Facing pressure to cut spending and distribute patients more efficiently through a crowded system, Mass General Brigham is reorganizing the leadership of its community hospitals and consolidating oversight of its community doctors.
The move, executives say, is the latest step in integrating the state’s largest health system, as it tries to move from a federation of hospitals and structures to a unified organization.
“From one perspective, we’re doing OK. But the truth is, this is an unprecedented, challenging time. Doing OK really isn’t good enough anymore,” said Dr. Gregg Meyer, president of the Community Division for Mass General Brigham. “We have to be able to make decisions clearly. People need to be able to get guidance relatively rapidly. … In the end, this is about us improving efficiency of decision making and clarity of authority.”
Like other health systems, Mass General Brigham is strained by workforce shortages, the high cost of temporary labor, and overcrowding due to delays in discharging patients to understaffed nursing homes, rehabilitation centers, and psychiatric clinics.
Yet the changes are bound to ruffle feathers, and some say they further consolidate power with a shrinking group of executives.
“This sends the message that I know a lot of physicians have been fearing, that this is moving the power locus clearly away from the individual institutions and instead moving it to MGB central,” said Dr. Paul Hattis, a senior fellow at the Lown Institute, a Needham-based health care think tank, and a former member of the state’s Health Policy Commission. “The docs are going to be upset about that.”
As part of the changes, Dr. David Roberts, currently president of Salem Hospital, will be appointed to the new role of senior vice president of community operations, overseeing budget performance, capital planning, and clinical programs for the system’s six community hospitals.
MGB is also stripping leaders of the community hospitals of their CEO titles; they will now function as presidents and chief operating officers.
Meyer, who will continue to oversee philanthropy, medical affairs, and board affairs for the community hospitals, said having fewer leaders at the hospitals would allow the system to implement initiatives more quickly, rather than trying to build consensus with different management teams spread throughout the region.
Additionally, Roberts will bring together and oversee six different employed-physician groups under the newly named Mass General Brigham Medical Group.
In the past, each community hospital had its own physicians’ group, with its own management structure and compensation and benefit packages. Over 100 other employed physicians, along with all affiliated doctors in the community, worked under Mass General Brigham Community Physicians.
Community physicians who are affiliated with, but not directly employed by, Mass General Brigham will still be overseen by Mass General Brigham Community Physicians.
The executives said the move will streamline the recruitment and management of employed community physicians. Consolidating management of the physician organization may ultimately result in staff reductions, though executives said it was still early, and they were evaluating people’s roles and skills.
“In the end, what we will need from one centralized management team will likely be smaller than the sum of all the disparate parts,” Meyer said.
Roberts said the reorganization would allow MGB to more easily spread best practices across hospitals and the 1,300 employed community physicians, and allow the community arm of the system to more easily identify where there is capacity and how to quickly get patients in for appointments.
“The demand on our organization is enormous. So creating capacity to see all our patients requires us to be really efficient with our resources,” Roberts said. “We have to make sure our ORs are running right, so wait time for our patients isn’t so long. The idea is to aggregate the operational part of the job under one leader, so we could focus on that.”
As part of the changes, Dr. Errol Norwitz, who served as president and CEO of Newton-Wellesley Hospital since 2020, will be leaving the organization. Taking his job will be Ellen Moloney, the hospital’s current chief operating officer, who will become president and chief operating officer starting March 1.
Additionally, Roxanne Ruppel, currently senior vice president of operations at Salem Hospital, will replace Roberts, becoming president and COO of Salem starting March 1.
Executives at the other community hospitals — Nantucket Cottage Hospital, Martha’s Vineyard Hospital, Cooley Dickinson Hospital, and Wentworth-Douglass Hospital — will all see adjusted titles.
Hattis said the benefits of the changes remain to be seen, though they will hopefully help hold back price increases.
“Even MGB is having difficulty getting to breakeven right now, because of the huge labor costs and inflation. Even they aren’t beyond reach when it comes to trying to find ways to survive and thrive in the world to come,” Hattis said. “They seem to be deciding in order to do that, they need to centralize decision making at the level of the system.”