Mass General Brigham’s proposed expansion jeopardizes community care

In a recent CommonWealth op-ed, John Fernandez of Mass General Brigham laid out his organization’s case for a massive proposal that would introduce three new ambulatory clinics to Westborough, Woburn, and Westwood. The care people receive in Boston “hasn’t always been accessible to the communities who need it most” because they couldn’t afford it or couldn’t commute into the city, he writes.

As a nonprofit CEO, a Worcester elected official, and a person of color, I am all for expanding health care in communities lacking access to it. But Mass General Brigham’s plan to extend into suburbs that already have plenty of care options doesn’t add up to its promises; moreover, if allowed to proceed it will jeopardize the care that is already in place.

Westborough, for example, is not contending with a dearth of care or resources. Its median household income is $112,000 – well over the statewide average of $81,000. Surrounding towns are similarly wealthy. There are more than a dozen health facilities within a 10-minute drive of Mass General Brigham’s planned site that already offer the services the health system is proposing. Meanwhile, residents from lower-income communities would need access to a personal vehicle to get to the new clinic because it is not well-served by public transportation. In this age of sustainability, how can any new facility serving thousands of people a year not be transit-oriented?

Rather than expand care in communities that most need it, Mass General Brigham’s proposed ambulatory centers are primed to attract affluent patients. This includes residents who already receive high-quality care from local providers. Despite Mass General Brigham’s insistence that it is simply looking to serve its existing patients, the locations it selected indicate that growing its size and influence is the main part of its plan. At the 2020 J.P. Morgan Health Care Conference, Mass General Brigham described its outpatient proposal as part of a strategy for increasing commercially-insured patients and referrals to its hospitals in Boston.

The problem with siphoning these patients away from their current providers is that it undermines and financially threatens local health systems that our communities depend on. The care these local systems provide to individuals with commercial insurance enables them to sustain services for MassHealth patients, people living in poverty, and patients affected by health inequities. Losing commercially insured patients to Mass General Brigham, which serves a much lower percentage of patients on Medicaid than local providers, could force community health systems to reduce safety net care or close those services altogether.

Such an outcome would have devastating regional effects. At Thrive Support & Advocacy, where we serve people with intellectual and developmental disabilities across Eastern and Central Massachusetts, I find it hard to contemplate how we would have made it through the pandemic without Marlborough Hospital’s assistance. The COVID-19 testing it provided for our employees and individuals helped us stay ahead of the virus. Whatever we have needed to protect the health of those we serve, the hospital has stepped up to provide it for us.

In addition to worsening health inequities, Mass General Brigham’s proposed clinics will also raise health care spending as more people move to its system, which is the most expensive in our state. Although Mass General Brigham says that the care at its outpatient clinics will be delivered at lower costs, it is only comparing those estimates against its own high-priced hospitals, not the providers already in these communities.

In fact, Mass General Brigham’s outpatient clinics are already increasing health system costs. According to the Massachusetts Health Policy Commission’s 2019 Cost Trends Report, payments per major outpatient surgery were almost twice as high at Mass General and Brigham and Women’s Hospitals as the state’s lowest-paid high volume hospital. In a Commonwealth committed to improving health equity and lowering costs in the process, how can we be expected to stand behind such a plan?

Our local health care providers are woven into the fabric of our communities. Care tailored to only the most affluent harms our community.

Sean M. Rose is president and CEO of Thrive Support & Advocacy and the District One City Councilor in Worcester.