What Do Medical Partnerships Mean For Healthcare?

Medical Center Partnerships or What’s Up Doc?

By Thomas M. Bincaniello, M.D.

Recently Stony Brook Medicine and the Mount Sinai Health System announced that they are entering into an affiliation agreement that includes collaboration in research, academic programs and clinical care.  Why one wonders would two academic medical centers that market themselves as “having it all” need to affiliate? 

They are, of course, not the first in the New York area.  NY Presbyterian and NY Hospital, each with an IVY league medical school, became one system NY Presbyterian some years back. On Long Island, North Shore University Hospital and Long Island Jewish Hospital, who were very competitive with each other, combined their hospitals into a system  North Shore-LIJ.  Recently the name was changed to Northwell.  Large systems often have smaller hospitals as part of their networks this helps to expand their base for referrals and the smaller hospitals benefit from the prestige and bargaining power of the larger system.

Affiliations or mergers advantage the systems at multiple levels – clinical, academic teaching and research. They don’t always achieve all that is desired, especially if there is a big cultural difference in the components that merge.  

Clinical advantages can include the combining of resources, elimination of duplicate competing services, larger patient bases, and more bargaining power with the payers.  Small hospitals often join these larger hospitals because alone they have little leverage with insurance companies.  On the other hand, it is difficult for an insurance company to not have a NY Presbyterian contract, which would make them less attractive to a large number of patient enrollees.  In addition, if not already part of a purchasing consortium they have a better bargaining position for prices on equipment and supplies needed for clinical care.

There is also an advantage to sharing the best clinical care processes to improve clinical outcomes.  Having a system with the resources to support standardization and quality care can make a big difference rather than trying to go it alone.

Teaching occurs at two levels in academic medical centers – students and post-graduate (residents and fellows).  At some institutions medical student teaching is governed by the medical schools.   So for example, Columbia Physicians and Surgeons and Cornell Medical College, Stony Brook and Mt. Sinai continue to have independent medical schools.  On the other hand, they may have residents in students rotate through their affiliates to take advantage of services that may be unique.

For the research mission, not only is there advantages in expanding the “brain power,” but the of sharing expensive research facilities and equipment.   Recruiting research scientists by having the combined resources and people to support the research makes such appointments more desirable for the candidates.  The prestige of the combined institutions makes them more attractive to graduate students, doctoral candidates and post-doctoral positions.    And when the research is translational (applying advances in basic research to clinical problems) have the larger patient referral base of the systems provides more potential patients for clinical trials.

As in any other business merger or affiliation, not all always goes smoothly.  The component members “cultures” may clash and old rivalries may not accept the new order.  So it may take years and a lot of effort to evolve into a smooth running system.

These partnerships can improve patient outcomes by focusing combined resources to improve care, bring new research advances to the bedside to advance care and teach medicine to future generations of providers fulfilling the Hippocratic oath to teach them this art.

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Thomas Biancaniello, MD is a Professor of Pediatrics (Cardiology) Columbia University Medical Center, Former Chief Medical Officer, Stony Brook University Hospital, Emeritus Professor of Pediatrics and Medicine, Stony Brook University

Comments

[Jeb Ladouceur]

This is a lucid explanation of a typically complex matter.
Dr. Biancaniello is to be commendeded for outlining it so well.
He clearly knows whereof he speaks.

- Jeb Ladouceur
Stony Hill Path