Health systems at 'high risk' in healthcare's darling state

Massachusetts has declared several regions "high risk" due to limited hospital capacity, a stark downturn for a state that is regularly heralded for the performance of its hospitals and healthcare system.

Two regions in the state — the Boston metropolitan area and Northeastern Massachusetts — are now categorized as "Tier 3" of the capacity designations created during the height of the pandemic. Region 5, which contains Southeastern Massachusetts and its cape and islands, has been in Tier 3 since the beginning of 2023 after natural disasters limited hospital capacity. 

There are four tiers total, with the third requiring hospitals to meet frequently to share bed availability and the possibility of facilities implementing "gradual and dynamic reductions in elective, non-urgent procedures and services," according to the Massachusetts Hospital Association. Tiering is based on a number of factors, including spikes in disease-specific cases including respiratory diseases, staffing constraints, emergency department usage, and medical-surgical bed availability. 

Hospitals in Boston, like Massachusetts General Hospital, were already struggling with capacity this year before Dallas-based Steward Health Care made news for its financial instability and looming risks for the nine hospitals it owns and operates in Massachusetts.

In mid-January, Massachusetts General requested permission from the state to add more than 90 inpatient beds amid what it says is an "unprecedented capacity crisis." The hospital revealed that its emergency department has been consistently overwhelmed with patients for the last six months, accommodating 50 to 80 individuals in the emergency department nightly who are awaiting an available bed. On Jan. 11, the hospital reached a peak with 103 patients boarding in the emergency department, marking one of the most congested days in its 200-year history.

Toward late January, Steward Health Care earned the attention of lawmakers and officials after local reports about looming hospital closures within the system. Most recently, the for-profit hospital operator secured funding to stabilize its nine Massachusetts hospitals for the time being, citing "no current plans to close any of our hospitals in Massachusetts," according to Michael Callum, MD, executive vice president of Steward. 

Massachusetts has 2.29 hospital beds per 1,000 residents, putting it slightly below the U.S. average, according to data from KFF. Its intensifying capacity problems are a sudden shift for a state that has been consistently well-regarded and recognized for its healthcare system. It was ranked No. 1 in the country for its healthcare system last summer by the Commonwealth Fund, which measured states on healthcare access, quality, utilization rates, costs and more. It held the second spot in the country for the 2023 ranking of states by health calculated by United Health Foundation. U.S. News & World Report put Massachusetts third in the nation for healthcare and, notably, No. 3 in the U.S. for access in 2023. 

"It is indeed a crisis for those on the frontlines and the public can play a role in helping to alleviate the stresses hospitals are under," Patricia Noga, PhD, RN, vice president of clinical affairs for the Massachusetts Hospital Association, said in an alert issued by the group. "It's imperative to seek the right care in the right place. Emergency departments will see any patient in need of care, but they are designed to handle severe illnesses and injuries that can't be addressed in the primary or urgent care setting. Going elsewhere when appropriate saves you time and ensures that patients with true emergencies get the care they need, when they need it."

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