The Great Suburban Healthcare Hunt
Hospital mergers, big-name acquisitions, and new medical facilities popping up nearly everywhere you look. Why is finding a doctor beyond the city limits such a confusing maze? It doesn’t have to be. From routine visits to chemotherapy and even life-saving surgery, your guide to getting first-class care—without ever having to drive into town again.
Illustration by Benjamen Purvis
See the 2021 list of Top Doctors
Well, you finally did it: You won the cutthroat suburban bidding wars, booked the moving truck, and now, at last, have the space, indoors and out, you’ve been desperately dreaming about since the start of the pandemic. The only issue you probably haven’t thought of since escaping the city? What to do about all of your tried-and-true doctors back in Boston.
The good news for everyone who’s participated in the great suburban migration of the COVID era (and for those who have long called the ’burbs home) is that the time is finally right to benefit from another kind of suburban migration—that of Boston hospitals. In recent years, the city’s biggest and best academic medical centers, which made the Hub world-famous for its top-quality healthcare and a go-to spot for ailing pop stars and princesses alike, have been expanding their footprints into the suburbs—and it’s a trend that’s showing no signs of slowing down. “The old model of how you used to get care from MGH and Beth Israel was you had to go into downtown Boston,” says David Cutler, a Harvard professor of economics who focuses on healthcare and is also a member of the state’s Health Policy Commission. “With the growth of people in the suburbs, it only makes sense that some of the care gets brought out to the suburbs and that very distinguished providers are moving out to where the patients are.”
Some of this expansion can be attributed to Boston heavyweights acquiring formerly independent hospitals or combining with rival hospital systems, as was the case with the massive 2019 merger between Burlington-based Lahey Health System and Beth Israel Deaconess Medical Center that brought together 13 hospitals, including some formerly independent ones, under the leadership of one of the most respected brands in Boston medicine. There is also a legion of new outpatient centers popping up in the northern, southern, and western ’burbs that are making it easier than ever to get primary and specialty care from trusted providers close to home (e.g., the massive $400 million expansion currently under way from Mass General Brigham).
The advantages for suburban patients are clear—namely, bypassing downtown traffic (not to mention exorbitant parking fees) without losing access to medicine’s best and brightest. The doctors staffing
suburban outposts of Boston hospitals are vetted by the flagship in some cases; in others they are the very same physicians who work in the city. “Often the community hospitals get access to a group of specialists they wouldn’t be able to retain on their own, who can be rotated out to the community—the kinds of doctors who otherwise you have to go to town to see,” says Nancy Kane, a professor at Harvard’s T.H. Chan School of Public Health who focuses on health policy and management. Another bonus, according to Kane? You can get top-notch care without the chaos that sometimes exists at teaching hospitals, where gaggles of medical students and residents routinely crash appointments.
Meanwhile, the construction of new facilities in the suburbs makes it more likely that patients will seek the care that they might otherwise forgo to avoid the inconvenience of schlepping into the city. “There’s no question that when you build more facilities, you end up treating more people,” Cutler says, adding that this is especially important for health services known to be underperformed, such as colonoscopies and diabetes management.
This is not to say that all of this growth hasn’t generated some controversy. Though hospital systems often justify mergers by pointing to improved quality of care, research from across the country has shown that they don’t always accomplish it, and may even worsen the patient experience. However, Bruce Landon, a professor of healthcare policy at Harvard Medical School who has studied the effects of consolidation, says there may be reason to believe that isn’t the case in Greater Boston, where mergers often occur not between two average hospital brands, but between a leading academic medical center and smaller hospitals. “I think in those cases, they’re actually expanding their expertise and their personnel to help staff and run those hospitals,” he says.
Concerns about costs, however, are more difficult to ignore. The bigger the hospital group, the harder it is for insurance companies to negotiate lower prices for services, says Boston College health economist Sam Richardson—which means smaller community hospitals that become part of a larger healthcare system can charge more than they used to, ultimately driving up costs for patients. Cutler also says that when big Boston hospitals open shiny new outpatient centers in the suburbs, local doctors that once charged lower rates at their independent group practice often affiliate with these facilities, which command higher prices.
