麻省总医院布莱根分院在重组过程中宣布史上最大规模裁员

【中美创新时报2025 年 2 月 10 日编译讯】（记者温友平编译）面对不断上涨的成本，并希望提高其庞大网络的效率，马萨诸塞州最大的私营雇主麻省总医院计划削减 2 亿多美元的工资成本。《波士顿环球报》记者Jessica Bartlett对此作了下述报道。

麻省总医院布莱根分院周一表示，将在未来两个月内裁员数百人，这是该组织历史上最大规模的裁员，因为该医疗系统正在努力应对预期的资金短缺和其 12 家医院的持续运营挑战。

麻省总医院布莱根分院拥有约 82,000 名员工，无疑是该州最大的私营雇主。高管们拒绝透露将裁员多少人，但表示目标是每年节省至少 2 亿美元，约占其工资和福利成本的 2%。高管们表示，本周将进行裁员，3 月份将再次进行第二轮裁员。随着医疗系统更紧密地整合其医院，裁员可能会在几年内以更慢的速度进行，但由于财务压力，裁员速度加快了。

“我们……面临着影响全国许多医疗系统的同样持续的压力，这些压力导致未来两年内预算缺口预计达到 2.5 亿美元，”麻省总医院通讯高级副总裁詹妮弗·斯特里特 (Jennifer Street) 在一份声明中表示。“我们现在采取行动，以便继续进行计划和未来的投资。”

斯特里特表示，裁员将集中在庞大组织的行政和管理层，不会影响支持面向患者的护理的一线临床工作者或工作人员。该系统还将整合一些职位，并取消一些空缺职位。

“如果我们现在不采取明确措施稳定财务状况，我们将无法继续投资于我们的使命，”MGB 首席执行官 Anne Klibanski 博士在一封发给员工的电子邮件中表示，该邮件已被《波士顿环球报》获得。

对于一个在过去两年中，在强劲投资组合的推动下，运营利润率每年都为正的医疗系统来说，削减开支似乎令人惊讶。在截至 9 月的 12 个月中，即最新的财务数据中，MGB 报告称运营利润为 4500 万美元，净利润为 20 亿美元，总收入为 206 亿美元。

观察该系统财务状况的专家表示，该系统最近的表现表明，它具有一定的韧性来应对未来的挑战，至少与现金较少、投资组合较小的其他马萨诸塞州医院相比是如此。波士顿大学公共卫生学院名誉教授 David Rosenbloom 表示，在这种情况下，削减开支可能更多地是为了提高效率，而不是为了弥补损失。

“他们目前没有面临挑战，”他说。“他们担心未来吗？是的。当我教授医院财务时，我说医院的主要和几乎唯一的规则是最大化你今天的收入，因为你不知道明天那些混蛋会对你做什么……当你发展到像 MGB 一样大的时候，可能还会出现规模效率低下的情况。”

MGB 高管对其核心业务表示担忧，称过去两年他们的大部分营业利润来自 COVID 或其他一次性联邦支付的联邦财政支持，而他们面临着长期前景不佳的问题。

他们描述了一个成本稳步增长快于收入的体系——收入主要来自私人和公共保险公司，而这些保险公司本身也面临着控制医疗成本的压力。虽然 MGB 能够通过提高效率节省一些钱，但他们已经到了需要控制劳动力成本的地步。

与此同时，与全州许多医疗系统一样，MGB 的医院人满为患，住院床位需求加剧了医院的积压，导致急诊室挤满了病人。这也带来了财务后果，因为医院每次出院基本上只报销一次，无论病人在医院待了多久。因此，尽管 MGB 的医院比以往任何时候都繁忙，但其收入增长却受到了抑制。

医院系统的一大亮点是过去几年获得了数十亿美元的投资收益。但是这些资金的收益大部分要么被捐赠者限制在某些用途上，要么被指定用于资本项目，例如马萨诸塞州总医院 20 亿美元的扩建。他们说，这些资金无法用于填补核心业务的财务漏洞。

几年前，罗森布鲁姆曾是当时被称为 Partners HealthCare 的审计和财务委员会成员，他说，该组织没有动用储备金来定期支付费用是有道理的。但他也指出，这是该机构对其资金做出的选择，只将其投资于资本项目，而不是弥补未来的潜在缺口。

总部位于马萨诸塞州的国家卫生政策咨询公司 Freedman HealthCare 的首席执行官约翰·弗里德曼博士也指出，MGB 的现金和投资是度过接下来困境的福音。

“任何价值数十亿美元的组织在运营过程中都会遇到困难和挑战，”弗里德曼说。 “问题是，他们的情况是否比马萨诸塞州其他所有医疗机构都更糟糕？答案显然是否定的。他们做得更好。他们有丰富的储备。”

