An Open Letter to the incredible families of Tufts Children’s Hospital

We wanted to update you on our planned changes to inpatient pediatric care at Tufts Medical Center and our new relationship with Boston Children’s Hospital (BCH). We are sorry this change has been difficult for many families and we are committed to doing everything we can to work quickly to give you the answers you need.

We continue to have important conversations with our doctors, our nurses, our inpatient staff, our trainees and others, all of whom play a vital role in helping us think through the best path forward in pediatrics on our campus and throughout the Wellforce health system. Tufts Medical Center promises to work with you and your child’s care team to make this change as easy as possible.

Before addressing the details, I want to make sure you know that nothing is changing today. We continue to provide all our services including inpatient hospital care. We will keep you informed if anything changes along the way - as far in advance as possible of any change.

WHAT IS THE PLAN?

As previously announced, we will close our pediatric inpatient units, effective July 1, 2022. After that date, any child who needs overnight hospitalization will be cared for at Boston Children’s Hospital. The good news is that other than when a child needs overnight care, the vast majority of services currently available at Tufts will remain open and unchanged, including our:

General pediatric and Asian clinics
Adolescent medicine clinic
Center for Children with Special Needs
Sub-specialty clinics (clinics that treat specific illnesses)– while our work around this transition is not complete, our intent is to keep most of our sub-specialty clinics open, in their current location, with the same care teams you see now, allowing you to use the same insurance you do now
Outpatient (same day) surgery
Our dedicated Pediatric Emergency Department (this is a change from our initial announcement -it will remain open)
Our 40-bed, Level 3 neonatal intensive care unit (NICU)

Also, we are also keeping our community-based services, including:

Our pediatric outpatient specialty centers in Brockton, Chelmsford, Lawrence and Woburn
Our special care nurseries and pediatric hospitalist services at Lowell General, Signature Brockton, MelroseWakefield, Lawrence General and MetroWest hospitals.

WHAT ABOUT YOUR CARE TEAM?

We understand you have created incredible relationships with members of your care team. We are working hard to keep your care teams in place at Tufts or, if necessary, to help them find opportunities to continue to care for you within Wellforce or at BCH.

GOING FORWARD:

Pediatric care is changing, and through this approach, Tufts and BCH are now in a position to help lead that change. Our teams are committed to ensuring that our patients continue to receive excellent care. Unless you are told otherwise, please continue to make any necessary appointments with your current physicians. As plans progress, and we have more specifics, we will keep you informed.

Thank you for your continued trust and patience throughout this transition. If you have concerns, please call the Tufts Medical Center phone line at 866-978-2399.

Sincerely,
Geoffrey Binney, Jr, MD, MPH
Pediatrician-in-Chief

*This information is still accurate as of 3/25/22.

With Increasing Demand from Critically Ill Adults, Tufts Medicine Plans to Convert Tufts Medical Center’s 41 Pediatric Beds to Expand Adult Capacity

BOSTON, MA – January 20, 2022 – The Tufts Medicine Health System today announced it plans to convert its 41 Tufts Medical Center pediatric inpatient beds to much-needed adult ICU and medical/surgical beds, increasing its capacity to care for critically ill adults at its Tufts Medical Center campus. Tufts Medicine approached Boston Children’s Hospital (BCH) about a collaboration -- and the organizations have now signed a letter of intent to work together -- to ensure seamless continuity of care for Tufts Medical Center pediatric patients and for children and their families served by Tufts Medicine providers in other communities. The collaboration agreement is expected to become effective July 1, 2022, subject to regulatory approval.

The collaboration comes at a time when the Boston-area health care market is rapidly changing. The number of adult patients in need of highly specialized medical care at Tufts Medical Center has risen dramatically – so much so that the hospital is forced to turn away hundreds of patients each month. At the same time, projections suggest fewer children will need hospitalization and those who do need inpatient treatment will have more serious health issues than ever before, requiring advanced, highly focused systems of care. Through this collaboration, pediatric patients who require acute or specialty care will be sent to BCH, where they will continue to have world-class clinicians and care teams.

“Since 1796, it has been our mission to serve the medical needs of the adults and children in our community with the very best care, and we have done that with extraordinary skill and compassion. Our Medical Center has never been stronger, but now patient needs are changing,” said Michael Tarnoff, MD, FACS, President and CEO of Tufts Medical Center. “As we look toward the future, we must make this difficult but crucial decision. I am confident that through this collaboration with Boston Children’s Hospital, we will best serve the long-term health needs and well-being of our patients, our families, our employees, our trainees and the communities Tufts Medicine serves.”

Tufts MC’s 40-bed, Level 3 neonatal intensive care unit (NICU) will remain in operation, as it is a vital component of the Medical Center’s highly regarded Maternal Fetal Medicine Program and the strong network that’s been built across eastern Massachusetts by our neonatology team. Tufts MC will also continue its pediatric primary care services, including the Pediatric and Adolescent Asian Clinic, an important 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.

