As the senior vice president and chief legal counsel of New England’s largest safety net hospital, David Beck administers and supports Boston Medical Center’s mission: “Exceptional Care Without Exception.” His legal professionals maintain the same goal as any physician on the campus, which is to provide the best possible care, especially to those with no other options or resources.
Boston Medical Center (BMC) is a 496-bed hospital in the city’s historic South End. As senior vice president and chief legal counsel, Beck oversees the legal department, the captive insurance company, and the corporate compliance department—a total of thirty-four professionals navigating the needs of hospital leadership, care providers, and patients.
Before joining BMC ten years ago, he was the deputy chief of the Massachusetts attorney general’s public protection bureau. That was near the beginning of Commonwealth’s healthcare reform efforts; regulations were changing, oversight was becoming more complicated, and hospitals’ volunteer boards of trustees were growing anxious about remaining compliant.
As Beck started to become responsible for the oversight of Commonwealth’s public charities (including virtually all the hospitals), he helped found what would become the office’s Health Care Division. Beck says that experience helped prepare him for the complexities of his role at BMC.
“We work on a broad spectrum of projects helping our providers who struggle with some very complicated questions about care and the rules around it,” he says.
Providers wrestle on a daily basis with issues such as patient privacy, malpractice insurance, and management of the hospital’s property.
University Hospital and Boston City Hospital, located just across the street from one another, had been coordinating services and staff when, in 1996, Mayor Thomas Menino initiated the merger that would form Boston Medical Center. For years, BMC operated two inpatient facilities. That is, until 2013, when the trustees adopted a plan to consolidate the hospital campus.
Now, construction and renovation are nearing completion. In an operation such as this, timing is critical; the work must have its own space without interfering with the institution’s daily functions. Beck describes how the organization is adding operating rooms, changing the configuration of patient floors, and expanding emergency capacity, all while maintaining a high level of service.
As of press time, the work is scheduled to be completed in 2018. Beck speaks admiringly of the new facilities, which include the new Women and Infants’ Center (featuring a striking view of the Boston skyline), a transport bridge between the helipad and the emergency department, as well as a demonstration kitchen.
The recently opened kitchen, Beck explains, is one component of BMC’s holistic care action. For years, the hospital has operated what he calls a “preventive food pantry,” where patients can receive foods prescribed by physicians as a component of their care. The hospital later realized that the cultural and economic diversity of its patient population meant that some of them were unfamiliar with their new “prescriptions.” The solution? A professional chef hosts cooking classes to ensure patients are more familiar with this type of care component.
Serving a diverse population as a safety net hospital means that more than half of BMC’s patients rely on government payers for their healthcare coverage. Due to the adjacent financial and educational challenges, BMC makes diligent efforts to ensure that patients can understand and follow their healthcare directives.
“With the challenges [our patients] face, they may or may not have a stable place to live; they may or may not be able to read the prescription again once they’re by themselves,” Beck explains. The physicians and the legal team have worked hard to provide clear discharge instructions, follow up with patients in the home, and even provide resources for legal support related to housing and utilities. That way, he says, “we can help them face some of those challenges in their lives so it’s more likely that their care will be successful.” The proposed partnership with MassHealth (a state agency that provides low- and no-cost health coverage) and the forthcoming accountable care reimbursement framework will provide a system to unify those efforts.
BMC is currently preparing its application for the initiative that will replace the fee-for-service model—which reimburses the medical center for each procedure performed—with an accountable care model. Under the new system, the facility will receive a certain amount of money to care for patients, then draw from all of its available resources to ensure that it’s providing care in the best possible way.
“The idea behind that is that if you have the responsibility—as an institution—for the patient’s whole care, and your reimbursement is based on that, there’s the right incentive to provide the right care. You do it in a better, more efficient way, and you save dollars.”
It’s always demanding for Beck and his team to keep up with this field’s pace of regulatory change, and he readily admits that nobody knows for certain what will happen next, especially at the federal level. “We’re pretty certain that there will be changes—we don’t know what they are, or what they will mean for us,” he says. For now, though, their aim is to remain agile, “ready to learn about those changes, prepared to help our leadership here implement and understand them.”
The work’s importance and complexity continue to attract great legal professionals to this institution. His staff is stable and durable, and Beck himself has served with BMC for ten years. “It’s a rare opportunity for lawyers to work in an environment like this, a hospital with a mission that connects deeply to things people believe in,” he says. The hospital’s mission, “Exceptional Care Without Exception,” remains a challenge worthy of the best.