Mass General Brigham this week halted controversial plans to build outpatient care centers in three suburbs outside of Boston.
MGB was seeking to spend nearly $2.3 billion on expansions and improvements at two of its existing hospitals, Massachusetts General Hospital and Brigham and Women’s Faulkner Hospital, and on the creation of three new ambulatory sites in Westborough, Westwood and Woburn. However, a 75-page analysis released in January by the Massachusetts Health Policy Commission, an independent state agency, found that the expansions would increase commercial health care spending by at least $46 to $90.1 million, resulting in higher commercial insurance premiums for residents and businesses, drawing ire from competitors in the health care field and from state officials.
The decision to nix the proposal for the three sites followed news that the Massachusetts Department of Public Health would not recommend the plans for approval, MGB said in a statement. DPH did, however, endorse the expansions at Massachusetts General Hospital and Brigham and Women’s Faulkner Hospital, which are expected to collectively cost around $2.03 billion.
“We are delighted that the Department of Public Health has recommended that the Public Health Council approve our plans to improve the standard of care for our patients at Massachusetts General Hospital and increase access to Brigham and Women’s Faulkner Hospital,” Dr. Anne Klibanski, MGB President and CEO, said in the statement.
The proposed sites in Westborough, Westwood and Woburn would have amounted to a $223.7 million expenditure and would each have included an ambulatory surgery center and an array of physician services, including primary care and behavioral health services.
“Mass General Brigham remains dedicated to transforming care delivery so that our patients receive the right care in the right place at a lower cost,” Klibanski said in the statement. “We will continue to honor our commitment to provide the best care to the 227,000 patients we currently serve at Mass General Brigham affected by the Department of Public Health’s decision.”
Among the array of improvements in the $1.88 billion proposed expansion at Massachusetts General Hospital are the additions of dozens of new medical/surgical and ICU beds at the Boston hospital, the conversion of nearly 400 semi-private beds to private rooms, a major expansion in oncology, cardiology and radiology services and various other expenditures.
The $150 million proposed expansion at Brigham and Women’s Faulkner Hospital includes adding 78 new medical/surgical beds and eight new observation beds, expanding endoscopy and imaging services and creating a “shell space” for future clinical additions.
The HPC said the three proposals — the expansion at Massachusetts General Hospital, the improvements at Brigham and Women’s Faulkner Hospital and the three new ambulatory sites — would not just result in a hike in commercial health care spending, but also lead many patients and a significant amount of revenue to go to the higher-cost MGB system and away from other lower-cost providers.
Additionally, according to the agency, the projects would negatively impact market functioning, including: “health care access and equity, as a substantial amount of commercial revenue is likely to shift to MGB and away from other provider systems that have fewer financial resources, lower average prices for commercial patients, and generally serve larger proportions of MassHealth patients and communities with higher indicia of social need.”
“Mass General Brigham has a spending problem,” HPC Chair Dr. Stuart Altman said in a statement in January. “Its spending performance and plan for new expansions at their flagship hospitals and into the Boston suburbs raise significant concerns. ... In fact, continuing in this manner is likely to impact the state’s ability to meet its spending benchmark and could do serious harm to the structure of the state’s delivery system.”
In the past two years, multiple health care organizations, including the Massachusetts Association of Ambulatory Surgery Centers and Health Care For All, as well as Massachusetts Attorney General Maura Healey’s office have stepped forward to criticize the proposals, similarly arguing that the new outpatient care centers, situated in more affluent communities, would drive up costs for patients.
“The proposed MGB expansion sites are targeted to predominantly white, higher-income communities that have a disproportionate share of commercially insured patients,” Health Care For All wrote in a letter to DPH in June 2021. “In contrast, the locations are not easily accessible to residents of lower-income communities who already face barriers to health care.”
“As a result, the new MGB sites would likely draw commercially insured patients from the target communities away from the local lower-cost and safety-net providers, thus removing a key revenue stream that helps to subsidize patients who are insured by public programs such as MassHealth or Medicare, or who are uninsured,” the organization added.
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