Mass General Brigham didn’t become the medical behemoth it is today by not knowing the first rule of health care poker — know when to fold ’em.
Faced with a wall of opposition to its proposed three new suburban outpatient surgical centers — not the least of which included a critical staff report by the Department of Public Health — the organization formerly known as Partners HeathCare cut its losses. In the end, MGB settled for partial wins on expansion plans on the main Mass General campus and at its Brigham and Women’s Faulkner Hospital.
Amid state efforts to control rising health care costs, however, there are lessons to be learned here — lessons not unique to the expansionist aims of MGB. The fractured nature of health care policy in Massachusetts with its alphabet soup of agencies — in this one instance working in remarkable harmony — is desperately in need of a makeover.
Massachusetts is blessed with a wealth of first-rate medical institutions, including MGB, which again rose to the occasion during the pandemic. The problem isn’t quality; it’s the cost.
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After all, hospital “development” isn’t just about adding a building here or a new unit there. Every one of those decisions will in one way or another add to the cost of care delivery. That balancing act requires all of those health care actors to be at the table, and that can’t be left to chance. It will in the end require a new legislative framework.
Even as MGB was pursuing what was originally a $2.3 billion expansion plan, the Health Policy Commission — whose mission is to contain health care costs — issued a notice to MGB that it would be required to file a Performance Improvement Plan outlining how it intended to contain spending that had risen above what it considered acceptable limits. It was the first time the commission had issued such an order.
The commission also said those proposed MGB outpatient centers for Woburn, Westborough, and Westwood would raise annual health care spending costs by between $9.3 million and $27.9 million.
At a meeting with the Globe editorial board, MGB president and CEO Dr. Anne Klibanski insisted the Performance Improvement Plan had “nothing” to do with the expansion plan.
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She also maintained that the suburban centers were merely for the convenience of MGB’s existing patients.
“I have zero interest in acquiring patients,” Klibanski said.
But the attorney general’s office advanced the notion that that’s not how things work in the real world.
“These patients will be creating a relationship with the MGB system that will (or may) likely involve long-term shifts in where they obtain primary, specialty, and hospital care,” wrote Eric Gold, head of Attorney General Maura Healey’s health care division, in a letter to the Department of Public Health. “Analysis of the project’s impact on the Commonwealth’s health care cost containment goals is not complete without considering the financial impact of the shift of commercially insured patients to the MGB system for all their care.”
The Massachusetts Association of Health Plans also weighed in, noting in a letter, “Unless and until MGB addresses its underlying drivers of cost growth, the pending proposals before DPH will only exacerbate our state’s high health care costs and wide variations in provider prices.”
MGB will probably still walk away with approval for considerable expansions in Boston when the Department of Public Health meets next month to consider its staff recommendations. Staff did not recommend those 94 additional beds MGB was looking for on its main campus — although it left the door open for a future amendment. And its new towers will allow the conversion of double rooms to single ones. The Faulkner expansion will also be subject to ongoing monitoring.
What shouldn’t be lost is that the state dodged a potential health care cost bullet here.
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Hospital expansions — officially called Determination of Need applications, which come under the purview of the Department of Public Health — should not be decided apart from the state’s cost-containment goals, now largely the work of the Health Policy Commission.
Legislation passed by the House last November — legislation near and dear to Speaker Ronald Mariano — seeks to do that. It would also establish a state Health Planning Council to look at the need for various services around the state and how future expansions help meet those needs.
It is not a perfect piece of legislation, and it gives an outsized role to community hospitals, also a favorite of the speaker. But the bill does provide a structure for making fair decisions in a way that takes into account cost and market share.
Maintaining the state’s reputation as a health care mecca and assuring that those services are available and affordable to its residents is a tricky balancing act — one that should not rely on fancy ad campaigns or political clout but on coordination by policy makers and by dogged ongoing analysis.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