除了当前的财务压力外，削减开支还将有助于提高效率，这是一项长期努力的一部分，旨在更好地整合整个系统，特别是其两家旗舰机构——麻省总医院和布莱根妇女医院。

这一过程已经进行了一段时间，领导层放慢了重新考虑工作的速度，并通过减员来削减职位。高管们承认，日益增加的财务挑战加速了这一进程，并促使制定了更广泛的重组计划。11 月，高管们开始与整个组织 100 多名高级领导进行对话，讨论如何精简 MGB 的行政结构。

高管们表示，对麻省总医院管理结构的研究还显示，麻省总医院每名一线员工的管理人员数量超过行业基准，管理角色重复，管理人员层级繁多。虽然高绩效组织在前线员工和首席执行官之间可能有七八层管理层，但在麻省总医院布莱根分院的某些地方，管理层多达 15 层。

“麻省总医院布莱根分院显然正在努力整合、提高效率、削减成本，并大幅改变内部组织方式，”研究健康和社会政策问题的国家组织 Commonwealth Fund 总裁 David Blumenthal 博士说。“这是否会打造出一个更强大、更整合、一流的 [学术医疗中心] 还有待观察。我认为这对这个社区来说是一场豪赌，我们将不得不看看结果如何。”

MGB 的整合工作已经遭到了一些反对，尤其是在医生中。2022 年将各医院的大型医疗服务整合在一起的计划引起了一些临床医生的焦虑，他们担心被排除在决策之外，并增加系统的公司化。

随后在 2024 年 3 月，该系统宣布了更广泛的临床整合，将麻省总医院和布莱根妇女医院的 34 个部门合并。当时，高管们表示他们预计不会裁员。

该声明在员工队伍中引发了一场风暴，他们在城镇会议上发言，表达了对变革的持续不满。随后，工会成立，首先是 MGB 旗下的塞勒姆医院，然后是麻省总医院布莱根雇用的 300 多名初级保健医生。

虽然这些裁员主要针对管理人员和行政人员，但可能会进一步打击士气。

而像 MGB 这样的大型医疗机构在过去几周遇到了新的挑战，从联邦研究经费到医疗补助资金，一切都受到了威胁。周五，为该国大部分基础生物医学研究提供资金的国家卫生研究院宣布，将削减对研究经费“间接成本”的支持——医院、大学和其他研究机构依赖这些资金来支付基本运营费用。

高管们表示，他们不打算削减预算以应对可能出现的联邦资金减少，但他们表示，现在创建一个更健康的组织可以增强财务韧性，抵御接下来可能发生的任何事情。

题图：麻省总医院布莱根分院位于萨默维尔的公司办公室。David L. Ryan/Globe 员工

附原英文报道：

Mass General Brigham announces largest layoff in its history amid ongoing restructuring

Facing rising costs and hoping to make its sprawling network more efficient, the state’s largest private employer aims to cut payroll costs by over $200 million

By Jessica Bartlett Globe Staff,Updated February 10, 2025 

Mass General Brigham’s corporate office in Somerville.David L. Ryan/Globe Staff

Mass General Brigham said Monday it will let go of hundreds of employees in the next two months, the largest layoff in the organization’s history, as the health system grapples with anticipated financial shortfalls and ongoing operational challenges at its 12 hospitals.

With roughly 82,000 employees, MGB is easily the state’s largest private employer. Executives declined to say how many people would be let go, but said the target is to save at least $200 million annually, or approximately 2 percent of its salary and benefits costs. The cuts, which will occur this week and then again in a second round in March, would likely have rolled out more slowly over the course of years as the health system more closely integrates its hospitals, executives said, but have been sped up because of financial pressures.

“We are … facing the same unrelenting pressures affecting many health care systems across the country that are contributing to a projected budget gap of a quarter of a billion dollars within the next two years,” Jennifer Street, senior vice president of communications at Mass General Brigham, said in a statement. “We are acting now to allow us to continue with planned and future investments.”

Reductions will be focused on administrative and management levels of the sprawling organization, Street said, and will not affect front-line clinical workers or staff that supports patient-facing care. The system will also consolidate some roles and eliminate some vacant positions.

“If we do not take definitive action now to stabilize our financial health, we compromise our ability to continue to invest in our mission,” said MGB chief executive Dr. Anne Klibanski, in an email to employees that was obtained by the Globe.

The reductions may seem surprising for a health system that has posted positive operating margins each of the last two years, buoyed by a robust investment portfolio. In the 12 months ending in September, the most recent financials that are available, MGB reported a $45 million margin from operations, and a $2 billion net margin, on $20.6 billion in total revenue.