“Boston Children’s Hospital is committed to improving the health and well-being of all children, across the breadth and depth of pediatric care services we offer,” said Kevin Churchwell, MD, President and CEO of Boston Children’s Hospital. “When the leadership of Tufts Medicine approached us with this potential collaboration, we recognized the important positive impact it could have on improving not only pediatric health, but adult health as well. We look forward to collaborating with Tufts Medical Center to provide a full range of care to pediatric patients, including inpatient care that cannot be provided in a community hospital setting.”

Talks are also underway between Tufts Medical Center and Boston Children’s to plan for collaborating in the delivery of pediatric ambulatory specialty services, including satellite physician services, and how to best support Tufts Medicine’s pediatric community hospital network and its thriving network of pediatricians who effectively coordinate care for approximately 70,000 pediatric patients across the region.

“This is an innovative collaboration that allows two world class institutions to coordinate highly sophisticated care to those most in need,” said Michael Dandorph, President and CEO of Tufts Medicine. “I am convinced, by working together we will expand access to high quality care in a way that also addresses the need to lower the overall cost of health care. We look forward to working out all the details with Boston Children’s in a way that ensures the needs of all stakeholders are best served.”

“More than 60 percent of Tufts Medical Center patients are enrolled in Medicaid, where the state controls reimbursement levels,” continued Dandorph. “Coupled with the fact that Tufts Medical Center has proven it manages adult care at a lower cost, while being one of the nation’s highest ranked academic medical centers from a quality and outcomes perspective, will help us continue to lower the overall cost of care in Massachusetts and beyond.”

The 41-bed closure translates to between 1,800 and 2,000 discharges per year that would be transitioned to BCH, eventually allowing that space to be repurposed to expand adult beds by an estimated 20 percent. News of the collaboration is being shared now, despite the current COVID-19 surge, because of upcoming recruitment deadlines for resident trainees. While the change will not occur until July 2022, announcing this today also allows ample time to plan for a smooth transition for those we serve, and to assist affected employees with new career opportunities. The Tufts Medicine Human Resources team will work closely with the several hundred Tufts Medical Center employees and physicians who are affected by the decision to close inpatient beds, helping them consider Tufts Medicine’s 2,000 open positions, as well as vacant jobs at Boston Children’s Hospital.

Tufts Medical Center and Boston Children’s Hospital will work together to ensure the highest level of continuity of care. Parents with questions can call the Tufts Medical Center pediatric hotline at 866-978-2339.

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About Tufts Medicine and Tufts Medical Center
Tufts Medicine is the parent organization of Tufts Medical Center, a world renowned 415-bed academic medical center in Boston that cares for the sickest patients in the region, includes a level one trauma center, the largest heart transplant center in New England and also serves as the principal teaching hospital for Tufts University School of Medicine. Tufts Medicine is also the parent organization of Circle Health (Lowell General Hospital), MelroseWakefield Healthcare; an expansive home care and hospice network; and a large clinically integrated physician network that cares for over one million patients per year. The health system is dedicated to providing patients with the highest quality of care as close to home as possible.

About Boston Children’s Hospital
Boston Children’s Hospital is ranked the #1 children’s hospital in the nation by U.S. News & World Report and is the primary pediatric teaching affiliate of Harvard Medical School. Home to the world’s largest research enterprise based at a pediatric medical center, its discoveries have benefited both children and adults since 1869. Today, 3,000 researchers and scientific staff, including 10 members of the National Academy of Sciences, 25 members of the National Academy of Medicine and 10 Howard Hughes Medical Investigators comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s is now a 415-bed comprehensive center for pediatric and adolescent health care. For more, visit our Answers blog and follow us on social media @BostonChildrens, @BCH_Innovation, Facebook and YouTube.

Media contacts:

Jeremy Lechan
(508) 333-4852
jlechan@tuftsmedicalcenter.org

Rhonda Mann
(508) 341-3996
rmann1@tuftsmedicalcenter.org

Essential Service Closure Filing to DPH 4-1-22

April 1, 2022

Via Email

Stephen Davis, Director
Division of Health Care Facility Licensure and Certification Department of Public Health
67 Forest Street, Marlborough, MA 01752

Re: Tufts Medical Center, Inc. – Tufts Medical Center– Closure of Pediatric Intensive Care Unit Beds and Pediatric Medical Surgical Beds

Dear Mr. Davis:

