Noble Pursuit – Community Hospital Explores Affiliation with Baystate Health

Nine years ago, Baystate Health was in serious talks to bring Noble Hospital into its system, but the potential deal fell through late in 2006.

But that was a much different time, said Ronald Bryant, who became Noble’s president and CEO four years ago and is engaged in revived talks to become a Baystate affiliate — the fifth acute-care hospital, in fact, under the Baystate banner.

“It’s a different healthcare environment today,” he told HCN, while being unable to specifically address what happened in 2006. “Noble is a different organization, and Baystate Health is a different organization. I can only deal with what’s in front of me.”

Specifically, that’s a financial and care-delivery landscape that has changed significantly for hospitals over the past decade, as economic pressures, technology costs, and regulations governing safety and quality have all increased, creating a perfect storm for small, independent, community hospitals like Westfield-based Noble.

For that reasons, the boards of trustees of Noble Hospital and Baystate Health have authorized the organizations to sign a letter of intent exploring, once again, the potential of Noble becoming a member of Baystate Health. That changing landscape, Bryant said, could make a merger a more attractive scenario for both entities.

“A few things are driving this change,” he said. “Obviously, the healthcare environment and new regulations are forcing hospitals to act differently from a reimbursement and quality angle. The market is being driven toward alternative payment methodologies and population health, and if we’re going to compete in those areas, we should be part of a system with greater resources.

“With that said, we’re all being measured more on quality today than at any other time. That’s only going to increase. If we want to maintain the quality we provide — and Noble has some of the best quality scores in the Valley — we want the resources and access that allows you to do that,” Bryant continued. “Because of the changing healthcare environment and demands on us to maintain quality and programs and equipment and our employee base, there’s pressure on community hospitals. As part of a system, we can ensure that we have healthcare in Westfield for many years to come. So, really, this is a product of the marketplace.”

It helps, he added, that Baystate and Noble are partners (along with other hospitals) in a regional heart-attack program that expedites emergency cases to Baystate Medical Center, the region’s designated angioplasty center. In addition, Baystate and Noble collaborate on telemedicine for stroke patients and women’s services, partnerships that have grown stronger since the failed merger in 2006.

“We have worked closely with Noble and its team of caregivers for a long time, and we recognize the excellent quality of care and compassion they provide to their patients,” said Dr. Mark Keroack, president and CEO of Baystate Health. “Given our common commitments to high-quality and high-value care, I share with our board members a strong belief that this potential partnership would serve the missions of both organizations and the needs of our communities.”

Taking Wing

The announcement comes just six months after Wing Memorial Hospital in Palmer officially became part of Baystate Health. Wing was the region’s third community hospital to join the system, following Franklin Medical Center in Greenfield in 1986 and Mary Lane Hospital in Ware in 1991.

Baystate officials said the Wing affiliation strengthens what the health system calls its Eastern Region, which also includes Baystate Mary Lane. Noble would represent a significant western expansion, as Noble serves patients from Westfield, Southwick, Agawam, and the hilltowns.

“We talk informally with many other organizations from time to time,” said Ben Craft, director of Public Affairs for Baystate Health, noting that the time seemed right to reconvene affiliation talks with Noble.

“It’s hard to pinpoint a formal start date, but our discussions with the Noble organization picked up in the past several months,” he told BusinessWest. “In the current environment, with all its change and strains, I’d say the majority of healthcare providers are looking at their current relationships and affiliations and any potential new ones, and assessing what’s going to be best for the patients and communities they serve.”

Craft said moves like the Wing merger and a similar potential move with Noble don’t spread Baystate Health too thin, but rather strengthen both the system and its individual hospitals.

“We believe a well-coordinated, cost-effective, and high-quality regional network of care is a critical element of the long-term health and success of our Western Massachusetts community,” he explained. “We believe this potential new relationship would help us better coordinate healthcare and wellness efforts, provide high-level care as close to home as possible, and reduce instances where patients need to travel outside their community for care when they prefer not to.”

Baystate and Noble have a history of working together, and this new partnership would be building on existing relationships, including referral relationships in which Noble’s providers already refer a significant number of patients to Baystate. Baystate Reference Laboratories provides clinical diagnostic services in partnership with Noble, which also maintains its own on-site lab services and Blood Donor Center.

“Our organizations already collaborate in many areas, including lab services, heart and vascular care, women’s services, and neurology,” Craft noted. “There is a strong referral relationship between Noble and Baystate. We’ve learned from these partnerships how well we can work together, and that leads us to believe that both organizations, and most importantly our patients, would benefit from a closer relationship.”

Bryant agreed. “Having a strong working relationship just makes the transition easier,” he said. “Any time you have an organization of their caliber so close, and they can help you bring more resources to your organization and to your patients — which they have been doing — it just makes any type of relationship going forward that much easier and stronger. The physicians are already familiar with each other at some levels, management is familiar with each other, and so are many employees. It makes for a more natural, fluid process.”

Bryant noted that many patients who come to Noble’s emergency room are transferred to Baystate, the region’s only level-1 trauma center and tertiary-care center, receiving referrals from across Western Mass. “In many ways, we’ve already been complementing them, and they’ve been complementing us for years.”

He emphasized the latter point, noting that Baystate isn’t the only organization bringing value to the table. “We’ve done tremendous things in the community. Four years ago, we employed one primary-care physician; now we have 16 at Noble Medical Group. Our physician-practice group has gone from 35 employees to 70.”

In addition, recent improvements include a renovated patient wing; a new Comprehensive Primary Care Office building; a new, $450,000 Noble Walk-In Express Care service next door that sees some 1,100 patients monthly; a urology practice; new orthopedic offices; and comprehensive breast cancer services with a full-time breast surgeon.

“We’ve done more and more each year, and we want to continue to do that, to provide more services to the community,” Bryant said. “If we partner with Baystate, we want to be sure we complement them and they complement us.

“It would really be a win for Westfield and the surrounding area,” he added. “You could walk into Noble Hospital with the confidence that we’re backed up by an academic, tertiary-care center with the status of Baystate Health.”

What’s Next?

Noble’s potential affiliation with Baystate Health now enters a period of review and due diligence within the organizations and in partnership with relevant regulatory and oversight bodies — work expected to occur over the next several months. In the meantime, Bryant and Keroack said, it will be operations as usual for both organizations.

“At this stage, we’re at the beginning of a discussion about this potential partnership, and patients should not expect to see any changes for the near future,” Craft noted. “I think we share with the leadership of Noble a lot of optimism about the potential in this proposed relationship, and we’d certainly apply that optimism to the future of Noble Hospital if we move forward.”

Added Bryant, “we’re in the due-diligence phase, where we share documents and regulatory agencies look at bylaws and financial-quality indicators. We want to make sure each organization is comfortable with the other. It’s a feeling-out process. Once we go through that and both sides are comfortable, then we’ll continue.”

Of course, there’s the matter of what a merger would do to Noble’s employment needs and which positions, if any, might be consolidated. Noble now boasts about 750 employees, while Baystate Health employs some 11,500 across its network of hospitals and other provider practices.

It’s much too early to say what might happen with staffing after a merger, Bryant told HCN. “We do know, certainly, that there’s apprehension among the employees. That part is natural. But this is about increasing utilization and access to care in our community.”

“There’s a lot of complexity in healthcare today,” he added. “But this is a process — a natural process.”

And one that might become more common for community hospitals weighing the benefits of joining a larger system or standing alone.