Mass General Brigham Reports Fiscal Year 2022 Financial Results

Rising costs, labor shortage, capacity constraints led to operational loss for health care system

Boston, MA – Friday, December 16, 2022 – Mass General Brigham, a not-for-profit, integrated health care system, reported a loss from operations of $432 million (-2.6% operating margin) for the fiscal year ending September 30, 2022. The health care system’s financial performance continues to be impacted by external pressures that have intensified over the past year, including historic cost inflation, significant workforce shortages, and a worsening capacity crisis.

Many health care systems and hospitals nationwide are experiencing the worst year financially since the start of the COVID-19 pandemic. While the impacts of inflation and labor shortages are widespread, health care providers face unique challenges with little flexibility to quickly adjust to rising costs. To ensure Mass General Brigham can continue to deliver the highest-quality patient care, invest in teaching and research, and serve the community as it has for two centuries, the health care system is taking action to plan for a long-term sustainable future. This plan includes the following initiatives:

Advancing integration initiatives to improve patient care and identify efficiencies

Mass General Brigham is continuing integration initiatives across the care continuum as part of its vision to deliver a unified experience for patients. This involves prioritizing the efficient flow of patients through the acute hospital and to post-acute care settings, including expanding home-based care and telehealth services to shift care beyond traditional hospital settings.

Addressing the labor shortage by building workforce pipelines

With the labor shortage affecting health care systems nationwide, Mass General Brigham is supporting programs to decrease the financial strain caused by reliance on temporary staffing, including the training of candidates to enter high-demand clinical roles and the building of employment pipelines for new mental health workers.

Reducing expenses

Mass General Brigham is identifying administrative efficiencies to reduce costs without impact to patient care, including eliminating vacant administrative positions. In addition, local leaders across the system will be revisiting fiscal year 2023 budget plans and projects to reduce non-labor expenses where possible, realize cost savings, and ensure available resources are directed at Mass General Brigham’s mission of enhancing patient care, investing in teaching and research, and serving the community.

“Health care is facing an unrelenting economic crisis that is impacting patients’ ability to access care. It is our responsibility at Mass General Brigham to continue to provide high-quality care while being good fiscal stewards on behalf of the 1.7 million patients whom we care for,” said Anne Klibanski, MD, President and CEO of Mass General Brigham. “While what we are experiencing today is unprecedented, it’s important to remember that we have overcome challenges before during our long history. The stress placed on our workforce and our system over the past several years has been enormous, and the employees at Mass General Brigham continue to show strength and resiliency. We are confident that thoughtful and strategic decision-making coupled with efficient resource management will enable us to continue investing in critical medical research, education, and the communities we serve, while ensuring that we can care for every patient who needs us.”

Provider activity resulted in a loss of $395 million (-2.5% operating margin), reflecting the impact of the Omicron surge during the March quarter along with unprecedented inflationary pressures and staffing shortages which limited inpatient and outpatient capacity. Insurance activity resulted in a loss of $37 million, including a $21 million premium deficiency reserve for anticipated losses in fiscal year 2023 related to the successful launch of Mass General Brigham Health Plan’s Medicare Advantage program. Excluding the reserve, insurance activity generated a loss of $16 million (-1.7% operating margin).

The system generated total operating revenue of $16.7 billion in 2022. Higher inpatient acuity coupled with longer lengths of stay at Mass General Brigham’s academic and community hospitals resulted in a decline in discharges (-2%) and curtailed patient care revenue growth ($437 million or 4%) to $11.9 billion. Clinical labor staffing vacancies suppressed bed capacity across the health care continuum, making it significantly more difficult to find post-acute placements. This contributed to an average acute care length of stay in excess of 6 days in 2022, approximately 15% longer than the average length of stay before the COVID-19 pandemic and resulted in increased overall resource use per patient. The capacity crisis is not unique to academic medical centers, and all hospitals in the Mass General Brigham system have been at, or above, 100% operational occupancy, on average.

“Heading into 2023, we are employing strategies and tactics to address capacity challenges and ongoing inflationary pressures on labor and supplies costs, including a heightened focus on clinical integration to enhance patient care efficiencies and resource stewardship. We have also prioritized engaging with Mass General Brigham’s leaders who are closest to the programs and services delivering care across the system to identify the most thoughtful and targeted approach to reducing costs,” said Niyum Gandhi, Chief Financial Officer and Treasurer at Mass General Brigham. “Simultaneously, we are taking the next steps in transitioning our care model to one based on value rather than volume, facilitated by the launch of a zero premium Medicare Advantage plan, moving approximately 140,000 Medicaid members into a full risk program and demonstrating our commitment to improving the affordability of patient care.”

