Mass General Brigham has bullseye on its back

 Mass General Brigham, the state’s largest hospital system and its largest employer, has been down this road before.

In 2015, when it went by the name of Partners HealthCare, the hospital system tried to expand by acquiring South Shore Hospital and two Hallmark Healthcare hospitals in Medford and Melrose. The deal was shot down by Superior Court Judge Janet Sanders, who feared it would give Partners too much control of the market. 

Now Mass General Brigham is trying to expand by building new outpatient facilities in Westborough, Westwood, and Woburn – and it is facing similar concerns. On the same day recently, the House passed legislation that would restrict Mass General Brigham’s ability to expand, Attorney General Maura Healey released a report suggesting the proposed outpatient facilities would generate $385 million in annual profits, and the Health Policy Commission indicated it may push for price caps on academic medical centers.

John McDonough, a professor at the T.H. Chan School of Public Health at Harvard University, and Paul Hattis, a fellow at the Lown Institute, said on The Codcast that what happened in 2015 seems to be happening again. 

“Partners HealthCare got a strong message in 2015 – your growth [through] hospital expansion and consolidation is over, get away from it,” McDonough said. “So now they’re trying to grow and consolidate in the outpatient space, and it looks like there’s a growing consensus of opinion that they’re going to get slapped down on that as well.” 

Hattis said the House, Healey, and the Health Policy Commission are all trying to rein in Mass General Brigham. “If I were MGB leadership hearing all three say that, I’d be a bit worried right now,” he said. 

At the Health Policy Commission’s cost trends hearing on November 17, Anne Klibanski, the president and CEO of Mass General Brigham, sounded very much like her predecessor from 2015, Gary Gottlieb. Gottlieb said acquiring South Shore Hospital and the two Hallmark hospitals in Medford and Melrose would allow the system to serve more patients in lower-cost settings. That was the same rationale Klibanski gave for building outpatient centers in Woburn, Westwood, and Westborough. 

Hattis said Klibanski talked about providing the right care in the right setting, but never mentioned the word price. And he said Healey’s report, documenting a projected annual profit of $385 million from the outpatient expansion, indicated the hospital system’s top priority. “It’s really about generating additional profit,” he said.

McDonough said what’s happening with Mass General Brigham is not unique to Massachusetts. “All across the country what we see are dominant major academic medical centers that have a dominating presence in their markets and continue to expand,” he said. “And they may be nominally not-for-profit, but they act very much like any for-profit business in terms of grabbing up opportunities and growing as much as they can, which is exactly what happens outside health care.” 

McDonough and Hattis ran through a list of possible options for regulators to pursue, everything from targeting higher-priced hospital systems with performance goals to adopting a statewide price-setting system for acute care hospitals along the lines of what Maryland is doing. 

McDonough sees signs that the federal government is moving in a new direction on antitrust issues, and he said the pushback against Mass General Brigham’s expansion plans in Massachusetts somewhat reflects that shift. He said the politics of health care could get interesting as the state heads into an election year next year.

“Just one little irony here, of course, is that one of the key people who approved the creation of Partners HealthCare in 1993-1994 when he was secretary of health and human services for the state of Massachusetts is now-Gov. Charlie Baker,” McDonough said. “And so there’s a history here that is just fascinating in terms of how it comes together. But it looks like there is a sea change going on and MGB is about to get caught up in it, I think.”




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