State health regulators are expected today to make it significantly harder for Boston's teaching hospitals to expand into the suburbs, a move designed to protect smaller community hospitals that feel under siege from their powerful rivals.
The measure drafted by the Patrick administration, which is almost certain to win support this morning from the Public Health Council, will force hospitals to prove that proposed expansions do not duplicate services. Until now, hospitals hoping to add overnight beds at outpatient facilities faced little scrutiny from the state.
Community hospital administrators have watched with increasing alarm as hospitals affiliated with Harvard and other universities - such as Massachusetts General Hospital, Beth Israel Deaconess Medical Center, and Tufts Medical Center - extended their reach into the suburbs. The satellite campuses, sprouting along Route 128 and other corridors, have focused mainly on outpatient services, ranging from high-tech care to more basic treatment that is the bread and butter of local hospitals.
Those concerns reached a pitch when the region's premier pediatric teaching hospital, Children's Hospital Boston, added 11 inpatient beds last year at its outpost in Waltham, an expansion that required only nominal state review.
State leaders also have their own reasons for being troubled by the arrival of teaching hospitals in the suburbs: economics. As Massachusetts becomes the first state to provide health insurance to nearly every resident, state government is picking up much of the tab for more than 300,000 newly insured residents.
Health regulators warn that if those patients flock to academic centers for care, it could substantially increase the state's costs, without necessarily improving how patients fare. Studies have shown that the higher costs of teaching hospitals do not uniformly translate into better healthcare, especially for routine services.
"We definitely believe that community hospitals play an important role within the state," said John Auerbach, the state's public health commissioner, particularly amid "a continual, rapid increase in costs associated with healthcare."
The change in state regulations governing expansions could prove to be a signal, and unusual, triumph for community hospitals.
But Matt Fishman, vice president for community health at Partners HealthCare, said his organization does not view the state's push "as an attack on teaching hospitals or on Partners HealthCare."
Executives at Partners, parent of Mass General and Brigham and Women's Hospital, believe "these reforms will create a level playing field that is better than the existing process," Fishman said.
While city and town planning agencies may exercise some say over hospital expansions, as they would for any construction project, the main responsibility resides with the state.
Tellingly, the reforms have received enthusiastic backing from major insurers, including Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans.
"We want to be very careful that there is not a propensity toward duplication of services within a particular area," said Jay Curley, senior vice president for public, government, and regulatory affairs at Blue Cross. "With a great duplication of services there comes a great potential of overuse."
Concerns about the viability of community hospitals transcend economics, a state regulator said. Local hospitals with their local boards of directors can have a better sense of a community's needs, said Paul Dreyer, director of healthcare safety and quality at the Department of Public Health.
"Whereas if a teaching hospital from Boston comes to a community, its governance is going to be different, and its strategic objectives are going to be different," Dreyer said. "Local control may lead to better outcomes than if policy is directed from a central place like the Prudential Tower."
That Back Bay office building houses the headquarters of Partners HealthCare.
The executive director of an umbrella group of Boston teaching hospitals said that suburban expansions were driven, in large part, by consumer demand. And John Erwin, head of the Conference of Boston Teaching Hospitals, said that those branches allow patients to avoid making the trip into the city for treatment.
But Donald J. Thieme, executive director of the Massachusetts Council of Community Hospitals, said suburban growth is more a reflection of harsh financial realities confronting academic medical centers. Because the state has such an unusual bounty of teaching hospitals, he said, they must constantly expand their turf, looking for patients whose more routine medical needs help pay for the high-priced research that defines those hospitals.
The change in the rules governing hospital expansions is part of a broader revision in the state's determination-of-need process for healthcare facilities and represents the most sweeping overhaul of the regulations in more than two decades.
The impetus for the revised rules originated with the state's top health official, Dr. JudyAnn Bigby. Bigby served on the state's Public Health Council in the 1990s, an experience that forged her belief that the rules didn't work as well as they should.
The need for change has only accelerated since, Bigby said yesterday in an interview. "These are conditions and medical treatments that community hospitals provide, and they do it with the highest of quality and usually with lower costs," she said.
Stuart Altman, a national health policy specialist at Brandeis University, said that while the rules make sense on paper, patients may still be lured by the brand names of teaching hospitals and travel to Boston for care.
"What do you do?" Altman said. "Do you force them to use community hospitals?"
Stephen Smith can be reached at firstname.lastname@example.org.