The system also generated $931 million in premium revenue (2% increase), $2.5 billion in research revenue (10% increase) and $1.4 billion in other revenue (23% increase, excluding $232 million CARES Act funds received in 2021). Operating expenses totaled $17.1 billion, an increase of $1.6 billion (10%) over 2021, and remain elevated due to increases in wages (9%, reflecting higher use and cost of temporary staffing as well as market wage adjustments to facilitate workforce retention), employee benefit costs (13%) and clinical supplies (13%).

In 2022, the system absorbed $2.3 billion in Medicare, Medicaid, and Health Safety Net shortfalls due to certain government reimbursements that do not cover the full cost of providing care to Medicare, low-income, and uninsured patients, an increase of $307 million (15%) compared to the shortfall absorbed in 2021.

Despite ongoing financial challenges, Mass General Brigham remains committed to improving value, outcomes, and quality for patients, making significant progress throughout 2022 toward its vision of building the integrated academic health system of the future with patients at the center.

Driving clinical integration to provide better care and generate efficiencies

Mass General Brigham is integrating service lines and clinical services as part of its comprehensive strategy to collaborate as one integrated academic health care system, enabling both exceptional care and a unified experience for patients. Progress made as part of this multi-year initiative includes integrating cardiac surgery, cardiology, pathology, radiology, emergency medicine, and anesthesiology. For radiology, Mass General Brigham now has a fully integrated digital imaging viewing system across all entities. Mass General Brigham is also monitoring patient care resources, such as CT scanners and operating rooms, through its proprietary Enterprise Asset Management platform. This initiative aims to deliver the most efficient care and support the best experience for patients and care teams. Enterprise Asset Management will be utilized systemwide by early 2023.

Ensuring patient access despite an ongoing capacity crisis

Hospitals across Massachusetts and nationwide are routinely operating over capacity, seeing more patients than they have beds for. Shifting the site of care through programs like Hospital at Home is one way that Mass General Brigham is seeking to improve access for patients. Home-based care is proven to provide more patient-centered and satisfying care, lower complication rates, reduce emergency department utilization, and improve outcomes for patients who can safely be transitioned out of a hospital setting. It also results in fewer readmissions, both alleviating capacity pressures and meaningfully decreasing healthcare expenditures.

In addition, Mass General Brigham is expanding access to telehealth by seamlessly integrating virtual and in-person care, including improving equity through access to medical interpreters during all virtual care encounters. Mass General Brigham has also implemented a remote healthcare program aimed at managing patients’ blood pressure and cholesterol levels, leveraging digital solutions to help break down barriers to care, especially among traditionally underserved patient populations. A research study that included more than 10,000 participants at Mass General Brigham showed the program lowered blood pressure and LDL-cholesterol significantly.

To increase access to care, Mass General Brigham opened a new, state-of-the-art integrated care center in Salem, New Hampshire, in September 2022, providing much-needed primary care and outpatient services, and helping to meet the need for behavioral health services in the community. Mass General Brigham also recently opened a 16-bed Acute Mental Health Unit at Salem Hospital, a new space for the Breast Imaging and Diagnostic Center at Brigham and Women’s Faulkner Hospital and received state approval for two transformative building projects at Massachusetts General Hospital and Brigham and Women’s Faulkner Hospital that will increase access and enhance the care experience.

Advancing patient-centered research and innovation

As a national leader in innovation, Mass General Brigham’s patient-centered mentality and systemwide collaborative approach facilitate research breakthroughs that drive medical innovation, gain new knowledge, and improve patient outcomes. Mass General Brigham operates the largest hospital system-based research enterprises in the country and currently has 2,700 ongoing clinical trials.

In recognition of its scientists’ expertise in infectious disease, Mass General Brigham was selected to participate in a collaborative nationwide study to understand prolonged symptoms of COVID-19 and how to recover from them. As part of a consortium of six sites in Boston, Mass General Brigham will support the recruitment of more than 900 participants who will be followed for three years to help researchers understand and define the long-term complications that can occur after infection and lay the groundwork for preventing and treating symptoms. Mass General Brigham researchers are also playing a critical role in genomic surveillance and education on emerging and novel pathogens as part of the Massachusetts Consortium on Pathogen Readiness.

Massachusetts General Hospital and Brigham and Women’s Hospital are part of a national trial to evaluate the effectiveness of a treatment for Mpox and, separately, were approved for more than $50 million in funding awards by the Patient-Centered Outcomes Research Institute for studies on treating two important mental health conditions – acute suicidal depressed state and bipolar depression.  

