The Massachusetts Association of Health Plans, which counts 15 of the state’s largest insurers except Blue Cross Blue Shield, has come out against Mass General Brigham’s proposed expansion.
The organization is another in a line of critics, including competitors and community organizations, who have opposed the $2.3 billion project. Mass General Brigham has proposed opening or growing ambulatory sites in Westborough, Westwood, and Woburn, and expanding Massachusetts General Hospital and Brigham and Women’s Faulkner Hospital in Jamaica Plain. The expansion, MGB says, will help increase capacity at its downtown hospitals and bring lower-cost outpatient care to its patients in the suburbs.
In a letter sent to the Department of Public Health on Tuesday, the association said the state’s largest and most expensive provider shouldn’t be allowed to get bigger, especially as it faces a “performance improvement plan,” — a spending audit from a state health care watchdog agency for excessive spending. MGB is the first system ever to be held to such an audit.
“We urge the Department of Public Health to reject the (expansion) applications, until such time as MGB addresses its system’s high health care unit costs, cost structure and cost growth that continues to contribute to overall rising health care costs here in Massachusetts,” said association president Lora Pellegrini in the letter.
Pellegrini suggested Mass General Brigham first successfully complete the spending audit and demonstrate its commitment to cost containment below the state’s 3.1 percent benchmark of spending growth before the state considers the system’s expansion. To approve the project while it faces scrutiny from a separate state agency over its spending would be “against the public interest,” she said.
In a statement, Mass General Brigham faulted the health plans association for submitting comment about its project after the comment period with the state had closed, and saying the organization’s objections were a “disservice to patients.”
“MAHP’s opposition is especially shortsighted as it will harm patients who are transferred from other Massachusetts hospitals to Mass General Hospital and Brigham and Women’s Hospital for the complex care that an academic medical center provides,” said Jennifer Street, a spokeswoman for Mass General Brigham, in a statement. “In the last year alone, 5,122 Massachusetts transfer patients were denied admission to these two hospitals due to the capacity crisis that Mass General Brigham’s plan will help alleviate.”
The deal is still pending regulatory approval by the Department of Public Health’s Public Health Council, expected in the coming months.
Earlier this week, Mass General Brigham requested a 60-day extension on responding to the spending audit, potentially pushing that discussion to after the approval process for its expansion.
The association has taken a similar stance before, coming out against Mass General Brigham’s (then called Partners HealthCare) 2014 expansion plans. Those included acquiring South Shore Health and Emerson Health. At the time, the association told a judge reviewing the deal that it was increasingly difficult to keep health care costs low when it had to negotiate with ever-larger health systems.
In her decision denying the acquisition on antitrust concerns, Suffolk Superior Court Judge Janet Sanders said the association’s letter was among “the most valuable” in her consideration.
The question of health care spending has been at the crux of the latest debate over Mass General Brigham’s expansion. An independent analysis, commissioned by MGB and required as part of the state’s regulatory approval process, found the project would result in modest savings for the state, as it planned to shift patients from expensive downtown beds into the suburbs.
MGB has referenced these points in a wide-ranging, multimillion ad campaign across print and broadcast media in recent months.
The watchdog Health Policy Commission found the independent analysis to be lacking in scope, and said in its review the expansion would raise annual health care spending by $46 million to $90.1 million by drawing patients to higher-cost facilities and creating a new referral pathway to the system’s downtown hospitals.