Maryland hospital systems have been growing for years, with some small systems joining larger systems, small hospitals joining systems and other hospitals remaining proudly independent.
It comes as no surprise that most systems are happy with where they stand as consolidation has continued in the state, believing they have found the right formula to treat patients with the best care at the right price.
Most Maryland hospitals are now a part of some sort of health system. Just a handful of hospitals — including Atlantic General Hospital in Berlin, Greater Baltimore Medical Center in Towson, Mercy Medical Center in Baltimore and Western Maryland Regional Medical Center in Allegany County — are independent of larger systems.
In other states, hospitals have banded together to improve their leverage as they negotiate with insurance companies over reimbursement rates. But in Maryland a state board sets reimbursement rates for all hospitals individually, regardless of their membership in a larger system.
Instead, one of the principal arguments for hospital mergers has been to improve cost efficiencies in non-medical areas.
LifeBridge Health includes Sinai Hospital, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and, most recently, Bon Secours Hospital. The system’s leaders say the real advantage of banding together has been in reducing overhead costs.
“The mergers result in cost efficiencies, but the cost efficiencies are in overhead agencies,” said David Krajewski, the system’s chief financial officer. He noted that the system does not sacrifice in health care areas.
“We’re not doing this so we can become a monopoly and raise prices, because we can’t,” he said.
When LifeBridge adds a hospital to its system, it looks for a cultural fit. LifeBridge, like most systems in Maryland, says it is focused on addressing the social determinants of health — things that can affect a person’s health, such as where they live, what they eat and their job status.
When the system merged with Bon Secours hospital this fall, it was adding a hospital in an area of west Baltimore that the system felt could use its focus on population health.
“We have never shied away from these challenged communities, while others have tended to focus (on adding hospitals) in less-challenged areas,” said Neil Meltzer, LifeBridge’s CEO.
In some hospital mergers, a fresh start under new leadership is considered important.
The University of Maryland Medical System has become a system of systems. It has 13 hospitals that generate more than $4 billion in revenue across the state, including through smaller regional systems including University of Maryland Upper Chesapeake Health, University of Maryland Shore Regional Health and University of Maryland Capital Region Health.
The system officially added Capital Region Health, a Prince George’s County system formerly known as Dimensions Health System, as part of a deal to provide a new hospital and get new leadership in a system that had lost the trust of many of the communities it served.
“The reason the state leadership and the county leadership reached out to us and said, ‘Will you help?’ was because we had a track record of successfully integrating health care in local communities into a larger system with high-quality, patient-centered care,” said Mohan Suntha, the incoming CEO of the University of Maryland Medical System.
Suntha also sees the system’s growth as an opportunity to address health along the entire continuum of care. He wants to increase conversations among the system’s regional system to see what works at improving quality.
“How do we act more like a system in thinking through health care delivery? So often in many industries when you can reduce variation, you improve quality,” he said. “That’s a good example of when you think about our system so that we can deliver high-quality care across our system by bringing providers together and having a conversation. … We actually will collectively raise the quality.”
Some independent hospitals believe they can accomplish their goals of improving patient health without joining a larger system.
John Chessare, president and CEO of GBMC, has been outspoken about keeping his hospital independent.
“We believe staying independent is the right thing to do because we are a not-for-profit and our goal is not to get bigger,” he said. “Our vision is to be a community-based health care system where everyone gets the care that we would want for our loved ones.”
Those goals are harder to accomplish when you are also focused on getting bigger, he added.
But he has also acknowledged that GBMC is not truly independent. It benefits from agreements with other hospitals, such as Johns Hopkins, to help with specialized cases.
GBMC has been growing in other ways. It has significantly increased its primary care and senior care options as part of its efforts to keep people healthy outside of the hospital so they do not have to utilize hospital care.
Still, Chessare said the system could add a hospital if it was necessary.
“Because we are attempting to keep people with chronic diseases out of the hospital, my hope would be that regionally we wouldn’t need another hospital because our goal is to keep people out of the hospital,” he said. “But it is within the realm of the possible that within the foreseeable future we might want to acquire another hospital because we need the capacity.”