Still, Cutler is optimistic that the trend toward the suburbs can ultimately benefit patients in terms of both quality and cost in a state like Massachusetts, where there is robust oversight of the healthcare sector. “We have monitoring, we have people paying attention, from the governor and the legislature on down to businesses and insurers,” he says. “So at least we have a far better chance at having it work out well than other states do.”
If all of the choices still seem dizzying, don’t add stress to your list of maladies: The following pages are designed to be your guide to navigating this brave new world of hospital mergers and suburban medical
outposts. So go ahead and make that appointment: Your health depends on it.
Who’s Who in Healthcare?
Confused about how hospital mergers have changed the medical landscape? Here’s what you need to know.
Beth Israel Lahey Health
Number of employees: 36,000
Hospitals in the city: Beth Israel Deaconess Medical Center, Mount Auburn Hospital, New England Baptist Hospital
Hospitals in the suburbs: Addison Gilbert Hospital, Anna Jaques Hospital, BayRidge Hospital, Beth Israel Deaconess Hospital- Milton, Beth Israel Deaconess Hospital – Needham, Beth Israel Deaconess Hospital – Plymouth, Beverly Hospital, Lahey Hospital & Medical Center, Lahey Medical Center, Peabody, Winchester Hospital
Mass General Brigham
Number of employees: 78,000
Hospitals in the city: Brigham and Women’s Faulkner Hospital, Brigham and Women’s Hospital, Massachusetts Eye and Ear, Massachusetts General Hospital, Spaulding Rehabilitation Hospital
Hospitals in the suburbs: McLean Hospital, Newton-Wellesley Hospital, North Shore Medical Center
Steward
Number of employees: 17,000
Hospitals in the city: Carney Hospital, St. Elizabeth’s Medical Center
Hospitals in the suburbs: Good Samaritan Medical Center, Holy Family Hospital, Morton Hospital, Nashoba Valley Medical Center, New England Sinai Hospital, Norwood Hospital, Saint Anne’s Hospital
Wellforce
Number of employees: 13,000
Hospitals in the city: Tufts Medical Center/Tufts Children’s Hospital
Hospitals in the suburbs: Circle Health/Lowell General Hospital, Lawrence Memorial Hospital of Medford, Melrose Wakefield Hospital
Should I Stay or Should I Go?
Not sure whether it makes sense to remain close to home or schlep downtown for your next appointment? It depends on what kind of care you need.
Routine Surgeries – STAY!
Need to have your appendix taken out or get a routine hernia repaired? The good news, according to Beth Israel Deaconess Medical Center internist Bruce Landon, a professor of healthcare policy at Harvard Medical School who researches quality of care, is that there’s no need to travel far from home for simple procedures. “There’s a lot of thinking in policy circles and among doctors that it can be better to get routine care…at a community hospital because it’s a less complicated place where they pay more attention to you, and it’s more convenient,” he says.
Hyper-Specific Care – GO!
For conditions such as advanced heart failure or rare esophageal disorders, you’ll need to see a subspecialist rather than a general cardiologist or GI doctor. In those cases, Landon says, it is usually better to go to the mothership, “where physicians who specialize in very narrow areas of care are based.”
Diagnostic Tests – STAY!
Stress tests, echocardiograms, X-rays—if your downtown doc orders one of these, don’t worry about scheduling another appointment in Boston. Such tests can usually happen locally at affiliated suburban hospitals or outpatient care centers, Landon says, then get forwarded along to your physician for interpretation.
Initial Oncology Workup – GO!
If you suspect you have cancer, you may want to consider venturing into Boston for a diagnosis and staging. “Leading cancer centers have more depth and experience with different types of cancer, and potentially are more skilled at interpreting biopsies and other pathology specimens,” Landon says. But you don’t need to trek into the city for every appointment. Once you’ve hashed out a course of treatment, Landon suggests receiving your chemo or radiation therapy at a convenient suburban site.
A rendering of Mass General Brigham’s forthcoming outpatient center in Westborough. / Photo courtesy of Mass General Brigham
The Boom Is Here
Brand-new or coming soon to a town near you, these exciting new medical developments promise all of the cachet—and none of the headache.