Experts looking at the system’s financials said its recent performance points to a level of resilience to face future challenges, at least compared to other Massachusetts hospitals that have less cash and smaller investment portfolios. In that context, said David Rosenbloom, professor emeritus at the Boston University School of Public Health, reductions may have more to do with becoming more efficient than to make up for losses.

“They are not currently challenged,” he said. “Are they worried about the future? Yes. When I taught hospital finance, I said the primary and virtually only rule of a hospital is maximize your revenue today because you don’t know what the bastards will do to you tomorrow … There may be (also) inefficiencies of scale, when you get as big as MGB.”

MGB executives have put forth a drumbeat of concern about their core operations, saying that much of their operating margin over the last two years has come from federal financial support lingering from COVID or other one-time federal payments, while they face a problematic long-term outlook.

They describe a system where costs are steadily rising faster than revenues — which mainly come from private and public insurers who are themselves under pressure to keep health costs in check. And while MGB is able to save some money through improved efficiency, they’ve reached a point where they need to rein in labor costs.

At the same time, like many health systems across the state, MGB’s hospitals are crowded, with demand for inpatient beds exacerbating backups that spill over into the emergency room. That has financial consequences too, as hospitals are largely reimbursed once for each discharge, regardless of how long the patient stays in the hospital. So while MGB’s hospitals are busier than ever, its revenue growth has been held in check.

One bright spot for the hospital system is the billions of dollars it has seen in investment gains over the past years. But earnings on that money are largely either restricted by donors to certain uses or earmarked to capital projects, such as a $2 billion expansion at Massachusetts General Hospital. It’s not available, they said, to plug financial holes in the core business.

Rosenbloom, who several years ago sat on the audit and finance committee of what was then known as Partners HealthCare, said it makes sense why the organization isn’t dipping into its reserves to routinely cover its expenses. But he also noted that was a choice the institution was making with its money, only to invest it into capital projects and not to cover potential future shortfalls.

Dr. John Freedman, CEO of Freedman HealthCare, a national health policy consulting firm based in Massachusetts, also pointed at MGB’s cash and investments as a boon to weather what comes next.

“Any multi-billion dollar organization has struggles and challenges in running itself,” Freedman said. “The question is, are they somehow worse off than all the other provider organizations in Massachusetts? The answer is a clear no. They are doing much better. They have rich reserves.”

Beyond current financial pressures, reductions will also help to achieve efficiencies as part of a long-running effort to better integrate across its system, and in particular across its two flagship institutions — Massachusetts General Hospital and Brigham and Women’s Hospital.

That has been underway for sometime, with leadership slowing rethinking jobs and eliminating roles through attrition. Executives acknowledged that the mounting financial challenges accelerated the process, and prompted a wider reorganization plan. In November, executives began having conversations with ultimately over 100 senior leaders across the organization to discuss ways to streamline MGB’s administrative structure.

Studies of Mass General Brigham’s management structure also revealed that Mass General Brigham had more managers per front-line worker than industry benchmarks, duplicative management roles, and many layers of managers, executives said. While high performing organizations may have maybe seven or eight layers of management between the front line worker and the CEO, in some places at Mass General Brigham, there were 15.

“Mass General Brigham is clearly trying to consolidate, become more efficient, cut costs, and dramatically change how it’s organized internally,” said Dr. David Blumenthal, president of the Commonwealth Fund, a national group that does research on health and social policy issues. “Whether it will result in a stronger, more consolidated, premier [academic medical center] remains to be seen. I think it’s a big gamble for this community and we will have to see what the outcome is”

There has already been some pushback to MGB’s integration work, especially among doctors. A 2022 plan to bring together large medical services across hospitals stirred anxiety among some clinicians, who worried about being shut out from decision making and increasing corporatization of the system.

Then in March 2024, the system announced broader clinical consolidations, merging 34 departments across Mass General and Brigham and Women’s. At the time, executives said they did not expect job cuts.

That announcement ignited a firestorm within the workforce, who spoke out in town meetings and voiced ongoing frustration about the changes. Unionizations followed, first at MGB-owned Salem Hospital, and then 300 more primary care physicians employed by Mass General Brigham.

While these layoffs are focused on managers and administrative staff, they could further strain morale.

And big healthcare institutions like MGB have encountered fresh challenges in the last few weeks, with threats to everything from federal research dollars to Medicaid funding. On Friday, the National Institutes of Health, which funds much of the country’s basic biomedical research, announced it would slash support for “indirect costs” for research funding — money that hospitals, universities and other research institutions rely on for basic operating expenses.

Executives said they did not plan budget cuts in response to possible reductions in federal money, but said creating a healthier organization now builds financial resilience to weather whatever comes next.