A boisterous political battle over a proposed growth by the biggest and most costly hospital system in Massachusetts is spotlighting questions on whether or not comparable expansions by huge well being programs across the nation drive up well being care prices.
Mass Normal Brigham, which owns 11 hospitals within the state, has proposed a $2.3 billion growth together with a brand new 482-bed tower at its flagship Massachusetts Normal Hospital in Boston and a 78-bed addition to Brigham and Girls’s Faulkner Hospital. Probably the most controversial component, nonetheless, is a plan to construct three complete ambulatory care facilities, providing doctor companies, surgical procedure, and diagnostic imaging, in three suburbs west of Boston.
On Jan. 25, the state’s 11-member Well being Coverage Fee unanimously concluded that these expansions would drive up spending for commercially insured residents by as a lot as $90 million a 12 months and enhance medical health insurance premiums.
The fee additionally ordered Mass Normal Brigham to develop an 18-month “efficiency enchancment plan” to sluggish its value progress. The motion, believed to be the primary time within the nation a hospital has been ordered to develop a plan to manage prices, displays concern about big hospitals’ position in rising well being care prices.
Different states, together with California, Delaware, Oregon, Rhode Island, and Washington, have created or are contemplating commissions on well being care prices with the authority to investigate the market impression of mergers and expansions. That’s occurring as a result of the normal “dedication of want” course of for approving well being facility expansions, which practically three dozen states nonetheless have in place, has not been efficient within the present period of well being system giants, stated Maureen Hensley-Quinn, a senior program director on the Nationwide Academy for State Well being Coverage.
The Mass Normal Brigham well being system, which generates $15.7 billion in annual working income, introduced that the huge growth would higher serve its present sufferers, together with 227,000 who dwell exterior Boston. Its leaders stated the brand new amenities wouldn’t increase well being spending within the state, the place policymakers are alarmed that value progress in 2019 hit 4.3%, exceeding the state’s goal of three.1%.
The hospitals’ cost-analysis report, submitted to the state final month, concluded that the system’s present sufferers would pay decrease costs on the new suburban websites than at its downtown areas. John Fernandez, president of Mass Normal Brigham Built-in Care, projected that costs on the new facilities could be 25% much less, and he stated sufferers won’t must pay additional hospital “facility charges” on the new outpatient websites.
“We’re all going to have a tsunami of sufferers over the following 20 years given the getting old inhabitants, and everybody has to step as much as meet that demand,” he stated in explaining the growth.
However a well-funded coalition of competing hospitals, labor unions, and chambers of commerce argues that Mass Normal Brigham’s invasion of the Boston suburbs would spike whole spending by drawing in sufferers from lower-priced physicians and hospitals. They cite the well being system’s personal planning projection, unearthed by the lawyer basic’s workplace in a November report, that the growth would enhance annual income by $385 million.
“How might you be fooled?” stated Dr. Eric Dickson, CEO of UMass Memorial Well being Care, a safety-net well being system serving the cities west of Boston that’s a part of the coalition of growth opponents. “If you happen to let the state’s most costly system develop wildly, it can drive up the price of care.”
The controversy indicators a shift within the considerations about the reason for quickly escalating well being care prices. So far, state and federal policymakers analyzing how hospital system progress impacts prices have largely targeted on hospital mergers and purchases of doctor practices. Research have discovered that these offers considerably enhance costs to shoppers, employers, and insurers. State and federal regulators have stepped up antitrust scrutiny of mergers and acquisitions.
Deep-pocketed hospital programs more and more are turning to solo growth to achieve an even bigger share of the market. These expansions fall exterior the authorized authority of antitrust enforcers.
Well being programs are constructing satellite tv for pc ambulatory care facilities to draw extra well-insured sufferers and steer them to their very own hospitals and different amenities, stated Glenn Melnick, a well being economist on the College of Southern California.
“The end result is similar as a merger — capturing sufferers and holding them,” he stated. “That’s not essentially good for shoppers when it comes to entry to care or value effectivity.”
Critics of Mass Normal Brigham’s plans additionally warn that the growth would financially destabilize suppliers that closely serve lower-income and minority residents as a result of a few of their extra prosperous sufferers would transfer to the brand new amenities. These sufferers’ industrial insurance coverage pay practically 3 times what the state’s Medicaid program pays.
“It’s a really, superb enterprise transfer for MGB,” stated Dickson, whose system serves a big share of Medicaid sufferers. “However they know fairly effectively it will impression our potential to take care of weak populations.”
The Well being Coverage Fee agreed with these opposing the growth and stated it might advise the state Public Well being Council — which is able to resolve on the three growth purposes by April — that the proposals aren’t in line with the state’s targets for value containment.
“Our sturdy evaluation is this is able to considerably enhance spending,” stated Stuart Altman, a well being coverage professor at Brandeis College who chairs the fee. As well as, “there’s a clear indication it might scale back revenues to these establishments we depend on to supply companies to lower-income and traditionally marginalized communities.”
In a written assertion, Mass Normal Brigham ripped the fee’s findings as flawed. It additionally disagreed with the fee’s determination to require a cost-improvement plan however stated it might work with the company to deal with the problem.
Underneath Massachusetts’ dedication of want course of, Mass Normal Brigham should present the Public Well being Council that its growth proposals would contribute to the state’s targets for value containment, improved public well being outcomes, and supply system transformation.
The council has by no means blocked a undertaking on value grounds in its practically 50-year historical past, stated Dr. Paul Hattis, a former member of the Well being Coverage Fee. He argues that Massachusetts wants extra express statutory energy to resolve whether or not well being system expansions are good for the general public, as a result of he doesn’t suppose the council understands its personal regulation.
A invoice handed by the Massachusetts Home of Representatives final fall would give the fee, which was created in 2012, larger authority to research the associated fee and market impression of such expansions. Its legislative destiny is unsure.
Upping the stakes within the Massachusetts growth struggle: Massachusetts Normal Hospital prices by far the very best costs within the state, and Brigham and Girls’s Hospital isn’t far behind.
Sufferers with a Mass Normal Brigham major care doctor had the very best whole per-member spending in 2019, practically $700 monthly, in response to the Well being Coverage Fee. That was 45% greater than spending for sufferers served by docs at Reliant, which is owned by UnitedHealth Group’s Optum unit. Common funds for main outpatient surgical procedure at Massachusetts Normal and Brigham and Girls’s have been practically twice as excessive as on the state’s lowest-paid high-volume hospital.