1. Primary and specialty care, mental healthcare, imaging, and surgery—the three new outpatient centers that are part of Mass General Brigham’s eye-popping $400 million expansion in Woburn, Westborough, and Salem, New Hampshire, will quite literally do it all when they open their doors in 2022. The healthcare giant is also planning an expansion of its existing complex in Westwood.
2. Being an athlete in the western ’burbs just got a little easier. In Wellesley, Steward Health Care recently opened the Boston Sports Performance Center to keep kids and pro athletes alike in peak condition. Staffed by former NFL, NHL, and MLB sports physicians and top trainers, the facility offers physical therapy, performance training, sports medicine specialists, and even a concussion clinic all under one roof.
3. Concord’s Emerson Hospital may be one of Massachusetts’ last independent hospitals, but that doesn’t mean it isn’t growing in its own right. Following the opening of urgent-care centers in Hudson and Littleton, it’s alsoexpanding with an outpost in Maynard this year.
4. Thanks to Beth Israel Lahey Health, there’s never been a better time to be a patient, well, just about anywhere. In 2018 it opened Lahey Health Hub at the MarketStreet Lynnfield complex, offering patients on the North Shore one-stop shopping for their primary-, urgent-, and specialty-care needs. The following year it unveiled a 37,000-square-foot outpatient clinical center at Beth Israel Deaconess Hospital – Needham. And in 2020 the healthcare group expanded its footprint south of Boston with an urgent-care facility in Dedham and a brand-new healthcare complex in Quincy offering primary and urgent care—as well as lab services and diagnostic imaging—under one roof.
5. Getting a cancer diagnosis is always difficult, but with the opening of a 30,000-square-foot facility in the Merrimack Valley last year, Dana-Farber Cancer Institute is making it a little easier for those who live north of the city. With dozens of exam rooms and private infusion bays, the facility also offers access to clinical trials, genetic counselors and testing, and even dietitians with experience in oncology.
Why Docs Love the Suburbs
Courtesy photo
“At Emerson I’ve been able to cut off all of the research and devote 100 percent of my time to patient care, which has been really rewarding to me. And I really like that I get to see a wide variety of GI patients, whereas at [the city hospitals], they’re super-super specialists. Plus, I have a really good work-life balance. I have two young kids, and we have a busy life. Being at a smaller hospital and a smaller community practice just leads to a better environment.”—Jennifer Nayor, Gastroenterologist, Emerson Hospital
Courtesy photo
“There are really so many advantages of being in a community hospital setting. I like the simple things, like being able to cut out a lot of the middleman conversations and interactions that happen at the larger hospitals simply because there are a lot more layers to have to get through. If I want to talk to one of our orthopedists, I talk to an orthopedist. If I want to talk to a surgeon, I talk to a surgeon. You run into them in the cafeteria. It’s a lot of that closeness and ease of communication.”—Melisa Lai-Becker, Chief of Emergency Medicine, CHA Everett Hospital
Courtesy photo
“I was at MGH for 13 years, and I’ve been at Newton-Wellesley for six months. I decided to take this job because I believe that the futures of community hospitals and academic medical centers are linked. In order for academic medical centers to serve very complex patient populations and do the research they should do, they need to be able to give up some of the procedures we can do here in the community. On a personal level, I’ve lived in Newton since 1998, so I know how important it is to get care at a community hospital.”—Sareh Parangi, Chair of Surgery, Newton-Wellesley Hospital
Beth Israel Deaconess HealthCare’s Chelsea outpost provides primary, specialty, and urgent care to an underserved community. / Photo courtesy of Beth Israel Deaconess Medical Center
Location, Location, Location
When it comes to equity in the healthcare industry, it can make all the difference.
There’s no doubt the suburban healthcare boom has helped bring more choices to those living beyond city limits. The question some are asking, though, is whether these new options are really benefiting everyone—or just a select few.
Take, for instance, the location of many recently opened medical developments. When considering where to add facilities, explains Harvard healthcare economist David Cutler, hospital systems tend to favor wealthier locales with a surplus of the most lucrative patients: those carrying private insurance. While this may help their bottom line, it doesn’t do much to help people in underserved areas who need access to care the most.
