Farber Cancer Institute has been planning to partner with Beth Israel Deaconess Hospital to construct an inpatient cancer hospital costing $1.7 billion with 300 beds. The opening of the hospital was met with positive unrest and optimism. President of Dana-Farber Cancer Institute, Benjamin L. Ebert, describes the expansion as one of the best opportunities for Boston and the state as a whole. He also mentions that the expansion aims to “improve the access to the highest quality cancer care without driving any material increase in the health care services.”
A Former Regulator’s Critique: Redundancy and Rising Costs
The former Administrator of the Centers for Medicare and Medicaid Services, Dr. Donald M. Berwick, projected his skepticism on the initiative’s ability to manage the costs. “I don’t think that this will decrease costs. I think that it’ll increase redundancy of services,” he noted. He also cited a lack of competition with Boston’s skyrocketing healthcare costs as, “So far, we haven’t seen competition in the Massachusetts market — in the Boston area—reduce costs at all. In fact, there has been a continual increase in costs in one of the highest-cost communities in the country.”
The Profit Motive: Competition for Lucrative Patients
As far as the business model of cancer care is concerned, this is one of its most problematic aspects. Smaller hospitals highly depend on and compete aggressively for cancer patients due to their significant profitability. Moreover, large hospitals with cancer treatment facilities, like Dana Farber, also exacerbate this issue due to their specialized services.
Change in Patient Flow: Comfort in Treatment Versus Community Care
For now, Dana-Farber’s main focus remains providing specialized cancer care. Patients who need to be hospitalized due to some complications of treatment, like chemotherapy or surgical procedures, are usually admitted to Brigham and Women’s Hospital or some other smaller community hospital. With the addition of a new cancer hospital, Dana-Farber could provide specialty cancer treatment along with primary care, all within its own system. Though this new setup might be more accessible for patients, it has the issue of community hospitals losing out on useful revenue streams.
Revenue Streams: Why This is Beneficial for Dana Farber
Specialists estimate that the new hospital will bring in tens of millions of dollars in new revenue for Dana-Farber. Still, those experts wonder whether this benefit is worth the lack of improved patient care with a narrow focus only to increase market share.
An Appeal for Control: Restraining the Growth of the Hospital
The clinical director of Mass General Cancer Center, Dr. David P. Ryan, also a potential rival, is one of those who have asked state regulators to restrict the new hospital’s capacity to 126 beds rather than the planned 300. He claimed that the healthcare services offered would not improve relative to the costs incurred and added that the larger facility would only add to already escalating healthcare costs.
The Effects of Merger: Is This A Competition Response?
In an expression of concern for the newer changes taking place at Dana Farber, Dr. John E. McDonough from Harvard School of Public Health—and a former Massachusetts State representative—suggested that the recently concluded merger of Mass General Hospital and Brigham and Women’s systems may be the catalyst for why Dana Farber intends to expand. He said he believes that Dana Farber is “left behind” by the merger and is therefore trying to strengthen its positioning within the market.
A System with Distressed Factions: More Concerns on Healthcare Destabilization
The senior fellow at the Lown Institute, Paul Hattis, a nonprofit organization focused on healthcare, sounded the alarm over the possibility of the new cancer center from Dana Farber further deepening the unfair distribution of healthcare services. He warned that it may siphon off funding from smaller and less-recognized hospitals, further weakening their financial health and ability to provide important healthcare services.
Expecting Reimbursements: The Economic Gain for the New Hospital
Under certain federal guidelines, the proposed hospital would receive greater reimbursements from Medicare. This provides a competitive financial benefit over the existing cancer treatment units at Brigham and Women’s, which do not receive the same rate benefits. This also furthers the controversy regarding financial considerations of the expansion.
Chasms of Institutional Interests Versus the Common Good
The author closes with the excerpted attention to particular strains—what would be the narrowing focus of the internal self-interest of large hospital systems and the external public interest. Health care scholars, like McDonough and Berwick, worried that the new cancer center might expand and centralize the institution at the expense of the community. They demand robust scrutiny of the project to ensure it complements the patients’ and healthcare system’s needs.
