gets a barcode; if the info doesn’t match up at bedside, the dose isn’t given. Newton-Wellesley is among the fewer than one percent of hospitals nationwide that use cutting-edge genetic screening to assess an individual’s risks for certain types of cancer. Yet while the high-tech is impressive, so is the low-tech. The mission is to reduce stress (known to be a negative influence on health) for all visitors, which means greeters will not only give you directions, they’ll also escort you to an appointment when needed. If you have a questionable mammogram, you’ll get an immediate follow-up. “We try to get you a diagnosis within 48 hours. If you find out you’ve got a positive finding on Monday, you’ll be meeting with a team by Wednesday or Thursday to discuss a care plan,” says Michael S. Jellinek, president of Newton-Wellesley Hospital and chief of child psychiatry at Mass General. “We don’t tolerate anything that increases the patient’s anxiety.”

NORTH

Lahey Clinic
Burlington
Beds  | 317
Specialties  | Surgery, urology, transplants, oncology, interventional pulmonology
Though Lahey ditched its Kenmore Square digs in the 1970s, it remains as clinically rigorous as any Boston teaching hospital. It’s a surgical powerhouse, meeting care standards at a rate that puts it in the top 10 percent of hospitals nationally. The facility is the world leader in living-donor liver transplants, a process it helped pioneer in 1999. The urology practice, led by John Libertino, is internationally known for its ability to deal with complex prostate and kidney cancers. In state-of-the-art operating suites, delicate procedures (on ureters, throats, ears, et cetera) are performed via robot-assisted laparoscopy, which minimizes downtime. Not one to rest on its technical laurels, Lahey continues to put resources into maintaining a scalpel’s edge over the competition: A major expansion in 2006 added five ORs and a dedicated surgical ICU. A whopping 24 isolation rooms prevent airborne infections among staffers, visitors, and patients who are infectious or vulnerable themselves. Annually, Lahey employees meet with staffers from Mayo, Cleveland, and other world-renowned clinics to share best practices. In recent years, they’ve worked to balance technical prowess with a softer side, including bedside visits before discharge to schedule follow-up care, and “patient-centric” office hours (meaning docs can be seen nights and early mornings).

Winchester Hospital
Winchester
Beds  | 229
Specialties  | Women’s health (including maternity), pediatrics, surgery and cardiology
Chimes sound throughout Winchester Hospital whenever a baby is born — close to 2,000 times per year. And whether it takes two good pushes or hours, each mom has a nurse dedicated to her throughout active labor. Not only does the hospital believe excellent bedside care is imperative, it was also the second Massachusetts hospital (right behind MGH) to achieve Magnet status, a rigorous, multiyear certification that only about 6 percent of hospitals earn nationwide. A number of studies have linked quality nursing to better health outcomes, but beyond data, it means that nearly 500 people show up for Winchester’s NICU reunion every year. “The hospital values its nurses. They seek our input and value our research and ideas,” says nurse Sheryl Smith, who works in labor and delivery. As an example, based on research on ventilator-associated pneumonia, Winchester nurses instituted new oral-care protocols for ICU patients, which cut the hospital’s rate of that deadly infection to zero year-to-date. (Nationally, there are 300,000 cases per year. ) In summer 2011 the hospital will open a new cancer center, and plans to roll out a new day surgery center in early 2012.

SOUTH

Brigham and Women’s/Mass General Health Care Center
Foxboro
Beds  | N/A
Specialties  | Sports medicine, day surgery, rehabilitative services
It may be an outpatient clinic, but when this place opened at Patriot Place in 2009, the relief of locals was palpable. No more schleps to Boston for an MRI. No more rushing to Attleboro for stitches (the local ER option, Southwood Hospital, closed several years ago). The center’s proximity to the stadium — it counts Patriots players among its patients — means it puts a premium on sports medicine. Here you’ll find everything from hip arthroscopy to the latest in drug therapies and other nonsurgical treatments for problematic joints, says Philip Blazar, a Brigham and Women’s hand surgeon who runs the Foxboro orthopedic practice. An enormous rehab department has a whirlpool and every form of exercise equipment, plus therapists who are geniuses with splints, braces, and bandages.

South Shore Hospital
Weymouth
Beds  | 318
Specialties  | Level-three maternity and neonatal intensive care units, cardiovascular care, trauma
South Shore Hospital may handle roughly 80,000 ER visits per year, but to Rockland resident David Kohler, the only patient who mattered was his six-year-old son: The facility stitched him up after a bike accident. “From the second I walked in, they took care of us,” he says. “I was carrying Ryan and someone got a wheelchair immediately.” A few popsicles, some Novocaine, and a Scooby-Doo video later, David left with a happier kid and written instructions for caring for the stitches. “People went out of their way to check on us, to tell Ryan he was being brave. It meant a lot.” The hospital excels in caring for children at every stage, whether it’s micro-preemies in the NICU or teenage athletes. An innovative outpatient program provides baseline neurological testing for kids involved in contact sports, so if a concussion is suspected, damage can be accurately assessed and monitored. “We are constantly listening and thinking about how to better serve our communities’ needs,” says John Stevenson, senior vice president and chief medical officer. For instance, when the ER saw more elderly patients admitted for fall-related traumas, the home-care division ramped up injury-prevention classes for caregivers. To address a growing orthopedic need, the hospital will open an out-patient musculoskeletal surgical center in Hingham in fall 2011.