The location of new facilities can be a problem for another reason. When Boston hospitals open ambulatory-surgery or diagnostic centers in the ’burbs, they can wind up luring commercially insured people away from existing community hospitals, siphoning off some of the most profitable procedures. This, in turn, can destabilize the finances of those facilities, threatening their ability to care for low-income patients. “The business model for a hospital is to make money on some stuff and use that to subsidize the losses on other stuff,” Cutler explains.
So how do we ensure fairness in local healthcare going forward? While there are regulatory measures that can block expansions or mergers that could have negative effects on the market when there isn’t a demonstrated need for a new facility, Nancy Kane, a professor at Harvard’s T.H. Chan School of Public Health who also sits on the board of trustees at UMass Memorial Health Care in Worcester, says doing so hasn’t always been easy: “Overcoming the political and financial clout of the big academic medical centers in any legislative or regulatory process is and has always been a problem.”
That’s not to say the state’s leaders aren’t trying to keep the big conglomerates in check. Attorney General Maura Healey, for example, made the merger between Beth Israel Deaconess Medical Center and Lahey Hospital & Medical Center contingent on a settlement with her office that included a $71.6 million commitment to support healthcare services for underserved communities.
For their part, both Beth Israel Lahey Health and Mass General Brigham say they are pledging to do just that. BIDMC owns and operates Bowdoin Street Health Center in Dorchester and Beth Israel Deaconess HealthCare in Chelsea, while Mass General Brigham’s expanded footprint includes community healthcare centers that serve low-income patients in Chelsea and Revere. Cutler says he hopes the COVID-19 pandemic and the many inequities it revealed will reaffirm hospitals’ commitment to ensuring that no one is left out of the wave of expansion. “There are all sorts of great reasons why it’s really good to have care where people are,” he says. “We just need to make sure that it’s not just rich people” who get it.
Face-off: Care in a Crunch
Don’t have a doc yet in the ’burbs but need to get something taken care of right now? No problem. The region is awash in walk-in drugstore clinics and urgent-care centers, both of which provide a wide range of basic medical care. Here’s what four healthcare services will set you back at each, pre-insurance.
Sources: CVS.com and Aaron Martin, CareWell Market Leader and Regional Manager
How Does Your Hospital Stack Up?
Before you check in, check out this roundup of results from leading ratings organizations.
Lahey Hospital & Medical Center
Healthcare Group: Beth Israel Lahey
Location: Burlington
Leapfrog’s Hospital Safety Grade: GRADE A
Better-than-average performance: 20 categories, including incidences of MRSA infections and post-surgical breathing problems.
Average performance: 3 categories, including incidences of C. diff infections and patient falls and injuries.
Below-average performance: 5 categories, including incidences of blood infections and death from serious treatable complications.
Medicare’s Care Compare: ★★★★★
Better-than-average performance: mortality; safety; patient experience.
Average performance: effectiveness of care; efficient use of medical imaging.
Below-average performance: timeliness of care; readmissions.
Average number of minutes patients spend in ER: 204.
Newton-Wellesley Hospital
Healthcare Group: Mass General Brigham
Location: Newton
Leapfrog’s Hospital Safety Grade: GRADE A
Better-than-average performance: 18 categories, including incidences of MRSA infections and post-surgical problems with breathing or blood clots.
Average performance: 1 category, incidences of C. diff infections.
Below-average performance: 9 categories, including incidences of blood infections and surgical wounds splitting open.
Medicare’s Care Compare: ★★★★
Better-than-average performance: mortality; safety; patient experience.
Average performance: effectiveness of care; efficient use of medical imaging.
Below-average performance: timeliness of care; readmissions.
Average number of minutes patients spend in ER: 209.
MetroWest Medical Center-Framingham
Healthcare Group: Tenet Health
Location: Framingham
Leapfrog’s Hospital Safety Grade: GRADE C
Better-than-average performance: 16 areas, including incidences of embolisms in the blood and deaths from serious treatable complications.
Average performance: 3 categories, including incidences of MRSA infections and dangerous blood clots.
Below-average performance: 7 categories, including incidences of accidental cuts and tears and bedsores.
Medicare’s Care Compare: ★★★
Better-than-average performance: mortality; readmissions.
Average performance: effectiveness of care; efficient use of medical imaging.
