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An Open Letter to the Community

At Beth Israel Deaconess, our patients always have and always will come first.

  • Date: 9/29/2000

At Beth Israel Deaconess, our patients always have and always will come first.

Our mission is clear:

Extraordinary care where the patient comes first, supported by world-class teaching and research.

To Our Community:

You may have read and heard stories about Beth Israel Deaconess Medical Center this week. As a community member and "owner" of this institution, you deserve to know the whole story. We are therefore taking the unusual step of describing our plan for the future in the newspaper.

First, we would like to thank our extraordinary staff for the exceptional care they have always provided and continue to provide to our patients in this changing health care environment. Thanks to them, Beth Israel Deaconess (BIDMC) is a world class medical center where the patient always has, and always will, come first.

To ensure the continuation of this exemplary care, we have worked hard over the past several years at BIDMC to improve our operating performance.

While we have made significant progress, it's clear that with the continued onslaught of external forces--declining payor reimbursement, rising costs of pharmaceuticals, federal cutbacks for academic centers--this improvement isn't enough.

Why hasn't the progress been sufficient? Simply stated, we have been treating an important symptom (operating losses) but we haven't yet addressed the underlying diagnoses. The plan approved unanimously by the BIDMC Board of Trustees addresses these underlying diagnoses with the following measures.

Real Estate and Capital Costs

The medical center currently occupies 3.2 million square feet of space. We are carrying capital costs that are two to three times greater than the national average for academic health centers. This makes for a heavy burden of debt service and depreciation; we cannot continue to shoulder this burden and become financially sound. When combined with other campus redesign programs that will better integrate our institution, the reported sale of four buildings will reduce our total space by 700,000 square feet.

These real estate transactions will generate major benefits, both programmatic and financial. As we provide our programs and services in 22% less space, the resulting reduction in costs in facilities and debt service will allow us to reinvest in the growth of exciting programs and services.

BIDMC as an Academic Medical Center

BIDMC has historically been a full service provider as we have sized our specialty programs to fit our primary care base, rather than growing a sizable program that serves both a regional, and even national referral base, as well as our own primary care physicians.

This plan positions BIDMC as a regional tertiary referral academic health center that will serve patients not only from our immediate market, but also from a broader base in Massachusetts and the country. (Think of "tertiary" as "those special and complicated/cutting edge services that you wouldn't expect to be available in a community hospital." A liver transplant is a good example.) To position the medical center more as a tertiary referral center, we would grow some programs and shrink others, so that, four years from now, we will achieve approximately the same mix of complex and more common procedures that BIDMC had in the mid-90's. In other words, we are working to strengthen our tertiary services while continuing our strong commitment to primary care.

To accomplish this subtle but important shift, the medical center will invest in growing its programs in the following areas (many of which you will recognize as longstanding strengths of our institution):

--Cardiology and Cardiac Surgery

--Cancer Care

--Vascular Surgery

--Pulmonary and Thoracic Disease


--Solid Organ Transplant

--Related Tertiary Surgical Services

As you look over this list, you will see that it covers a very broad swath of the medical and surgical landscape. In other words, we are applying greater focus in certain areas, but we are not becoming a niche player in medical care.

In order to simultaneously grow these services and reduce the total square footage of the Medical Center, some programs or services will have to be resized or delivered in collaboration with other CareGroup organizations.

By the end of next year, we plan to close our inpatient psychiatry service (currently 42 beds), and provide a consult liaison psychiatric service. This is a common model that exists in many other major medical centers, both locally and nationally.

Orthopedics will continue to be a major part of our Level I Trauma Service. Over the next couple of years, however, our patients and orthopedic physicians will have the opportunity to work with our colleagues at New England Baptist Hospital, one of the nation's premier orthopedic programs, for most elective and outpatient orthopedics.

Obstetrics and Gynecology will continue to be a major part of our mission and service mix. Construction of an integrated research facility could reduce our total complement of obstetrics beds from 60 to 42 sometime during the next several years. Whatever research scenario unfolds, there will still be thousands of BIDMC babies born each year.

We are planning to focus our dermatology services on cancer-related dermatology as part of our overall growth initiative in cancer care. We will make sure that our primary and specialty care providers and patients have access to general dermatology services, and will work to arrange those as conveniently as possible to our campus.

Finally, post-acute care and a few other services will need to be relocated, and we will work to coordinate those services with other CareGroup hospitals and affiliates, as well as the broader community of care providers.

These decisions about services were complex and difficult. It is not correct to conclude that we have chosen to focus only on "lucrative" services. The main factors in making these decisions were space (we have to fit our programs into 22% less space) and "fit" - what services would best support our areas of strength and strategic focus.

A Big, Bold Research Initiative

We have the fastest growing research program in Boston, if not in the whole country, and are now ranked #3 among hospital recipients of federal research funding in the United States. This stream of discovery and innovation cannot continue to grow without investment in space and people. As a means of fortifying this important aspect of our mission as an academic health center, we plan to link our research program with a strong partner. As a part of this initiative, together with a partner we plan to build a world-class research institute in the midst of the biomedical research capitol of the world, the Longwood Medical Area.

Streamlining Operations

Thanks to the efforts of many people over the last two years, Beth Israel Deaconess Medical Center is already performing at or near national benchmark levels of efficiency in clinical operations. We have other opportunities to improve our efficiency and we plan to do so.

What Will the BIDMC Look Like in the Future?

When this plan is fully implemented over the next four to six years, the Beth Israel Deaconess Medical Center will:

--Be a tertiary academic health center serving Boston, and in certain services, a regional and national community.

--Balance growth in our tertiary services with our continuing commitment to provide the highest levels of primary care.

--Deliver a very broad array of clinical services, although somewhat smaller in number, on a campus with 700,000 fewer square feet.

--Together with a partner, create the finest translational research institute in the world, housed in a facility that will be an international talent magnet.

--Have a clear mission: Extraordinary care where the patient comes first, supported by world-class teaching and research--and be financially capable of delivering it.

We appreciate and value your trust in us, and we will continue to earn that trust as we move forward to strengthen our service to you, your family and neighbors.

James L. Reinertsen, M.D.
Chief Executive Officer
CareGroup and Beth Israel Deaconess Medical Center

Michael Rosenblatt, M.D.
Beth Israel Deaconess Medical Center

Sharon O'Keefe
Executive Vice President and Chief Operating Officer
Beth Israel Deaconess Medical Center