Statement on proposed Ambulatory Center in Westborough by Mass General Brigham
Dear Director Szent-Gyorgyi,
As the State Senator for the Middlesex and Worcester District, including Westborough, Northborough, Southborough and Marlborough, and 10 other communities in the MetroWest region, I am writing to express my serious concerns about the proposal by Mass General Brigham (MGB) to build ambulatory centers in Westborough, Woburn and Westwood. As the State Senator representing the town of Westborough, I am particularly focused on this ambulatory center and its potential negative healthcare costs, job loss, and widening inequality impacts and general detrimental effects on regional hospitals not only in my district, but throughout MetroWest and Central Massachusetts.
I recognize and completely understand that the town of Westborough is on record in support of this project. However, when it comes to healthcare, I think it is critical to look at this ambulatory care center proposal through the lens of the entire healthcare system, and therefore very different from almost every other industry or service.
I also want to acknowledge that our state’s and our country’s healthcare system is broken, with far too much focus on profit and competitive share between different healthcare networks, and an unequal patient compensation system for residents, often based on income and the kind of health insurance people have. To be frank, in our healthcare system, very few stakeholders’ hands are clean. It is my opinion, however, from a big picture point of view, that the approval of these proposed ambulatory centers will only exacerbate healthcare inequities that have been laid bare by the COVID pandemic.
In conversations with my constituents, first and foremost I hear that it is extremely important that a community hospital is close to them. While there is no doubt that an ambulatory center could provide some of the healthcare needs of area residents, an ambulatory center has a different mission from a hospital, especially community hospitals.
For the Senate district that I represent, this includes Marlborough Hospital, Emerson Hospital, and Nashoba Valley Medical Center. If any of these hospitals were to close, it would be absolutely devastating. Given the proximity of MGB’s proposed ambulatory center in Westborough to Marlborough Hospital, and its affiliation with UMass Memorial Hospital in Worcester, my comments here are focused on Marlborough Hospital.
Marlborough Hospital and UMass Memorial are safety net hospitals. Marlborough Hospital is a safety net hospital with some 65 percent of its patients covered by public payor plans (MassHealth or Medicare) or uninsured. And UMass Memorial is a safety net system which serves the majority of MassHealth patients in Central Massachusetts and more than any other health system in the region. Because MassHealth pays significantly below the actual cost of care (typically about 60 to 65 cents on the dollar of cost), safety net hospitals remain financially solvent (and therefore open) by depending on revenue from patients who have commercial health insurance plans. More often than not, such patients, and residents live in communities like Westborough, Southborough, and Northborough. I am very concerned that MGB’s proposed Westborough ambulatory center is precisely located where it is easily accessible to the region’s wealthier towns, but is not nearby nor easily accessible to most low income patients. Therefore, MGB could cherry-pick commercial patients from local healthcare providers such as Marlborough Hospital, and disrupt the ability of safety net providers to remain fiscally viable.
I am also very concerned about the potential for job loss at the Marlborough Hospital and UMass Memorial Hospital if MGB’s proposed ambulatory center is approved. Over the past month, I met with nurses and administration officials at the Marlborough Hospital, many of whom have worked at the hospital for decades, who are deeply dedicated to providing healthcare for residents throughout the Metrowest and Central Mass region, including many of my constituents. They are very concerned about the potential job loss at these hospitals, whether due to fewer patients going for care, or even the possibility that particular healthcare units, or an entire hospital could close. While I recognize that MGB’s proposed ambulatory care center would create some jobs, it’s critical to realize that an ambulatory care center is very different from a hospital. I take very seriously any government policy, federal or state investment, or private corporation that takes an action that could lead to the current hospitals serving my district to no longer exist.
Finally, from an equity lense, I think it is important to emphasize that an ambulatory center generally serves a very different population compared to safety net hospitals, including Marlborough Hospital and UMass Memorial Hospital, around race and ethnicity, and income. As more and more state laws, agencies, and programs are reviewing policies, investments, and decisions through an equity lense, I most certainly hope that all Department of Public Health offices, including the Determination of Need Program reviews all proposals with a focus on how BIPOC communities and low-income residents could have more or less access to what I consider a human right, healthcare, if such a proposal becomes a reality. While again I am mostly focused on these impacts on constituents in the Senate district that I represent, I want to emphasize that since MGB’s full proposal is for three ambulatory centers in three regions of Massachusetts, the Department of Public
Health, and the Baker-Polito administration’s decision on this proposal has massive consequences from that equity lense for the entire Commonwealth.
In conclusion, I do want to reiterate my serious concerns around DPH approving this proposal from Mass General Brigham. I know that in reviewing all proposals, DPH automatically solicits an independent cost analysis to better understand the complex and multifaceted potential impacts on healthcare access across the region. I urge DPH to ask for an analysis that includes impacts on BIPOC and low-income communities, the potential financial impacts on safety net hospitals, and through standard or urgent need for additional healthcare facilities in the region, versus convenience. Finally, I urge DPH to maintain robust public outreach and stakeholder engagement at every point in the Determination of Need process, including to BIPOC, low-income, and working class communities, and healthcare workers.
Thank you for your ongoing work to facilitate this process and please do not hesitate to contact me with any questions.
Sincerely,
James B. Eldridge
State Senator
Middlesex & Worcester District