It took just 13 minutes for the state of Massachusetts to end more than 80 years of independence for the Martha's Vineyard hospital, and transfer ownership to the state's biggest health care provider.
With only one condition and minimal questioning, the nine members of the state Department of Public Health public health council, meeting on Tuesday in Boston, agreed to the deal which cedes ownership to the Massachusetts General Hospital, a subsidiary of the nonprofit giant Partners Health.
It was a quick end to a quick process. The plan to affiliate was announced by the hospital eight weeks ago, and the final agreement signed off by the board less than two weeks ago.
And the final approval by the public health council would have been even quicker, but for a measure of celebratory rhetoric about the public benefit which would flow from the Partners takeover of the Vineyard and Nantucket hospitals. The words came from state Sen. Robert O'Leary, who attended the meeting to "put my vote on behalf of this proposal."
"I participated in a public forum on the Vineyard some weeks ago, and I've been in contact with my constituents on Nantucket both in the community at the political level and at the hospital, and you know, there's nearly universal support for this," Mr. O'Leary said.
"I know something like this is complicated and there are elements of risk in terms of the identity of the institution and its association with the community, but I feel confident that the way this has come forward... will acknowledge the role the hospital in community is protected," he said.
In a time of increasingly sophisticated and complicated health care, Mr. O'Leary said, "a relationship with an entity like Partners is something that's highly desirable."
Asked by the board to give his assessment of the views of Islanders, he said he heard little outright opposition, but rather questions about detail.
Harkening to the Nov. 19 public forum, in which executives from both Massachusetts General and the Vineyard hospital were grilled by residents, he categorized Islanders as a "pretty sophisticated" bunch of consumers.
"They asked some tough questions, but I think they got some good answers," Mr. O'Leary said.
They certainly asked a lot more questions than members of the public health council did.
Apart from seeking the senator's assessment of public opinion, members asked only a couple of general questions about the governance of the hospital under the new regime.
They were told 80 per cent of the members of the board of the Vineyard hospital would continue to be Vineyarders. Partners would appoint the other 20 per cent.
"There will always be 80 per cent Island residents," said the Vineyard's chief executive officer, Timothy Walsh.
Mr. Walsh also said the affiliation should make staffing the hospital easier during the tourist season, when the Island population swells up to eight-fold.
"We staff up for the summer," he said. "It's always a very difficult task to identify people to bring in and we're hoping with the affiliation that we'll get really an easier task in doing that and more importantly, we'll hope to get the same people coming back each year. That will enhance the quality of the delivery system."
And that was about it, as far as new information went.
The only condition attached to the approval was one agreed to by the new owners, relating to the provision of interpreter services and the collection of data on the race, ethnicity and language "to improve care for all patients."
Health council members did not broach the major unanswered question about the deal: whether it would be the Vineyard hospital or Nantucket cottage hospital that would be required to give up critical access status, a special designation for small rural hospitals which allows them full Medicare reimbursement for their services.
Under the terms of the affiliation deal, one or other of the hospitals must do so. Last week, Mr. Walsh suggested that giving up critical access designation could cost the Vineyard about $1 million a year in reimbursement, which would have to be made up by Partners.
Under the complex system by which reimbursements are made, having two critical access hospitals costs the state of Massachusetts an estimated $250 million in Medicare payments, including tens of millions denied to hospitals affiliated with Partners.
But there was no mention at the hearing of this fact, one of the driving forces behind the change of ownership.
After 13 minutes, the council unanimously approved the Vineyard hospital deal, before moving on to the parallel agreement with Nantucket, which was passed even more quickly.
The rest is largely just paperwork. Executives of the three hospitals now will decide which of the two small facilities changes status under Medicare. The new arrangement should be finished before April.