Steward Health Care: Advice to the Boston Globe

The Boston Globe plays an indispensable role in Massachusetts. It acts as a watchdog over powerful institutions including the Catholic Church, state government, health plans and hospital systems. The Globe contributes to better governance and accountability, which benefits residents of the state.The story of Steward Health Care System is a vitally important one for Massachusetts. The Globe understands this and is devoting substantial resources to covering the company, including a lengthy front-page story on Sunday. But the Globe could improve its coverage by focusing more on substantive issues and less on superficial topics and complaints tossed out by Steward critics with an axe to grind.Here's what the Globe should be looking at:

• What role is Steward playing in helping or harming the goals of Massachusetts health reform? In particular, is Steward making it easier for employers and employees to afford health insurance as mandated by the law?
• What impact is Steward having on other health care providers, including community hospitals and academic medical centers? Is it taking market share away from one or the other? Is it forcing other providers to cut costs, improve service, merge, raise capital or otherwise act differently?
• What is the impact on communities and the state overall of having a new for-profit, tax-paying entity replace non-profit, largely tax exempt hospitals?
• How is Steward affecting health plans' offerings, and do the plans consider Steward an ally or a competitor or both?
• Is Steward improving or harming quality of care and patient experience or not?
• Why did Steward and Cerberus pick highly-regulated, non-profit dominated Massachusetts as the beachhead for a national strategy?
• Why is Steward taking such a hard line with nurses in its negotiations? What is the impact on affordability and patient care?
• Why have physician groups chosen to affiliate with Steward?
• What are the likely next steps for Steward once its key investor, Cerberus, reaches the end of its investment time horizon?

These are difficult but important questions. I'm a health care expert who knows Massachusetts well, yet I don't have definitive answers to most of these questions. The Globe can and should devote its resources to understanding and addressing these topics.Sunday’s article does address some of the important issues, at least in passing. We learn that Steward uses e-ICUs to control cost, and that Steward is focused on reducing readmissions and offering lower cost insurance products. We hear that the CEOs of Blue Cross and Tufts Health Plan consider Steward to be making a big impact. But much of the article --like the Globe coverage that has preceded it-- is devoted to secondary topics that reveal the Globe’s open suspicion of Steward including:

• The replacement of a few security guards by a “New Jersey contractor with ties to Cerberus.” (Who cares if they’re from NJ since obviously the new guards will be working in MA? What does “ties to Cerberus” mean and why is that relevant or bad?)
• “Eyebrow-raising pacts” to refer complex patients to MGH and the Brigham. (The agreements are actually straightforward and the rationale is easy to understand.)
• Nurses complaining of their voices being stifled. (They would have been stifled a lot more if the Caritas hospitals had been closed rather than acquired.)
• The fact that Steward lost money in its first year of operation. (Of course it did. If the turnaround of nearly-bankrupt hospitals could have been accomplished instantly that would have been a lot more suprising.)

Ideally the Globe will publish a series of in-depth articles on Steward focused on the primary topics, providing readers and policymakers with greater insight than what’s been available to date.