This letter is submitted on behalf of Tufts Medical Center, Inc. (the “Medical Center”), which owns and operates Tufts Medical Center, located at 800 Washington St., Boston Massachusetts 02111, in follow-up to the initial essential services closure notice that the Medical Center filed on February 18, 2022 with the Department of Public Health (the “Department”) and the appropriate parties required by the Department’s regulations. Pursuant to 105 CMR 130.122(B), the Medical Center hereby provides the required ninety (90) day notice to the Department of the proposed closure of ten (10) licensed pediatric intensive care unit (“PICU”) beds and fifty-seven (57) licensed inpatient pediatric medical surgical (“Pediatric Unit”) beds. As you may be aware, due to the level of patient demand, the Pediatric Unit has operated at thirty-one (31) beds. Included in the closure are the Pediatric Unit bone marrow transplant (“BMT”) beds, which are a subset of the Pediatric Unit. In addition, when the Pediatric Unit closes, the Medical Center will no longer provide outpatient chemotherapy services to pediatric oncology patients. This active treatment component of the pediatric oncology service treats on average 35 patients annually and is inextricably related to the operation of Pediatric Unit. All services will remain open to new and existing patients throughout the closure process. During this period the Medical Center will actively work with patient families to facilitate each patient’s transition to the alternative providers that are available.

The PICU and Pediatric Unit (collectively, the “Service”), are underutilized at the Medical Center. In compliance with 105 CMR 130.122(B), the following information regarding the discontinuation is provided for the Department’s review.

Current Utilization Rates. The following table details the Service for the last three fiscal years (“FY”), including FY22 through February.

PICU	FY19	FY20	FY21	FY22 through February
Number of Cases	676	536	683	368
Patient Days	2,070	1,532	1,998	792
Average Daily Census	6	4	5	5
Pediatric Unit	FY19	FY20	FY21	FY22 through February
Number of Cases	2,103	1,859	2,289	1102
Patient Days	5,616	5,200	7,363	3262
Average Daily Census	15	14	20	21
As illustrated in the table above, the Average Daily Census (“ADC”) in the PICU ranges between 40-60% of available capacity and ADC in the Pediatric Unit ranges between 45-67% of available capacity. Utilization rates for FY21 and FY22 are impacted by the COVID-19 pandemic, which explains the increase in bed use. Additionally, these data include adult patients in the PICU and Pediatric Unit during FY20, FY 21, and FY22. During FY21 and FY22, 8% of utilization in the units was for adults, and in FY 20, 11% of utilization was for adults. Also note that a single admission may result in multiple Cases in the event that the patient occupies beds in multiple units during the course of the admission.

Impact of Discontinuance. The Medical Center understands the concern and inconvenience it creates for some patients and their families, however it does not anticipate significant impact. Comparable services are available at other hospitals, including but not limited to, Boston Children’s Hospital. Boston Children’s Hospital is located approximately 2.7 miles away from the Medical Center and is scheduled to open additional inpatient services in 2022. In recent years, the neighborhood in which the Medical Center is located, Chinatown in Boston, accounts for on average only 15 inpatient discharges per year.

Date Set of Discontinuance. This ninety (90) day notice is hereby provided for a target closure date of July 1, 2022.

Health Care Coalitions and Community Groups. The following community groups may have an interest in the discontinuation of the Service:

Gavin Foundation,
675 E 4th St, South Boston, MA 02127

Josiah Quincy Elementary School,
885 Washington St, Boston, MA 02111

Chinese Progressive Association, 28 Ash St, Boston, MA 02111

Asian Community Development Corporation, 38 Oak St, Boston, MA 02111

Boston Chinatown Neighborhood Center, 38 Ash St, Boston, MA 02111

Boston Center for Youth and Families - Quincy School site. 885 Washington St, Boston, MA 02111

Community Engagement and Planning Activities. Tufts Medical Center conducted the following community engagement and planning activities with respect to the closure of the Service.

Communicated with representatives of the following coalitions and community groups regarding the inpatient closure: Gavin Foundation, Josiah Quincy Elementary School, Chinese Progressive Association, Asian Community Development Association, Boston Chinatown Neighborhood Center, Boston Center for Youth and Families - Quincy School site, South Boston Community Health Center, South Cove Community Health Center.

Tufts Medical Center sent direct communication to approximately 140 local community members and groups, including bilingual information.

On multiple occasions, Tufts Medical Center sent email notices to pediatric patients regarding the closure of the Service. The emails were sent to nearly 27,000 patient addresses.
Communicated with Sampan community newspaper. Communicated with elected and appointed statewide leaders
Communicated with Boston elected officials including city council, state legislators and congressional delegation
Communicated with legislative officials representing area of MelroseWakefield Hospital Communicated with legislative officials representing area of Lowell General Hospital Met with staff from members of Massachusetts Congressional delegation

Tufts Medical Center established a dedicated phone line for questions related to the Service closure. Questions about the service closure can be directed to (866) 978-2399.

Thank you for your attention to this matter. If you have any questions, please contact Zachary Redmond, SVP and Deputy General Counsel at (617) 636-8058.

Sincerely,

Michael Tarnoff, M.D.
President and CEO, Tufts Medical Center

cc: E. Kelley, DPH
W. Mackie, Esq., DPH
R. Rodman, Esq., DPH
K. Fillo, DPH

Health Policy Commission
Office of the Attorney General (Massachusetts) Center for Health Information and Analysis
Executive Office of Labor and Workforce Development

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