A misguided hospital building boom coming?

Therapeutic victory stories edited by the country’s Academic Medical Center (AMCs) are a media major: CAR-T therapy stimulates the body’s immune system to fight cancer! Patients are dying after a double lung-heart transplant! Academic researchers have played a key role in developing the COVID-19 mRNA vaccine!

And, if you’re like me, you have friends who, after receiving a serious diagnosis from their regular physician, go to the local or national AMC for a second opinion. If the initial diagnosis proved positive they probably got their treatment there.

This is called Prestige Medicine. If you have a serious heart condition, who wouldn’t want to go to the Mayo, Cleveland Clinic or their local counterparts; Or Memorial Sloan Catering, MD Anderson, or the local Academic Cancer Center if you have a life-threatening tumor?

But is there good care? Not necessarily. Patient safety advocates, such as the LeapFrog Group, have repeatedly pointed out that leading academic hospital safety grades can be anywhere from A to D, some of which are familiar (such as the Northwest and the University of Illinois at Chicago in my hometown) just earning passing marks.

For results, a recent study suggested that AMCs achieve better results than community hospitals when measured by death within the first 30 days after treatment. Yet the same study found that they did not perform well in the case of routine surgical procedures. A recent study by a healthcare consulting firm was less conclusive, finding that AMCs actually follow up on measuring the core outcomes of their community-based competitors.

One thing is for sure: AMC costs more অনেক much more if you are insured commercially. This has led many employers to adopt higher-discount plans, forcing patients to first bill $ 1,000 or more. Many insurers are starting to exclude expensive academic centers from their network, and many patients seeking prestige medicine pay more out-of-pocket costs than going to their local community hospital.

But cost concerns have not prevented the country’s 140-plus AMCs and their outpatient outpatient facilities from gaining significant market share in recent years. In some markets, such as Pittsburgh and Boston, they have become so influential that no insurer can exclude the system from its network, giving AMC tremendous power to claim higher prices. And they do.

Recent developments are working to exacerbate this imbalance that will exacerbate healthcare inflation and accelerate the rapid decline of community-based healthcare in rural and low-income areas across the United States, exacerbating existing system inequalities. Already have

Consider what’s happening in Boston right now. Mass General Brigham (MGB), a recent merger of the two countries’ elite medical institutions affiliated with Harvard Medical School, announced last year a $ 2.3 billion expansion plan that would both modernize its two flagship hospitals and increase their capacity to more than 100 beds. . The original plan also called for the creation of three outpatient surgery facilities in affluent suburbs. The expansion plan has drawn widespread opposition from local community hospitals, insurers, patient advocacy groups, the state attorney general and the Massachusetts Health Policy Commission, which aims to control spending.

Last week, the MGB withdrew part of its suburban expansion plan in the face of opposition. But the state is leaning towards approving a $ 2 billion restructuring plan for the main hospital. A win for MGB, which could come in a matter of days, would not only accelerate the restructuring of the city’s hospital sector but also open floodgates for similar projects in other markets and could deal a serious blow to the United States’ efforts to rein in total healthcare spending. Which already costs 20 percent of GDP, the highest in the world by a long shot.

The restructuring of the country’s hospital sector began well before COVID, the result of a trend of hospital use that shows every sign of resumption after the epidemic subsides. Numerous large hospital construction projects have been announced by major academic medical centers in recent months.

The University of Chicago Medical Center recently announced plans to build a new $ 633 million cancer hospital, part of a $ 1 billion project that would increase its total capacity by 24 percent to 597 beds. Multi-billion-dollar expansion projects are underway at the University of California Medical Center in San Diego and Irvine. Penn Medicine in Philadelphia has just launched its $ 1.6 billion expansion project. There are also several large nonprofit systems with large projects on the drawing board that serve as influential hospitals in their markets and teaching hospitals of local medical schools.

