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Proposed Westborough MGB facility, Image courtesy Mass General Hospital
A new analysis of Mass General Brigham's proposed clinics in Westwood, Woburn and Westborough predicts that the sites will result in a "small overall decrease" in health care spending for the services they would offer, a conclusion that the hospital system views as encouraging while project opponents say it leaves out other key impacts.
The expanded site in Westborough targets a location on West Park Drive near the Route 9/I-495 interchange. The MGB web site
states : “Mass General Brigham will bring teaching hospital doctors and high quality care to Westborough with a new health care center to serve our 40,000+ patients in this area so they can receive the same quality care closer to home.”
Possible Squeeze on Local Hospitals Seen
Meanwhile, nearby institutions, such as Milford Regional, are watching the project warily. “At a time of continued consolidation and limited resources in healthcare, maintaining access to quality healthcare services in a community setting is critical. Community Hospitals like Milford Regional are an important part of the healthcare infrastructure and our capacity to serve the community is improved via our collaborative relationships with a range of larger systems including UMass Memorial, Mass General Brigham, Dana Farber Cancer Institute and Boston Children’s Hospital,” noted Edward J. Kelly, president and CEO of Milford Regional Medical Center:
As part of a broader expansion that also involves a new $2 billion expansion at Massachusetts General Hospital and additions on the Brigham and Women's Faulkner Hospital campus, the health system put forward a $224 million plan to open new ambulatory care centers in Westborough and Woburn and expand an existing site in Westwood. Perhaps unsurprisingly, according to documents shared by Allen Edinberg, Chair of Westborough Select Board, the town has strongly supported the MGB plan.
The state's largest hospital system, Mass General Brigham has touted the suburban expansion as a way to offer its patients services at a lower cost than at its flagship academic medical centers while also saving them a drive into Boston.
Other health care organizations and business groups that have organized against the plan argue that MGB, a more expensive provider, will threaten the financial viability of community hospitals by drawing away their commercially insured patients.
The proposals are working their way through the state's "determination of need" process, through which the Department of Public Health vets hospital expansions and other transactions.
State Officials Dig Deeper
In March, the DPH notified Mass General Brigham that the system would be required to commission an independent cost analysis to review whether its plans align with the state's health care cost containment goals. The notice said the department would develop questions for the analysis to address, and that the analysis "should be led by a professional with experience in health care economics and financial management."
Analyses for the three projects -- the Faulkner Hospital expansion, new Massachusetts General Hospital tower, and ambulatory care sites -- were published Tuesday.
Government agencies including Attorney General Maura Healey's office, the Center for Health Information and Analysis and the Health Policy Commission will have until Jan. 27 to comment on the analyses, as will the ten-taxpayer groups formed to weigh in on the projects. The DPH says it will consider the analyses and comments in its review and recommendations.
Groups opposing the ambulatory care expansion, banded together as the Coalition to Protect Community Care, knocked the analysis, saying they had hoped for broader scrutiny "through the lens of cost impact, community demand, and health equity across the state and in regions where MGB proposes to expand."
"By only analyzing how the proposal will affect the costs of MGB's present patient panel and ignoring cost-drivers, such as the recruitment of commercially insured patients from low-cost providers and increased referrals to the state's most expensive doctors and hospitals, the ICA inadequately examines long-term implications for the entire state and leaves residents of the Commonwealth with an incomplete picture of how this ill-advised proposal would alter the state's healthcare landscape," a coalition spokesperson said.
The coalition said regulators and residents "deserve an impartial examination that considers evidence such as that unearthed" by Attorney General Healey, whose office in November flagged some details from its own review of documents MGB produced in response to a civil investigative demand.
Healey's report said an expansion's ultimate effects on costs "depends in large part on whether it shifts commercial market share to or away from higher-priced options," and that MGB in 2018 "projected that the multi-year MGB ambulatory expansion plan would ultimately increase MGB's share of the market for inpatient hospital services and covered lives."
The MGB proposal -- along with the larger trend of health care market consolidation -- is one factor that prompted House Speaker Ronald Mariano to bring forward legislation that would impose another layer of state review on hospital system expansions, with the goal of protecting community hospitals from encroachment by large, higher-cost systems. The House passed that bill, which would grant the Health Policy Commission the authority to investigate the cost and market impact of hospital expansions, on a 158-1 vote last month.
Outside Organizations Concerned about Wrong Kind of Competition
Barbara Anthony, a former cabinet secretary in the gubernatorial administration of Deval Patrick, and currently a fellow at Pioneer Institute, a regional think tank, recently co-authored a number of reports on health care costs. She expressed concern with the MGB proposal.
“The thing Pioneer is always concerned about is cost,” she said. The organization would like to see changes in the market to make it easier for low-cost providers, with appropriate quality controls, to enter the market.
MGB isn’t cut from that cloth and, in fact, “in terms of rate structure, they are several times higher than the Medicare rates,” she said.
“I think the smaller players are concerned that MGB will draw from their pool and cut into their revenue stream,” she said. That, in turn, can impact the ability of those smaller hospitals to provide services, which in turn can further erode their ability to compete.
Although competition is “good” for consumers in many markets, healthcare is a more complicated situation, she admitted, since well-insured consumers often have freedom to access expensive providers while those less-well-insured consumers tend to get shut out. The situation can be especially dire for lower-income people, she noted.
“Consumers have a certain perception of quality and price but many studies have shown little correlation between costs and quality,” she noted.
“I think this overture by MGB to expand has shed light on this problem in a way that other situations haven’t in the recent past,” she said. Several years ago, she explained, Mass General was prevented from acquired two suburban hospitals through a ruling by Judge Janet Sanders due to concerns about potentially adverse impacts on market competition.
Anthony said that ruling blocked acquisitions but left open the door to building new facilities, for MGH and (now) MGB.
Regulators still have opportunities to put the kibosh on the expansion plans. Whether they will or not remains to be seen.
“We have confidence that the regulatory process will carefully consider implications of expansion on existing providers, resources and community health services and urge regulators to continue to prioritize access to local, affordable and high-quality health services in their review,” added Milford Hospitals Kelly.
Below, Barbara Anthony, healthcare cost expert
