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GAZETTE FILE PHOTO

Big changes are in motion for Cooley Dickinson Hospital, above, as trustees prepare to decide which organization will take over the Northampton hospital.

NORTHAMPTON - Now that courtships with merger partners are over, Cooley Dickinson Hospital's trustees are deep under the hood on a deal, as this new year starts. By the end of February, after reviewing acquisition proposals from two big health-care nonprofits, trustees are expected to make perhaps the biggest decision of their 125-year-old hospital's history.

Cooley Dickinson will likely end 2012 as a subsidiary of Baystate Medical Center of Springfield or of the Massachusetts General Hospital in Boston. Though hospital officials are clear on reasons to seek such a change, just how it will all play out for patients remains unclear.

CEO Craig Melin says Cooley Dickinson went into the search for a new owner in a good bargaining position, because its balance sheet is strong. Being part of a larger health-care organization will enable the Northampton hospital to manage rising costs in a time of great change for the industry.

It could conceivably broaden services and fill gaps in care, while lowering overhead costs through access to buying through a larger organization. Or it could see some medical services shrink in Northampton, perhaps costly ones that have recently been operating at lower volume, including cardiac care, cardiac catheterization, robotic surgery and inpatient pediatric care.

Melin is adamant the big change on the table is critical for his hospital's survival. In a September interview, Melin told the Gazette, "We don't think a community hospital our size or smaller can make it in this environment."

In a business that depends so much on consumer trust and acceptance, a lot is riding on the hospital picking the right merger partner.

As it offers itself up for purchase, the hospital is using Hampshire County's attractiveness as a health care market to secure assurances from the bidders. Trustees want to know how a merger partner will benefit care here, not just exploit it, those inside the review process have said.

It remains to be seen how either of the two suitors will change the provision of care in Northampton. One fear, expressed by some staff at the hospital, is that its current medical services will be reduced and higher-level care handled out of town, particularly if Baystate emerges as the choice. Services that operate now at high volume at Cooley Dickinson include medical-surgical care, lab work and emergency care, Melin has said.

Changes in U.S. health care will continue to wash over all institutions, and pulling up a drawbridge in Northampton in an attempt to resist new ways of doing business wasn't an answer. As they move toward a big change, Cooley Dickinson's stewards likely realize that once significant shifts occur, the results can be unpredictable. Melin said this fall that the hospital cannot expect to come away with the level of independence it retained through its earlier affiliation with the Dartmouth-Hitchcock Alliance.

As if acknowledging that, trustees voted late this fall to solicit the views of more members of the hospital's medical staff, as well as opinions of more community members. They also extended their review period by three months.

There are countless stakeholders in the investment that is Cooley Dickinson, and the more who speak out now, trustees must have concluded, the better.

Larry Parnass, the Gazette's editor, can be reached at editor@gazettenet.com