Massachusetts is at risk of approving the largest hospital construction project in state history, an expensive $1 billion building in the heart of the congested Longwood Medical Area. The proposal, by Boston Children’s Hospital, rests on ephemeral, shifting rationales that deserve in-depth scrutiny by state regulators.
The proposal, which would double the size of the hospital and add at least $138 million per year to the hospital’s operating costs, is before the Department of Public Health for a Determination of Need certificate. The Health Policy Commission, charged with helping control health care costs, may also weigh in.
In 2014, when the expansion plan was approved by the BCH board, the hospital claimed that rising patient volumes were creating an overcrowding problem on the main campus. However, both inpatient and outpatient volumes had actually declined 14-to-17 percent over the most recent five-year period.
The BCH application for state approval made it clear it did not seriously consider alternatives. Several sites on Longwood Avenue that could be altered or expanded would appear to accommodate the demonstrated needs of the hospital. Also, BCH is planning a $300 million expansion of the Waltham campus that will include new inpatient beds.
Next, hospital representatives told the media that additional space was needed because medical advances meant that more complex patients required longer stays, and more privacy in single rooms.
These assertions by the hospital have not been objectively validated.
Finally, BCH floated the rationale that it needs additional revenue to keep up with changes in reimbursement trends for teaching hospitals. Actually, the hospital — a nonprofit organization — booked $158 million in profit in 2014 and $78 million in 2015, according to Forbes. Of course hospitals need revenue, but BCH is in the same position as other Boston teaching hospitals. How much revenue – and profit – is enough when other segments of the health care system are struggling?
BCH may well need new space for a larger neonatal intensive care unit and modernized operating rooms. However, these needs do not justify a 12-story building that would add enormous new costs to the state’s health care system, wipe out the hospital’s unique therapeutic healing garden, and further squeeze out low-income patients from access to the hospital’s fine medical caregivers.
BCH’s widely reported shift away from providing care to low-income residents of Massachusetts presents a direct challenge to Gov. Charlie Baker, Health and Human Services Secretary Marylou Sudders and legislators who have worked hard to increase access to health care and control costs.
The days when hospitals can simply tell the state what they are doing, and expect insurers and taxpayers to foot the bill, are long gone.
Susan Regan is a retired health care attorney who served as a member of the New York State Public Health Council from 1995 to 2013. She is a member of the Friends of Prouty Garden.