Mass General Brigham is home to more than 400 leading gene and cell therapy researchers from five nationally ranked academic medical centers. The system recently announced gene therapy pioneer Roger Hajjar, MD, as the inaugural director of the Gene and Cell Therapy Institute at Mass General Brigham following a nationwide search. In this position, Dr. Hajjar will leverage ongoing, groundbreaking research efforts at Mass General Brigham and recruit leading scientists conducting cutting-edge projects. The objective of the Gene and Cell Therapy Institute will be to translate the scientific discoveries made by Mass General Brigham researchers to first-in-human clinical trials and, ultimately, life-changing treatments for patients.

Furthering provider-payer integration to improve outcomes and reduce costs

As part of Mass General Brigham’s unified system strategy, AllWays Health Partners introduced a series of initiatives in FY2022 to improve health outcomes and reduce costs through provider-payer integration. These measures were supported by the announcement of a new integrated brand identity, Mass General Brigham Health Plan, starting January 1, 2023.

Expanding the benefits of integrated, accessible healthcare and coverage to more populations, Mass General Brigham Health Plan recently introduced Medicare Advantage products, received approval to support the Mass General Brigham Accountable Care Organization (ACO) through the state’s re-procurement of Medicare and Medicaid services, and responded to a mental health crisis exacerbated by the COVID-19 pandemic by partnering with Lyra Health to provide a robust mental health solution with more access, options, and ease of use. These initiatives are transforming the member experience, while addressing health disparities and social determinants of health.

Reducing health disparities in our communities, creating workforce pipelines, addressing climate change

Massachusetts General Hospital received a gift of $50 million from Robert K. Kraft and The Kraft Family Foundation to address healthcare disparities caused by race, ethnicity, geography, and economic status and to ensure the highest quality equitable health care is available in all the communities served by the hospital.

To further improve the health of the communities it serves, Mass General Brigham has invested $50 million in a new, comprehensive community and mental health strategy. Through partnerships with several community-based organizations, this initiative targets programs to improve mental healthcare capacity, workforce development, chronic disease management, as well as nutrition security and equity. Mass General Brigham’s commitments to promote nutrition equity and security, support food-as-medicine programs to tackle diet-related diseases, and fund food-related programming at local community-based organizations in Massachusetts were also highlighted at the White House Conference on Hunger, Nutrition, and Health by the Biden-Harris Administration in September 2022. Separately, Mass General Brigham joined the Biden-Harris Administration to pledge meaningful action to decarbonize the health care sector and make health care facilities more resilient to the effects of climate change. This commitment includes reducing emissions by 50% by 2030 and achieving net zero emissions by 2050.

Mass General Brigham has utilized “Clinics on Wheels,” or mobile community care vans, to increase access to COVID-19 services for underserved populations and meet people where they live, breaking down barriers to care. To date, the program has provided almost 20,000 COVID-19 vaccination doses in 12 low-income and minority communities in Massachusetts. Two new papers published in October 2022 demonstrated the effectiveness of bringing COVID-19 health care services to where people need them the most and described the success of the new program, which had higher vaccination rates among adolescents, non-white populations, and people of Hispanic ethnicity compared to vaccination rates in the state and in the local communities. The mobile community care vans will soon focus on providing hypertension management and substance use disorder services to the community.

Mass General Brigham also has a systemwide initiative to address racism and inequities called United Against Racism that focuses on improving health equity for patients, improving health in the communities served by the system, and creating workforce equity. The United Against Racism initiative is widespread throughout the system and includes, as one example, translating Mass General Brigham’s website and patient messaging tool into the six most commonly used languages by patients. This is the first Epic site in the nation to undertake translation at this scope and involves staff and support from several Mass General Brigham teams representing digital, equity, and patient experience.

Overall, the system reported a loss of $2.3 billion in 2022. This includes a nonoperating loss of $1.8 billion, reflecting heightened unfavorable volatility in the financial markets.

In 2021, the system reported operating income of $442 million. This includes $232 million of permanent grants from the Provider Relief Fund of the Coronavirus Aid Relief and Economic Security (CARES) Act, which were used to prevent, prepare for, and respond to cases of COVID-19, and $30 million in Affordable Care Act risk corridor program subsidies for insurance coverage provided in 2014-2016. Excluding these funds, operating income was $180 million (1.1% operating margin), including income from provider activity of $203 million (1.4% operating margin) and a loss from insurance activity of $23 million (-2.5% operating margin). The system reported an overall gain of $3.2 billion in 2021, including a nonoperating gain of $2.7 billion during a period of heightened favorable volatility in the financial markets.

Read more about Mass General Brigham’s Fiscal Year 2022 results at emma.msrb.org.