An ambitious plan by Mass General Brigham to expand into affluent suburbs miles from Boston has set off a fight about the future of outpatient health care in Massachusetts.
A group of rival health care companies has mounted an opposition campaign to block the expansion plan, worried that the state’s biggest health care provider will become even more powerful at their expense.
They argue that Mass General Brigham’s plan to build outpatient surgery centers in Westborough, Westwood, and Woburn will encroach on the turf of important community health care providers and raise costs for the state by drawing patients away from these less expensive providers.
Mass General Brigham officials dismiss the criticism as grievances from competitors working to protect their own interests, and insist their project will provide high-quality and cost-effective care that patients need and want.
“If it provides a positive benefit to patients,” spokesman Rich Copp said, “it should be approved.”
But critics say that if Mass General Brigham gains market share, particularly among wealthier patients, local providers will lose critical revenues.
“The MGB expansion is on a size and a scale that’s unprecedented. It’s going to change the landscape of health care should it go forward,” said Thomas A. Shields, chief executive of Shields Health Care Group, whose imaging and surgery centers compete with Mass General Brigham.
“The question is: Is there a need in the community?” Shields said. “Those areas are already being well served.”
The increasingly bitter spat over health care market power is an abrupt shift from much of the past year, when hospitals put competition aside and worked together closely to manage the COVID crisis.
The debate will play out over the next several months as the state Department of Public Health reviews the expansion project. The department is requiring Mass General Brigham to hire an outside expert to analyze whether its plans will help the state contain health care costs. The Health Policy Commission, a state watchdog agency, also plans to weigh in.
Mass General Brigham and several of its competitors — including Shields, UMass Memorial Health Care, and Wellforce — have been mobilizing support from patients, politicians, businesses, and nonprofits.
Mass General Brigham has mailed fliers to hundreds of thousands of households in the Westborough, Woburn, and Westwood areas. It’s running online ads that plead: “We need your help.” Its competitors, meanwhile, have flooded public hearings with speakers opposed to the project.
The stakes are high: outpatient care — anything that doesn’t require admission to the hospital — is a big and growing part of health care as medical treatments advance and patients demand more convenient options.
For Mass General Brigham — formerly called Partners HealthCare — the new surgery centers are part of a sweeping effort to reinvent the company, which was founded 27 years ago by the renowned Massachusetts General and Brigham and Women’s hospitals. One pillar of the strategy is to expand the prestigious health system’s reach through community sites. The company already has begun building an outpatient surgery center across the state border in Salem, N.H.
By offering routine surgeries at the sites, it hopes to free capacity at its Boston teaching hospitals for more local, national, and international patients.
At the same time, the company is seeking approval for a $1.9 billion expansion at MGH in Boston, which would include two new towers and 94 additional beds designed for the sickest and most complex patients. A third project would renovate and expand Brigham and Women’s Faulkner Hospital.
These initiatives — first announced in 2019 — together represent $2.3 billion in new spending.
Executives say they need to build new sites to better serve their existing patients — including about 40,000 who live in and around Westborough.
The company plans to build a 62,000square-foot clinic in the town about 30 miles from Boston, where patients could get cataract surgery, hip and knee replacements, hernia repairs, and other common procedures. The site also would offer MRI and CT imaging, primary care, mental health care, and specialists.
The new surgical centers are ”part of our overall strategy to become an integrated health care delivery system,” said John Fernandez, president of Mass General Brigham Integrated Care, the company’s new outpatient division.
“These sites are all about trying to make it easier for our patients — who are already getting our services — to get to an MGB site,” he said.
Mass General Brigham executives said local patients support their plans: a poll they commissioned shows 71 percent to 81 percent approval in the communities they want to serve. And more than 1,000 people have sent letters to state officials praising the expansion plan — through a website that Mass General Brigham created to gin up support.
The surgery centers would be licensed as clinics, not hospital facilities, and Fernandez said Mass General Brigham expects insurers to pay 25 percent less for services delivered at these sites compared with its community hospitals. This is an important part of the company’s plan to lower medical expenses, he said.
But even those reduced payment rates could be greater than what other health care providers are paid for the same services. That means the surgery centers, if successful in drawing new patients, could raise statewide health spending — costs that consumers and businesses ultimately would pay through insurance premiums.
“This is a major expansion of the health care capacity not only of Mass General Brigham, but also of the whole state,” Stuart Altman, chairman of the Health Policy Commission, said at a public meeting last month. “It’s also a provider that has a good record of high quality — but high costs as well.”
The communities where Mass General Brigham wants to build all have household incomes higher than the state median of $81,000. Residents of those communities are more likely to have private health insurance, instead of coverage through Medicaid, which means they’re more lucrative for health care providers.
Wealthier patients already make up a greater share of Mass General Brigham’s patient base than at many other health care providers. Poorer individuals on Medicaid are a relatively small share — about 15 percent — of the company’s patients, according to data the state Center for Health Information and Analysis provided at the Globe’s request.
Dr. Eric Dickson, chief executive of UMass Memorial, said he’s worried Mass General Brigham will draw even more wealthy patients if it’s allowed to build in Westborough. His health system runs hospitals nearby in Marlborough and Worcester and relies on those high-income patients for its bottom line.
“This one in Westborough is clearly a reach outside of their primary service area into an area that is primarily commercially insured patients or Medicare — very little Medicaid,” Dickson said.
“They’ve got enough of the revenue,” he said. “Do they really have to come and steal it from the little guy?”
In Woburn, Mass General Brigham’s proposed site would sit just a few miles from several competitors, including MelroseWakefield Healthcare, part of the Wellforce system.
Susan Sandberg, chief executive of MelroseWakefield, said Mass General Brigham has begun hiring away her system’s doctors with big salary increases — and their patients are likely to follow.
“Is it hard to compete against them when I’m a smaller hospital that charges less? Yes,” she said.
Beth Israel Lahey Health, the state’s second-largest health system, has community hospitals close to the Woburn and Westwood sites where Mass General Brigham is planning to expand. But it has stayed out of the fray.
The current debate has echoes of 2014, when Mass General Brigham — then called Partners — tried to acquire South Shore Hospital, MelroseWakefield Hospital, and Lawrence Memorial Hospital of Medford. Competing health systems fought the acquisitions, and Attorney General Maura Healey ultimately threatened to sue if the company moved forward.
Now, critics say, Mass General Brigham is pursuing a different strategy with the same goal of growing market share.
“The state really has to look at this closely,” Sandberg said, “because it will increase costs.”