Longwood hospitals plan raises cost concerns
A new patient floor just opened up in Boston’s dense medical neighborhood, and more expansions are in the pipeline, prompting the question: Does Longwood need more beds?
The hospitals in the Longwood Medical Area, which are planning to add a total of 134 beds, say they need to accommodate more overnight patients with complex medical problems. But observers worry the growth, which amounts to about 7 percent greater capacity among the hospitals, will drive up costs for insurers and add traffic to one of Boston’s most congested areas.
The new patient floor opened on Oct. 5 at Beth Israel Deaconess Medical Center, adding 23 general medicine beds, the first such expansion in over seven years, according to spokeswoman Jennifer Kritz. The 672-bed hospital plans to expand again next spring, adding a cardiac unit with 20 private rooms, she said.
Meanwhile, Brigham and Women’s Hospital, which has 793 beds, plans to add 20 in a revamped neonatal intensive care unit in 2017. And Boston Children’s Hospital, which has 404 beds in Longwood, is seeking approval to add 71 more, according to spokesman Rob Graham. Most of those would be in a new clinical tower that Children’s plans to open by 2021.
Alan Sager, professor of health policy and management at Boston University School of Public Health, said the expansions appear to continue a trend: Since 1970, major teaching hospitals in Massachusetts have been gobbling up an increasing share of inpatient admissions.
And because Longwood hospitals charge higher rates, that costs more for insurers and patients, which eventually amounts to “taxing sick people through higher out-of-pocket payments,” Sager said.
The three plans for adding capacity “seem to signal that despite the rhetoric about restoring a balance between community and teaching hospitals, the pendulum continues to swing in the expensive direction,” Sager charged.
Stuart Altman, chair of the Massachusetts Health Policy Commission, said he’s likewise concerned the expansions would hike up the cost of health care — and the amount of traffic.
Kritz defended the move: She said Beth Israel Deaconess is focusing on using its Longwood campus for more complex cases, such as brain or heart surgery, and shifting more routine care outside of Longwood by expanding outpatient services in Chestnut Hill, Lexington, and Chelsea. But as the hospital’s network has grown, it is seeing more patients who need complex care. Despite the extra Longwood beds, she said, the overall strategy is more cost-effective because more routine care is taking place at less expensive sites.
Boston Children’s Hospital is taking a similar approach, shifting less complex cases to community hospitals and satellite sites in Waltham, Lexington, and Peabody, Graham said. Almost all of the beds the hospital seeks to add in Longwood would serve “the most complex patients,” he said. He added that Children’s is keeping costs from growing over the state benchmark of 3.6 percent per year.
So what about the traffic? That’s driven by the thousands of people who travel to Longwood each day for outpatient care, Kritz argued, not by the number of hospital beds.
Boston doctor’s jaundice bed debuts in Africa
The invention looks like a space-age bassinet: A basket of reflective material, covered with canvas dotted with blue LED lights. It aims to treat an ancient problem. Jaundice — an excess of bilirubin that turns the skin yellow — kills 100,000 babies per year, many in developing countries. But exposure to plain blue light can cure it.
The device, called the Bili-Hut, was inspired by inventor Donna Brezinski’s experience as a neonatal doctor at Boston Children’s Hospital. One day, about ten years ago, she was caring for a pair of jaundiced newborn twins at a community hospital that partnered with Children’s — but found only one available phototherapy lamp, the standard treatment for severe cases. When she looked into buying another lamp, she was shocked by the $4,000 price tag.
Sewing together simple materials at her kitchen table in Winchester, she set about creating a cheaper and more portable alternative that could be used in the developing world. She came up with a bassinet that reflects blue light around the baby’s body. She started a company, Little Sparrows Technologies, to produce and distribute the device. It weighs less than three pounds, can be rolled up to fit inside a FedEx tube, and costs only $250 to make.
While the device awaits clearance from the Federal Drug Administration for use in the United States, a rural hospital in Burundi has been testing out a prototype and has reported promising results.
Dr. Alyssa Pfister, a pediatrician at Kibuye Hope Hospital in east central Burundi, found the Bili-Hut on the Internet and e-mailed Brezinski. The inventor sent a free prototype to the hospital, which started using it in September.
“Voila!” Pfister wrote in a blog post. “We’ve now treated five babies with neonatal jaundice. And it works!”
Dr. Vinod K. Bhutani, a professor at Stanford University School of Medicine who studies neonatal jaundice, said the device might be a promising addition to other portable and semi-portable phototherapy devices used in the developing world.
“It’s a brilliant idea,” said Bhutani, who is not involved in the company. “It just needs to be tested.”
He suggested the company conduct clinical research to make sure the device doesn’t overheat or cause infections. “It would be good to know if it’s been tested in the United States before we bring an untested device into a developing country,” he said.
Brezinski said the device provides the same intensity and quality of light recommended by the American Academy of Pediatrics and used by other blankets and lamps approved by the FDA. She has tested it on synthetic skin samples and expects to hear back from the FDA within 18 months.
Her aim is simple: “We shouldn’t be seeing babies die of this,” she said.