MASS GENERAL BRIGHAM’S recent press release on its quarterly financial results masterfully blends positive numbers to impress current and future bondholders while obscuring how well the hospital system is doing financially so that government policy makers do not make decisions which could thwart business imperatives.
The press release starts with an opening paragraph saying “the system’s strategy is focused on building more affordable models of care for our patients closer to home.” Clearly, that’s an effort to defend the system’s ambulatory care expansion project, now under review, from the charge by competitors and community advocates that this is simply another strategy to gain market share and revenues from suburban, well-insured patients. Instead, the press release repeats the hospital system’s refrain that the expansion is all about serving longstanding patients nearer to where they live at prices that are less than the ones charged at the system’s flagship hospitals.
Catering more to bondholder worries about future profitability, the second paragraph quotes CEO Dr. Ann Klibanski as praising new systemwide integrated programs in sports medicine and radiology. Both of these services are highly lucrative and tend to cater to wealthy patient cohorts that have more freedom of choice for where they obtain these services. Reading between the lines, the message to bond investors seems to be that the various pieces of the Mass General Brigham hospital system are working together to attract well-heeled commercial patients needing care for sports injuries and expensive imaging services—and so don’t be worried about our ability to have good operating results going forward.
There is also a section in the statement on community benefits, highlighting the hospital system’s vaccine outreach to communities of color and others whose vaccination rates still remain much less than is needed. Translation: Look, we try to do some good things with our resources, so there’s no need to pass legislation mandating needed price caps on commercial payments that we receive and which tend to worsen inequities, something I wrote about previously. As expected, the press release provides standard financial results about Mass General Brigham operations – healthy operating margins ($128 million in the quarter), realized gains on investments (nearly $1 billion), and the operating loss of its undersubscribed and overpriced health plan, Allways Health Partners. Allways always seems to have an operating loss, even when all other health insurers are significantly in the black.
There was also a lot of attention devoted to the negative financial impacts of COVID last year. Quarterly reports always contain prior-year comparisons, but the detail here about 2020 seems exaggerated. Mass General Brigham reported hundreds of millions of dollars in operating losses during 2020. During the third quarter last year, the system lost $373 million, even after receiving $334 million of government relief funds.
But then the reader has to wade through two pages of other narrative before being told that, to date, Mass General Brigham has received a total of $778 million in government aid. The aid, combined with the system’s own operating revenues, yield a net positive operating margin of $157 million over the last 21 months. This is not exactly a doomsday business scenario.
Of course, the financial statement saves the best for last. We learn in a brief concluding paragraph that, during the first nine months of this fiscal year, Mass General Brigham’s net worth grew by a whopping $2.9 billion – driven mainly by investment growth. As I noted last month, Boston Children’s Hospital is perhaps the wealthiest system in Massachusetts when you compare net assets to annual operating expense, but Mass General Brigham’s net asset level is now close to $14 billion, placing the system in the top five in terms of net asset wealth among nonprofit health care providers in the US.
Sadly, by the time I finished reading this four-page press release, the more I was worried about how it illustrated a public policy failure. In particular, did government do the right thing in handing Mass General Brigham $778 million in governmental COVID relief?
I would say no.
It’s hard for anyone to credibly say that Mass General Brigham really needed $778 million from the federal government to assure the stability of its operations. Lawrence General Hospital, which serves a high proportion of poor patients, mainly of color, is a different story. Even with over $60 million in COVID government relief for 2020, the hospital still lost over $13 million and is projecting a $20 million operating deficit for this year.
I’m sure Mass General Brigham and Lawrence General received the money they were entitled to under federal law, but what if wealthy systems like Mass General Brigham received only half of what they were owed and the other half was held in escrow until it was determined whether the money was actually needed. Let’s say it was decided Mass General Brigham didn’t need the other half, and the leftover money—nearly $400 million—could be used over a period of years to help backstop distressed hospitals like Lawrence General.
That would make sense. Lawrence General and other financially pressed hospitals in the state could gain some financial breathing room when needed, and Mass General Brigham would end up with net assets closer to $13.5 instead of $14 billion.
I would hope the Mass General Brigham bond investment community could tolerate that sort of result. If they can’t, God help us.
Paul A. Hattis is a senior fellow at the Lown Institute, a nonpartisan think tank based in Brookline that focuses on health care. He is a former commissioner of the Massachusetts Health Policy Commission.