FOR GENERATIONS, Boston has been known for having the best health care in the world – the best trained doctors, the broadest spectrum of care, and the most innovative, research-infused treatments. The challenge? This care hasn’t always been accessible to the communities who need it most – either because they couldn’t afford it or because they couldn’t fight through miles of congested traffic and parking garages simply to see their doctor in the city. Many were resigned to the fact that healthcare in Massachusetts and New England might always be that way.
The pandemic proved otherwise.
On a dime, medical professionals across the Commonwealth deployed telehealth services to provide routine and chronic care to patients while the threat of coronavirus persisted. At Mass General Brigham, our clinicians completed more than 1 million telehealth visits over five months’ time over the phone and through video.
But we can’t stop at digital health. Mass General Brigham has a strategy to provide care closer to patient’s homes and at a lower cost. And part of that plan is to build two ambulatory care centers in Westborough and Woburn and expand our current site in Westwood. We are currently awaiting approval for our plan from the Department of Public Health through its Determination of Need (DON) process, which the state requires for any significant capital expenditure in health care.
The need for these services couldn’t be greater. Delivering primary care, behavioral and mental health care, and specialist care such as cardiology and orthopedics in addition to imaging and day surgery, these ambulatory centers will increase access to care closer to home, improve the patient experience, and lower costs.
The impact will be significant. Today, hundreds of thousands of our patients live within 20 minutes of the proposed site locations – and yet tens of thousands of them last year traveled to Boston to receive care at Mass General or the Brigham and Women’s.
But it’s not just about convenience. These centers will provide lower-cost options for everything from imaging services (such as CTs, MRIs, x-rays and mammography), to surgical services (including general surgery, orthopedics, and ophthalmology), to specialty services (such as OB/GYN and pulmonology), while also improving overall health outcomes by increasing access to preventative care and providing a simpler experience for patients overall.
Despite the obvious benefits to our patients, our plan has been met with breathless opposition – not from health care consumers — but from competing providers. These competitors have been brazen in their opposition by having their executives and family members serve as the primary voices of opposition to these projects.
The DON process is not intended as a popularity contest, nor is it a forum for squeaky wheels protecting their own economic interests. It is supposed to be a determination, on the health care merits, of the value of the capital expenditure. If it provides a positive benefit to the proponent provider’s patient panel, it is supposed to be approved.
Our proposed ambulatory care projects clearly meet that standard, and will allow us to deliver the right care, at the right time, in the right place, and at a lower cost.
Unlike traditional hospital settings, which have costly emergency departments, around the clock psychiatric care, and intensive care units, ambulatory settings have fewer fixed costs and a lower overall cost structure, allowing doctors to charge lower prices. The care provided at these centers would be reimbursed at lower rates than care in the Mass General Brigham hospitals – not only for patients with private insurance but also Medicaid and Medicare patients. That means more people will be served – and for less money.
Instead of looking at changes in health care as a zero-sum game, we have always looked at it another way: “What is best for the patient?”
Should the patients who get the best care be those who either live in Boston or can afford to commute there? Or should we be finding innovative, cost-effective ways to bring the best specialists, the best treatments, and the best services to anyone who needs them? If the pandemic has taught medical professionals like me anything, it’s that the latter is not only possible – it’s our obligation.
John Fernandez is president of Massachusetts Eye and Ear and president of Mass General Brigham Integrated Care.