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Brigham aims to expand while cutting back

Building planned as hospital gets leaner

President Elizabeth G. Nabel says the hospital must be prepared to compete for patients. President Elizabeth G. Nabel says the hospital must be prepared to compete for patients. (Wendy Maeda/Globe Staff)
By Robert Weisman
Globe Staff / December 7, 2011
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Brigham and Women’s Hospital plans to expand its sprawling campus in Boston’s Longwood Medical Area even as it moves to cut expenses by $160 million over three years to make health care more affordable.

The board of the Harvard teaching hospital has approved construction of a 12-story, $450 million clinical and research building near the corner of Brookline Avenue and the Riverway, and a $55 million restoration of the grassy common that once graced the entrance to the former Peter Bent Brigham Hospital at 15 Francis St.

At the same time, Brigham and Women’s has begun an initiative aimed at reducing annual expenses by about 10 percent - twice as much as the target set for the hospital by its corporate parent, Partners HealthCare System Inc.

The cost-cutting steps range from consolidating vendors and temporary hiring agencies to monitoring the use of towels, sheets, and blankets. So far, the hospital said, there have been no layoffs, though some workers have been shifted to new positions.

“There’s a thousand opportunities to make better use of our resources,’’ Brigham and Women’s president Elizabeth G. Nabel said. Hospital executives want to be aggressive in weeding out excess costs to set an example, Nabel said, and to make sure Brigham and Women’s doesn’t lose patients to rivals that charge less for care.

Hospital employees are scheduled to hear about the moves today at a “town meeting’’ hosted by Nabel, who took the top job two years ago after running the National Heart, Lung, and Blood Institute, a major National Institutes of Health lab in Bethesda, Md. At the meeting, she will also unveil a strategic plan that calls for shifting the hospital’s emphasis from providing “episodic care’’ to managing patients’ health throughout their lives.

Hundreds of Brigham and Women’s 15,000 employees took part in drawing up the plan, which seeks to lay out the hospital’s goals and challenges in the context of changes sweeping the health care industry. It envisions a more coordinated, team-based approach to delivering health care, as well as state-of-the-art facilities.

A central part of the strategy is the proposed 12-story “Brigham Building of the Future.’’ It would be built on a vacant Fenwood Road lot and house clinical and research operations for such areas as neuroscience, immunology, genomics, and regenerative medicine. The 350,000-square-foot building - connected by a walkway to the hospital’s Shapiro Cardiovascular Center - would also include 400 parking spaces on two or three underground levels. The hospital hopes to break ground in 2013 and complete the project in 2016.

“Brigham Green,’’ the name of the hospital’s project to restore the old Francis Street common near Huntington Avenue, would add another 400 underground parking spaces. The green itself would feature a rose garden and vegetable garden, hospital officials said, and is expected to be finished in 2014.

Both projects - which require Boston Redevelopment Authority approval - would be funded through a mix of debt financing and donations.

Nabel, a cardiologist and clinical researcher who trained at Brigham and Women’s in the 1980s, said she had not anticipated that reducing expenses would become a major focus of her job as president of the hospital, one of the nation’s top recipients of NIH grants. “As a physician, I had never been thinking of cost and efficiency,’’ she said.

Now, as hospitals move toward better coordination of medical treatment, Brigham and Women’s has been sending more patients to affiliated community hospitals for routine care while more complex and costly care is provided at the Boston campus. It also has embraced a system of “global payments,’’ under which doctors are given annual budgets for individual patients’ care instead of billing for each visit or procedure.

Nabel, a member of the governing board of the new national Health Care Cost Institute, said the next generation of doctors must be trained in meeting budgets and boosting efficiency as well as providing medical treatments.

Brigham and Women’s, like its sister Partners institution Massachusetts General Hospital, commands some of the most generous health insurance reimbursements in the state, according to data collected by the Massachusetts attorney general’s office.

But being a highly paid hospital has some drawbacks at a time when new “tiered’’ insurance plans are channeling patients toward lower-cost medical centers. Brigham and Women’s suffered a blow early last year when Harvard Vanguard Medical Associates, the state’s largest independent doctors group, began sending many of its Boston patients to rival Beth Israel Deaconess Medical Center in a bid to reduce health care costs.

“This was an affordability issue,’’ Nabel said. She noted, however, that Brigham and Women’s has been able to keep many Harvard Vanguard patients and its overall business volume has remained stable.

Still, Brigham and Women’s strategic plan warns that the hospital is vulnerable to losing patients to competitors if it can’t trim spending and make better use of its other facilities, which include Faulkner Hospital in Jamaica Plain, an ambulatory care center in Chestnut Hill, and a health care center in Foxborough.

As part of its community service mission, the hospital also will expand its Division of Health Equity, which staffs hospitals in poor countries such as Haiti and Rwanda with Brigham and Women’s doctors.

Nabel said the program could potentially double its current corps of 40 physicians, who spend part of the year working in Boston and the rest overseas. Brigham and Women’s recently signed a memorandum of understanding with Rwanda to allow the hospital and Harvard Medical School to provide medical education to the country’s doctors for the next seven years.

“I view this as a modern-day Peace Corps,’’ Nabel said. “These individuals are totally committed to social justice and the belief that health care is a right.’’

Robert Weisman can be reached at weisman@globe.com.

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