“Take me to MGH”
One day my husband came home from work and announced that he wanted to get a tattoo. Greg was a neuroradiologist at Massachusetts General Hospital — more of a science nerd than an ink lover — so this caught my attention. He said he wanted to have a tattoo right across his forehead that said:
“IF FOUND DOWN, TAKE ME TO MGH.”
If he ever collapsed somewhere, he said, he wanted to be sure that he was taken to Mass General, and not to the nearest community hospital.
Greg had started working at a lab at MGH when he was in medical school, and he had done his radiology residency and fellowship there, so his ties to the hospital went back a long ways. But this bit about the tattoo was more than just institutional loyalty. He was convinced that the care at Mass General was better than at many of the smaller hospitals.
He proved his commitment to MGH one night when he became a patient himself. One evening I came home and found Greg lying on the bathroom floor writhing in pain. On the 1-to-10 scale of pain, he said he was at a 10. He clearly needed to be seen by a doctor, so he managed to get himself out to the car, and I started heading to the nearest emergency room. “No,” he said. “Take me to MGH.” Every bump in the road caused him to moan in pain, and and every extra minute of the drive was excruciating, but even in unbearable pain, he was adamant that he wanted to go to Mass General.
His problem turned out to be kidney stones, and all the hospital could really do for him was offer him strong pain medication while he waited for the stones to pass. Could a community hospital have pumped him full of morphine just as well? Almost certainly. But we hadn’t known what the problem was, nor what the treatment would be, and he had wanted to play it safe. If it had turned out to be a complicated medical emergency, he wanted the MGH team on board.
In his work at MGH, he regularly saw what they called “train wrecks” — patients who started out in smaller community hospitals, but then were transferred to Mass General when their cases turned out to be too difficult. Sometimes this was because they had a particularly challenging illness or a host of complicating factors. But sometimes it was because of mistakes in the smaller hospitals: Appendicitis was misdiagnosed as ovarian cancer. Pre-eclampsia was thought to be gallstones. A stroke was dismissed as just a fainting spell.
Of course many, many patients receive excellent care at the community hospitals. And MGH, of course, could still improve in some significant ways. But in Greg’s mind, there was no question that the overall standard of care was higher at Mass General than at the community hospitals.
He is not alone in that view. In its most recent survey on hospitals, US News asked nearly 10,000 specialists to rate hospitals in a number of different categories. Mass General took the top spot — it was ranked as the number one hospital in the entire country.
This raises some real questions about the tiered insurance plans that many insurance plans are now introducing in Massachusetts. In these plans, patients are free to choose which hospital they use, but they pay less for some hospitals and more — a lot more — for others.
The idea is to push patients toward the most cost-efficient hospitals — the places where they can get the best care for the least amount of money. It’s a great goal, but does it really work out that way?
In practice, it’s hard to put a value on all the different things that go into making a great hospital. How much is it worth to have a neurologist in the emergency room 24 hours a day? How much do you subtract for a wrong diagnosis? Is it valuable to have access to an MRI scanner anytime? Does a hospital need an acute cardiac care team? Are nurses with extra training better than recent graduates? Is it valuable to have a doctor who is involved in research? All those factors can make a difference for patients, but they are awfully hard to measure and score on a spreadsheet.
In the end, the tiers in the insurance plans seem to be mostly about price. The insurance companies are trying to push more patients out to the community hospitals because they are cheaper, not because they offer better care.
The result will be more inequality in our health care system. People who can afford to pay thousands of dollars in co-pays will be able to use the Boston teaching hospitals. People who can’t afford those huge co-pays will end up in the community hospitals.
The insurance companies tell us that the community hospitals meet their quality benchmark. But ask yourself: If your child collapsed in the playground and started having a seizure, would you rather go to a community hospital or to Children’s? If your mother suddenly couldn’t move one side of her body, would you want her taken to a local hospital or to Brigham and Women’s? If you found out that one of the valves in your heart was defective, would you rather have open-heart surgery in a community hospital or at Mass General?
For my husband, and many other customers in Massachusetts, there’s simply no question. If found down, they want to go to MGH.