The following is the most comprehensive list of critical care hospitals in the Commonwealth lacking magnetic resonance imaging (MRI) capabilities: Fairview Hospital, Great Barrington. No such list should exist.
If you need an X-ray, Fairview has you covered. But if your physician needs advanced insight, it’s off to Pittsfield you must go. If Berkshire Medical Center (BMC) was two rather than 22 miles away, that might be fine, but there are times when proximity matters. In certain circumstances, a 35-minute drive to BMC could be life-changing—not in a good way.
MRI scans are principally used to diagnose conditions that affect soft tissues, joints, and injury to internal organs, including the brain, heart, spine, and digestive system. Certain conditions, such as strokes, are best diagnosed and treated using MRI rather than other imaging. A circumstance where a physician is not able to immediately obtain advanced imaging to diagnose a stroke patient could be subpar. The question becomes, then, is it boneheaded for Berkshire Health Systems (BHS) not to provide Fairview’s physicians with on-site MRI capabilities?
As is widely known, Great Barrington’s stellar Fairview Hospital has earned five-star accolades in those areas in which it practices. While major surgeries are not performed at Fairview, its maternity ward does a bang-up business. It is an acute care hospital—think in-and-out diner compared to BMC, which offers a full menu of healthcare capabilities. But even diners need grills and fryers to properly meet their customers’ needs.
BHS is a health system providing healthcare throughout Berkshire County that, to viably manage costs, quite reasonably does not provide all facets of care in every corner of the county. History shows that the county cannot financially sustain multiple hospitals providing the full spectrum of care at each facility. Thus, the Phelps Cancer Center in Pittsfield specializes in chemo and radiation therapies. In sparsely populated Berkshire County, one central facility treating certain chronic diseases, such as those treated at Phelps, makes sense. But for acute care, it is fair to wonder whether having a single central location with MRI capabilities makes sense.
As far as I know, BHS has not detailed the bases for having MRI capabilities at but one facility in the county, so the following is a (hopefully somewhat informed) supposition as to the grounds for its decision.
BMC offers all means of high-end imaging, including CT, MRI, and PET scanning. Fully trained staff run the expensive diagnostic equipment 24/7. Premium square footage in a specially-constructed facility is dedicated to imaging. From a purely financial perspective, it makes sense for BHS to drive as much traffic as possible to a single imaging facility. If cost recovery is BHS’ sole motivating factor, higher revenues in one location is the way to go. The problem is that driving traffic to one imaging facility causes patients to drive 25, 30, 35 miles for advanced imaging services, and that is if the patients can drive. If one is not ambulatory, BHS then needs to arrange for ambulance services at not inconsiderable expense, and ambulance services in the county are constrained at times. Of course, ambulance costs are borne by the patient or the patient’s insurer, so this is unlikely to be a financial consideration reflected on BMC’s balance sheet.
Let’s agree that, from a purely business perspective, less competition is generally better. Dunkin’ would prefer that Starbucks not open up next door. But healthcare is not morning coffee, and BHS is not, after all, a profit seeking purveyor of snacks.
While it is likely that physicians would prefer to have MRI capabilities readily available at Fairview Hospital, I would like to be very clear that I am not aware of a single instance of an adverse outcome resulting from the hospital’s lack of advanced imaging technology. On the other hand, one can easily surmise there could be adverse consequences.
Let me acknowledge that it is generally untoward for a layperson to second-guess the complex decisions of dedicated, seasoned hospital administrators, but I won’t let that stop me. I think I am in good company suggesting that every hospital in the state should have MRI capabilities, and I say that because every other hospital administrator in the state has reached that conclusion. That is, all other hospital administrators in the state have determined that MRIs, like scalpels and Tylenol, are essential to their hospitals’ toolkits. And around the country in 2019, there were 40.4 MRI machines per million Americans, which implies that you would expect five MRI facilities in the county rather than one or two. Not a good look for Berkshire County.
There was another hospital in the state without an MRI on site, sharing the equipment with a nearby facility. In 2013, Winchester Hospital applied to the Massachusetts Department of Public Health to make the case that it needed an MRI on site (an application that was granted). The hospital supported its application with the following statement, which sounds right:
“This lack of existing on-campus MRI services at WH is not ideal from a timeliness and care experience perspective, particularly for inpatients and emergency department (‘ED’) patients who require urgent access to MRI services to diagnose and treat acute or emergent conditions. Moreover, WH inpatients and ED patients in need of an MRI during the hospital visit must be transported via ambulance to the clinic and back to the Hospital, resulting in additional costs. This current arrangement disproportionately impacts older adults — who make up substantial percentages of both WH’s and the Applicant’s patient panels — as they are typically higher-acuity and have complex care needs, are at higher risk for adverse outcomes during transport, and often have fixed incomes. The Proposed Project [MRI] will address these concerns …”
Winchester Hospital convinced the Department of Public Health of its need for an MRI on site. The question is, what will it take to similarly convince BHS of Fairview Hospital’s need?
Let me also posit that BHS may be looking at this the wrong way. Rather than assuming that MRI capabilities at Fairview will take too large a slice of the imaging pie away from BMC, maybe experience will demonstrate that a second imaging facility will increase the size of the imaging pie. Maybe patients in Hillsdale, Copake, Salisbury, and points in between, if given a choice, will prefer to travel to Fairview rather than Sharon Hospital or Columbia Memorial Health. No shade intended toward those institutions, but given the choice, I know I would always prefer to travel to five-star Fairview Hospital for care.
We have not addressed the considerable cost to outfit a hospital with an MRI. Depending on the bells and whistles, an MRI ranges in cost from about $250,000 to $500,000, and that is solely for the imaging machine. In addition to the MRI, BHS would also have to construct a customized room to house the MRI, would have to consider staffing (but current imaging staff is likely cross-trained on MRIs), and other sundry items that will add to the cost. If Fairview Hospital is space constrained, mobile MRI facilities cost about $450,000. Just a thought.
I think I can say with some certainty that, if Fairview expressed this need to the local community, that community, in a heartbeat, would be tripping over itself to raise funds to cover the anticipated costs to permanently locate an MRI there. The community feels that having MRI capabilities at Fairview Hospital would enhance the image, and imaging, of an already acclaimed institution. As has been shown many times over the decades, the community has Fairview’s back. All the Fairview Hospital community can ask is that BHS has Fairview Hospital’s back as well.
