Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center have announced plans to build a new free-standing inpatient hospital for adult cancer care in Boston, severing the cancer hospital’s almost 30-year relationship with Brigham and Women’s in a move executives said will reshape oncology care in the region.
The new hospital, to be located on Beth Israel’s Longwood Medical Area campus, will be operated under the Dana-Farber license, with Beth Israel Deaconess Medical Center and its affiliated physician group, Harvard Medical Faculty Physicians, providing surgical oncology care and medical subspecialty expertise.
“This is the biggest shakeup in health care since the creation of Partners,” said Ellen Lutch Bender, a health care consultant with the firm Bender Strategies, referring to the original merger of Brigham and Women’s with Massachusetts General Hospital, a joint entity now known as Mass General Brigham. “This is a major loss to Mass General Brigham.”
The deal will move Dana-Farber’s inpatient oncology care away from Brigham and Women’s Hospital, which has provided it since the mid-1990s, after Globe health columnist Betsy Lehman died of an overdose of chemotherapy drugs while undergoing treatment at Dana-Farber. Until then, Dana-Farber had provided inpatient oncology care within its own hospital.
According to a person familiar with the discussions, Brigham and Women’s had been finalizing an agreement with Dana-Farber for a multiyear extension to its contract, including talks to construct a new facility. The decision to partner with Beth Israel came as a surprise to MGB executives.
In a statement, Mass General Brigham said, “The Dana-Farber Brigham Cancer Center has combined the strengths of a leading medical oncology and research institute and one of the nation’s most respected hospitals to achieve the best outcomes for hundreds of thousands of patients battling cancer.” It added, “There will be no changes to the excellent care that our patients currently receive.”
MGB had long protected the relationship the Brigham had with Dana-Farber, creating a firewall between Mass. General Hospital’s and the Brigham’s cancer programs, which have not been integrated. With the eventual evaporation of that partnership, the Brigham and Mass. General Hospital could move to work more closely together on oncology.
Today, Dana-Farber patients receive outpatient care, including chemotherapy infusions, at the institute, but are admitted for inpatient care to Brigham and Women’s — connected to Dana-Farber by a bridge. Dana-Farber physicians provide oncology care to patients while they are at the Brigham, though Brigham doctors provide surgical oncology, radiation oncology therapy, radiology, and pathology services.
Dana-Farber’s move away from the Brigham comes as the Brigham has begun more closely integrating with its sister facility, Mass. General Hospital, which has its own cancer center.
Dr. Laurie Glimcher, chief executive of Dana-Farber, denied that the decision was related to Brigham’s connections with Dana-Farber’s competition. Instead, building an independent cancer center has been a longheld vision.
She noted that Dana-Farber’s cancer program, in partnership with Brigham and Women’s, was the highest ranked cancer center in New England by U.S. News and World Report, followed by Beth Israel’s.
“Our collaboration is solely driven by a desire to offer patients something that doesn’t currently exist in this market,” she said — an inpatient hospital solely dedicated to adult cancer patients.
However, the move is a massive realignment that will bolster the size and scope of Beth Israel while moving Dana-Farber away from the dominant health system in the market.
Currently, 40 percent of all Brigham surgeries are related to cancer, a Brigham spokesperson said. The hospital also conducts 100,000 radiation oncology treatments annually. One in four of the patients tested in the Brigham’s emergency room has cancer, and 8,700 inpatients are cared for by Brigham cancer experts each year, the hospital said.
“Part of why this is a substantial loss to Brigham and Women’s is [that] a significant proportion of those Dana-Farber surgical patients won’t use Brigham,” Bender said. “The Brigham will still have a cancer program, but they will lose a significant part of the population, and it will be felt on the bottom line.”
Mass General Cancer Center surgical oncologists perform over 9,200 surgical procedures per year.
David E. Williams, president of the Boston consulting firm Health Business Group, noted that a new cancer center would be a draw for physicians, who might move from the Brigham to Beth Israel. However Mass General Brigham may seek to invest more in its own program to retain its talent and patient volume, he said.
The pivot is a huge get for Beth Israel Lahey Health, formed just four years ago with the merger of Beth Israel Deaconess Medical Center, Lahey Health, orthopedic specialty hospital New England Baptist Hospital, and a slew of community hospitals. Dana-Farber gives the BILH system another specialty hospital.
“BI had been stepping up and trying to create a big entity that is big enough to challenge MGB,” Williams said.
For at least the next five years, inpatient oncology care will continue at the Brigham, Glimcher said. What happens with outpatient satellite operations in communities like Weymouth is not yet clear.
Dana-Farber doctors have also provided care for patients at Boston Children’s Hospital since its founding in 1947. That practice will continue.
Once a new clinical building is constructed, Beth Israel’s existing cancer care will move into the new space on the West Campus, the current site of the Joslin Diabetes Center, which will relocate.
The hospitals could not yet detail how their two programs would integrate, and whether Beth Israel’s existing inpatient and outpatient cancer care would merge with Dana-Farber’s. Dana-Farber will keep outpatient oncology operations in its current building.
Other details have yet to be worked out, including how many beds the new clinical building will have and its design. The state’s Department of Public Health, the Health Policy Commission, and the city will weigh in on the collaborative partnership, the creation of new beds, and the building design. The Medicare program will also review relocating and expanding the number of Dana-Farber beds.
Dana-Farber executives thought carefully about whether to rebuild inpatient capabilities internally or do so with another partner, Glimcher said, ultimately opting to join with Beth Israel.
“It seemed it was the right thing to do for health care costs, and given the excellence of Beth Israel’s surgeons, and also their medical subspecialties,” Glimcher said. “There was no need to copy that.”
Having a dedicated space for adult cancer care was of particular importance, said Dr. Kevin Tabb, chief executive of Beth Israel Lahey Health, the parent organization of BIDMC.
“There’s no question that you get better outcomes when you can dedicate a facility and a team or a set of teams solely to a disease,” Tabb said.
Despite much of cancer and medical care moving to the outpatient setting, Glimcher said there is a growing need for inpatient care. The incidence of cancer has increased as people live longer. Cancer in young people is also on the rise.
Tabb said that today there aren’t enough beds to take care of cancer patients, and the beds that are available are sometimes occupied with patients needing non-cancer medical care.
“We are never going to get away from the fact that there’s a desperate need for inpatient care for cancer,” Tabb said. “These are patients uniquely sick and intense. They need around the clock, intense surgical or medical treatment that can only be provided in the hospital.”
Glimcher acknowledged that the plans are a shift for patients, some of whom might remain at the Brigham, and said she has a deep respect for the hospital.
“We value our longstanding and successful partnership with Brigham and Women’s. As we look to how we can best support our vision for the future of cancer care, we really fully explored every option possible,” Glimcher said. “Ultimately, this decision that we’ve made is informed by how we believe we can best deliver on our longstanding commitment to creating a hospital devoted exclusively to treating adult cancer patients.”