What we know about plans for patients and doctors as Tufts closes children’s hospital

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Health

While pediatric outpatient care will remain at Tufts, Boston Children’s will soon take over inpatient care.

Local nurses held a vigil last month to draw attention to the closure of Tufts Children’s Hospital. Craig F. Walker/Boston Globe Staff

In January, Tufts Medical Center announced plans to close its 128-year-old pediatric ward. Now plans are accelerating and new details are emerging about what this closure means for patients, families and doctors.

Why is Tufts closing its children’s hospital?

In its announcement earlier this year, Tufts representatives cited an urgent need for increased care capacity for critically ill adults. The hospital’s 41 pediatric beds will be converted to adult intensive care and medical/surgical beds. Tufts pediatric patients will now be referred to Boston Children’s Hospital. The changes will take effect on July 1.

The number of adult patients requiring highly specialized care has increased significantly, according to the announcement. This forced the hospital to turn away “hundreds” of patients every month. Tufts’ projections suggest that fewer children will need hospitalization in the future, and those who need hospital treatment will have serious health conditions that require advanced, highly targeted care systems. Boston Children’s will open 50 new beds by mid-July as part of the first section of a new clinical building, the hospital said.

How might patients be affected?

Outpatient pediatric care will remain at Tufts. This includes pediatric primary care, day surgeries, pediatric emergency room and neonatal intensive care unit. The hospital will retain the Asian Pediatric and Adolescent Clinic, a vital resource for Chinatown residents. The Center for Children with Special Needs and New England Pediatric Care, a long-term care facility for children, will also remain open.

A clinic specializing in rheumatology also remains open, The Boston Globe reported this week. Mental health and rheumatology often overlap in the conditions caused by the disorders treated at this clinic.

Tufts’ 41 pediatric ward beds translate to between 1,800 and 2,000 discharges per year that would be transferred to Boston Children’s, according to the hospital. Eventually, this space will be reallocated to enlarge adult beds by approximately 20%.

Inpatient pediatric chemotherapy will no longer be provided at Tufts. This will affect 35 families, World reported. While chemotherapy is usually given on an outpatient basis to adults, children normally receive the treatment in hospital. It will now be dispensed at Boston Children’s.

More than 60% of patients at Tufts Children’s Hospital are enrolled in Medicaid, which means the state controls reimbursement levels, said Michael Dandorph, president and CEO of Tufts Medicine, in the initial announcement. Tufts has “proven to manage adult care at lower cost, while being one of the highest ranked academic medical centers in the country for quality and outcomes,” Dandorph added. This will help the hospital continue to reduce overall health care costs, he said.

As more low-cost inpatient beds are on the way, the costs of pediatric care could very well rise. According to data from the State Health Information and Analysis Center obtained by the World“pediatric care is 25% more expensive at Boston Children’s than at Tufts for patients insured by Massachusetts’ Blue Cross Blue Shield, the state’s largest insurer.”

How might doctors and nurses be affected?

This week, Tufts shared new information with the World about the impact these changes will have on physicians. Boston Children’s will create a foundation for current Tufts doctors, who will have privileges at Children’s, but Tufts would rent and pay for doctors’ time. Tufts physicians will be professors and professors at Tufts University School of Medicine, instead of having Harvard affiliations like other Boston Children’s physicians, the World reported.

Details of how surgeons will be assigned are still being worked out, but non-surgical specialists will now direct hospital care to doctors at Boston Children’s. Tufts told the World that three quarters of its 140 doctors have decided to join the foundation or continue to work for the hospital.

Tufts officials plan to have enough doctors to maintain most specialist outpatient services, the World reported. However, there remains a possibility that Boston Children’s doctors may need to help cover shifts as Tufts hires more medical professionals. Some outpatient services may be transferred entirely to Boston Children’s.

In total, these changes will affect 95 Tufts nurses, the hospital said. All of these nurses found employment elsewhere at Tufts or with other organizations. Four affected nurses have taken early retirement, according to the World.

In March, doctors and nurses told the World that Tufts Children’s Hospital may be forced to close earlier than July 1 as staff leave for new jobs.

Boston Children’s will add additional ambulances between the two hospitals, CEO Kevin Churchwell told a Department of Public Health hearing in April. Boston Children’s will also create a portal for clinicians to share medical records, he said.

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