A better MGH, but affordable?

A better MGH, but affordable?

May 29, 2007

THERE WASN'T a whisper of opposition last week at the state Public Health Council as Massachusetts General Hospital presented its plan to replace some old buildings with a $498 million complex that will include a larger emergency department, 71 surgical suites, and 150 new beds. The council approved the plan unanimously, but the expansion raises the question of whether the state can afford to rely so heavily on healthcare providers who combine quality with high costs.

When the new building is completed in 2011, MGH will have 1,052 beds, still fewer than at its peak of the late 1980s. The hospital downsized in the 1990s in the expectation that the strictures of managed care would reduce demand. It did, but mainly for lower-cost beds in community hospitals. Massachusetts residents demanded that their insurance plans continue to give them access to MGH, the most prestigious hospital in the state.

Under almost any circumstances, patients go to MGH, a trend that has caused chronic overcrowding in the emergency department. Dr. Peter Slavin, the hospital's president, said it is trying to encourage use of other hospital emergency rooms, but for many people in Boston and points north, the MGH habit will be hard to break. The council recognized this in approving the expansion project.

The increase in surgical space will allow a better flow of patients from the emergency department to surgery and back to the new in-patient rooms. The aging of the baby boomers will increase demand for every form of care in the new building.

Many boomers are picky about their accommodations, as Slavin observed at the hearing. To make them comfortable, the new rooms will be single-bed only, with space for family members to sleep overnight. This amenity will increase the cost of a hospital stay -- and will hinder access to healthcare if it helps make health insurance unaffordable.

The health insurance law approved last year made affordability a matter of vital state interest. The state cannot expect everyone to buy policies if the high cost of care forces the price of insurance beyond reach.

The Quality and Cost Council, created by the law, met last week to consider "pay for performance" standards to take effect in October. Hospitals contracting with the state Medicaid program, including MGH, will get bonuses if they meet new quality goals. The hope is that if hospitals tighten standards, they will avoid errors and minimize costs.

MGH got a jolt in December when the commission that oversees hospital accreditation found sloppiness in 10 areas, including such simple tasks as hand-washing. Slavin, who had just appointed a vice president for quality, sent a stiff memo to the staff. If it hasn't already, everyday quality of care should soon match the MGH reputation for excellence.

Slavin is right that the people of Massachusetts expect much from the hospital: the best of care no matter how difficult the case, the training of physicians, and advances in medical research. But government, business, and consumers in the state can only afford so much. The long-term cost trends at MGH will be evident in a year or two, when private insurers negotiate their rates with the hospitals. If rates don't moderate, more and more people could find themselves priced out of the splendid new facilities approved last week.

Boston Globe