All of these constructions will take place in immovable hospital admissions. On a per capita basis, the number of hospital admissions has been declining for decades, according to the American Hospitals Association. Advanced technology, the emergence of outpatient surgery centers, and increasing hospital-to-home mobility have combined to reduce hospital admissions and patient stays, and, in turn, reduce the number of staff beds inside the hospital.

The victims have been community-based hospitals, including stagnant or declining populations and rural hospitals in cities and regions. The winners are able to capture patients previously served by their neighboring, community hospitals with large systems and AMCs, whose non-profit status, stable balance sheets and superior reputation. A Massachusetts Commission survey estimates that the $ 2 billion expansion of MGB will not only lead to sharply higher costs for commercially insured patients but will also transfer $ 261 million a year from struggling community hospitals to existing costs in MGB.

“These providers often operate on thin margins, so even a small shift can remove a core revenue stream that enables them to serve patients insured by MassHealth (state’s Medicaid program) or Medicare or those who are not insured,” wrote Tim Murray, Worcester. Amy Rosenthal, president of the Chamber of Commerce and executive director of Health Care for All, a consumer advocacy groupIn the commonwealth MagazineFinancial instability could eventually force them to close or scale out complex medical, behavioral health and other services. ”

Massachusetts is one of only five states to have adopted a measure that sets an annual benchmark for the overall cost of healthcare. In 2019, the year covered by the state’s most recent annual report, spending rose 4.3 percent, well above the benchmark of 3.1 percent.

The Health Policy Commission has blamed Mass. Brigham, the state’s most expensive system, for the extra spending. This past January, the state instructed MGB to formulate a performance improvement plan to reduce its overall costs, the first such commission in its history.

HPC Chairman Stuart Altman, a professor of health policy at Brandes University, said: “Mass. General Brigham has a cost problem.” “Continuing in this way could affect the state’s ability to meet spending standards and cause serious damage to the state’s distribution system structure.”

The MGB, for its part, has rejected every claim of the policy commission. It has run a massive local advertising campaign for expansion and has sought to burn its image through full-page advertising. New York Times, Which has a wide readership in Boston MGB spokeswoman Jennifer Street said: “It’s important that people know the facts, and that advertising is a way to ensure that information is known to the public and that direct records are made from baseless claims.” Boston Globe.

The MGB has rejected objections to its planned expansion in a commission report submitted to the state agency, which is expected to rule on the request. “The predicted changes in shares of Mass General Brigham associated with the proposed project are modest and unlikely to significantly change the system’s bargaining leverage with health insurers,” the report, prepared by Charles River Associates Consulting, said. “Rather, the weight of the economics literature suggests that allowing power-limited healthcare providers such as Massachusetts General Hospital to expand would put downward pressure on healthcare costs and reduce spending on healthcare services.”

This is an intriguing claim, given that the economics literature hints at exactly the opposite. The MGB report summarizes the life work of Victor Fuchs of Stanford University, whose pioneering work since the 1960s outlines the inconsistency of information that leads patients to more expensive care and hinders competition; Atul Gawand’s study, book and journalism from Dartmouth Atlas of Healthcare, documenting how supplier-driven supply and physician-induced demand has drastically changed the amount of healthcare delivered in different markets; And huge literature on physician-driven needs.

The MGB report failed to consider the rapidly changing healthcare market. It estimates a steady increase in demand based on the aging of the population. It did not mention the progress of the procedure in technical driving surgery and outpatient patient settings or changed the patient’s preference for short stay and home care.

Neither Mass. Briggs nor the Health Policy Commission has considered what should be done to rebuild Boston’s largest hospital. What about flexible facilities to accommodate future epidemics, natural or man-made disasters, or mass casualties? How can new construction projects provide better services for poor health with low longevity and poor access to healthcare facilities for low-income residents? There is no public debate in Boston and across the country.

I raised that question with HPC’s Altman. “Who’s planning for the future? We’ve stopped focusing on that,” he replied. It was abandoned in the 1980’s. This decision really needs to be reviewed. “

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