Below-average performance: safety; patient experience; timeliness of care.
Average number of minutes patients spend in ER: 159.
Morton Hospital
Healthcare Group: Steward
Location: Taunton
Leapfrog’s Hospital Safety Grade: GRADE B
Better-than-average performance: 15 categories, including incidences of C. diff infections and dangerous bedsores.
Average performance: 1 category, incidences of death from serious treatable complications.
Below-average performance: 11 categories, including incidences of MRSA infections and dangerous blood clots.
Medicare’s Care Compare: ★
Better-than-average performance: N/A
Average performance: safety; mortality; effectiveness of care; efficient use of medical imaging.
Below-average performance: patient experience; timeliness of care; readmissions.
Average number of minutes patients spend in ER: 156.
Beth Israel Deaconess-Plymouth
Healthcare Group: Beth Israel Lahey Health
Location: Plymouth
Leapfrog’s Hospital Safety Grade: GRADE A
Better-than-average performance: 20 categories, including incidences of blood infections and deaths from serious treatable complications.
Average performance: 1 category, communication about medicines.
Below-average performance: 7 categories, including handwashing and incidences of C. diff infections.
Medicare’s Care Compare: ★★★★★
Better-than-average performance: mortality; safety.
Average performance: patient experience; effectiveness of care; efficient use of medical imaging.
Below-average performance: timeliness of care; readmissions.
Average number of minutes patients spend in ER: 275.
North Shore Medical Center
Healthcare Group: Mass General Brigham
Location: Salem
Leapfrog’s Hospital Safety Grade: GRADE C
Better-than-average performance: 15 categories, including incidences of blood infections and collapsed lungs.
Average performance: 1 category, communication with nurses.
Below-average performance: 12 categories, including incidences of accidental cuts and tears and patient falls and injuries.
Medicare’s Care Compare: ★★★
Better-than-average performance: mortality.
Average performance: safety; effectiveness of care; efficient use of medical imaging.
Below-average performance: patient experience; timeliness of care; readmissions.
Average number of minutes patients spend in ER: 186.
Lawrence General Hospital
Healthcare Group: N/A
Location: Lawrence
Leapfrog’s Hospital Safety Grade: GRADE B
Better-than-average performance: 13 categories, including incidences of blood infections and surgical wounds splitting open.
Average performance: 2 categories, communication with doctors and incidences of MRSA infections.
Below-average performance: 13 categories, including incidences of death from serious treatable complications and C. diff infections.
Medicare’s Care Compare: ★★
Better-than-average performance: mortality.
Average performance: effectiveness of care; efficient use of medical imaging.
Below-average performance: safety; patient experience; timeliness of care; readmissions.
Average number of minutes patients spend in ER: 190.
Cape Cod Hospital
Healthcare Group: Cape Cod Health Care
Location: Hyannis
Leapfrog’s Hospital Safety Grade: GRADE A
Better-than-average performance: 19 categories, including incidences of MRSA infections and collapsed lungs.
Average performance: 1 category, communication about medicines.
Below-average performance: 8 categories, including blood infections and dangerous blood clots.
Medicare’s Care Compare: ★★★★★
Better-than-average performance: mortality; safety; patient experience.
Average performance: readmissions; effectiveness of care; efficient use of medical imaging.
Below-average performance: timeliness of care.
Average number of minutes patients spend in ER: 172.
*Leapfrog’s Hospital Safety Grades, from spring 2020, and Medicare’s Care Compare data, from January 2020, were the most recently available at press time.
How much stock should I put in hospital ratings, anyway?
It all depends on what you’re most interested in evaluating. If you’re only keen to learn how safe a suburban hospital is, check out Leapfrog’s Hospital Safety Grade, which crunches all manner of data to give the hospital an overall letter grade. It also offers easy-to-interpret graphics that let you see a hospital’s performance for a whole slew of safety indicators. For the most comprehensive rating system, check out Medicare’s Care Compare website, where you can find everything from how long average ER visits last to how successful a facility’s cataract surgeries are. To find information about another hospital close to you, go to hospitalsafetygrade.org or medicare.gov/care-compare.
Note: An earlier version of this article incorrectly listed Lawrence General Hospital as part of the Wellforce healthcare group.
