Clarence Fanto: Primary care strain has been eased


LENOX -- The doctors are in at Berkshire Medical Center’s new Lenox Family Health Center, a satellite outpatient department that opened Monday at a state-of-the-art facility in Lenox Commons, off the state highway.

The landscape of medical care is barely recognizable compared to three decades ago, when there were many single-practice doctor’s offices, four independently owned hospitals, and numerous private nursing homes.

Berkshire Medical Center had been formed in 1967 as a merger of Pittsfield General and St. Luke’s Hospital. Berkshire Health Systems (BHS) was created in 1983 and acquired Fairview Hospital in Great Barrington four years thereafter, followed by the purchase of Hillcrest on Pittsfield’s West Side in 1993.

North Adams Regional is likely to be reborn as a satellite of BMC within a few weeks, at least for emergency services, if all goes according to plan.

Combined with BHS’s medical practices and other health care facilities too numerous to list, the opening of the new Lenox primary-care center reflects the ongoing consolidation of medical services in our region.

"It’s a national trend," said Thomas Romeo, the vice-president of physician services at BHS in a recent interview. "It’s very difficult for physicians to be on their own and financially successful because of the requirements associated with electronic medical records," along with costs of recruiting new doctors to replace retiring providers. BHS spends more than $1 million a year recruiting new primary-care physicians.

"The margins [surpluses] in health care are very, very slim," Romeo commented. "In Massachusetts, if a hospital can make a 2 percent margin, it’s doing very, very well. There are intense pressures out there."

To our east, hospitals have been partnering at an accelerating pace, not only in Boston but also in central sections of the state.

Access to primary-care services remains challenging, as Romeo acknowledged -- "the models are changing, and we’re trying to change with them and predict some of the needs."

The new Lenox practice, a $425,000 investment not including the costs of leasing the building at Lenox Commons, remains linked to BMC’s Hillcrest Family Health Center on North Street in Pittsfield, since physicians in both locations will be able to cover for each other.

Nearly 1,500 patients in the practices of Dr. Heather Flynn and Dr. Mehernosh Khan will now be seen in Lenox instead of Pittsfield. Two more primary-care physicians will join the Lenox center, and the Hillcrest operation will remain fully staffed.

Since the two sites are never closed to new patients, the shortage of primary care in Berkshire County has been eased, especially compared to two years ago when a flock of departures and retirements sent several thousand people scrambling for new doctors.

Aside from consolidation under the 21-year leadership of BHS’s CEO David Phelps, the front-and-center role of nurse practitioners is another dramatic evolution in health care -- one that has created some controversy. Some doctors are concerned about the trend, as reflected in lively opinion page debates and letters to the editor in The New York Times and other national media.

But Flynn is among the physicians embracing the enhanced involvement of nurse practitioners such as Raya Ariella, based at the Lenox center.

As Flynn explained, "We’re fortunate in this community that we do have nurse-practitioners who have been practicing for quite a while and have set the precedent of showing that they can provide quality care and partner well with the other providers in the practice."

She voiced enthusiasm for Ariella’s involvement not only in teaming with the physicians in complicated cases but also providing care to her own primary-care patients.

Flynn also acknowledged concerns about patients elsewhere who can’t access their own doctors and end up at walk-in clinics where they’re not known. National and regional pharmacy chains are adding such clinics at some stores.

"One of our goals is to really center our care around the patient and what they need, so that when someone comes in, they’re known here and we can anticipate when people are going to need a little more, know who’s complicated, and work together as a team," Flynn added. "Nurse practitioners are going to play a great role in primary care."

She pointed out that they are well-trained, "very good at coordination, patient education and partnering with patients to make healthy choices.

"In many ways, they play a similar role to a physician and certainly can help in terms of improving access, because some patients are complicated and need to work with a physician," Flynn commented. "The primary-care field benefits from a more multi-disciplinary approach."

As the county’s population ages -- in Lenox, 34 percent of residents are 65 and older -- the need for prompt access to medical care will expand.

The region’s consolidation of hospitals, related facilities and medical practices is an example of how strength in numbers can be beneficial, a silver lining in the health care playbook.

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