Mass General Brigham says it is saving more lives. Some doctors aren't so sure.

BOSTON — In a November 2024 meeting for Mass General Brigham doctors, Dr. Giles Boland, president of Brigham and Women's Hospital, articulated a vision aimed at making the health system the premier institution in the nation. He stated that following the corporate merging of its hospitals, the organization was on track to achieve this goal by focusing on delivering optimal patient outcomes, particularly the imperative of saving lives.

Boland highlighted Mass General Brigham's advancements in a metric known as observed-to-expected mortality, which evaluates the actual deaths of hospitalized patients against the anticipated number of deaths that should occur based on their severity of illness.

"This serves as a motivating force for our team," Boland remarked in the meeting, a recording of which was acquired by the Globe. "We can take pride in our achievements."

Nearly two years later, executives at Mass General Brigham assert that their successes have continued to amplify. By refining quality metrics and enhancing their focus on such measures, they claim to have improved healthcare quality and saved a minimum of 1,400 additional lives.

Leaders attribute these improvements to significant advancements in quality rankings from Vizient, a healthcare analytics firm that Mass General Brigham regards as the industry's gold standard. These rankings assess numerous metrics, including mortality rates, hospital-acquired infections, and the duration of patient stays. Unlike the U.S. News & World Report's rankings, which consider reputational assessments from physician voting, Vizient’s evaluations are solely based on measurable outcomes.

Despite their academic and clinical excellence, Mass General Brigham had seen a decline in Vizient's rankings over the preceding two decades, acknowledged by leaders who suggested that certain aspects of routine patient safety had been overlooked. Just four years ago, Massachusetts General Hospital (MGH) and Brigham and Women's Hospital ranked 96th and 72nd, respectively, among their peers. With recent reforms, they reported improvements to 37th and 36th places by 2025.

"It is remarkable work," stated Dr. Rachel Sisodia, chief quality officer at Mass General Brigham. "It is transformative, and that is why we emphasize it."

However, a segment of the medical community remains skeptical about the claimed reduction in mortality rates. Some physicians question whether these achievements stem from genuine clinical enhancements or merely from administrative modifications in data reporting, such as increased hospice admissions and improved clinical documentation. They contend that there hasn’t been a significant decline in patient deaths and believe that Mass General Brigham's emphasis on these improved figures distracts from critical operational issues like prolonged wait times for specialist appointments and inadequate primary care access for existing patients.

This skepticism is exacerbated by longstanding concerns among clinicians regarding the increasing corporatization of the health system since the hospitals began to integrate in earnest. Many believe that the physician perspective has been marginalized in strategic decision-making and express distrust toward the motivations of leadership.

"Very few doctors are pleased with this integration, leading management to persuade clinicians that this is a positive development because quality of care is improving," remarked Dr. Mark Eisenberg, a primary care physician and addiction specialist at MGH. "It feels like a propaganda campaign."

Seemingly amazing feat

At first glance, the reported achievements appear astonishing.

In an email to staff, Chief Medical Officer Dr. Will Curry noted that Mass General Hospital managed to halve its mortality ratio by the conclusion of September 2024.

Typically, when the number of hospital deaths aligns with the expected figure, the mortality ratio is approximately one. Dr. Curry reported that MGH had reduced its ratio from 1.1 to a record low of 0.62.

An analogous memo from Brigham and Women's Hospital indicated that in early 2024, the institution had "set the bar for all of MGB" regarding observed-to-expected mortality.

By March 2025, a post on Mass General Brigham's website highlighted that the system's integrated approach to quality and safety had crucially resulted in the reported saving of more than 1,400 lives at both the Brigham and MGH between January 2023 and December 2024.

Among the successes attributed to this achievement were timely interventions aided by an early warning system utilizing predictive analytics to flag at-risk patients, in addition to enhanced infection control measures. Integration had purportedly facilitated a more cohesive approach to monitoring and addressing these issues.

The article further suggested that improved clinical documentation practices played a role; however, the emphasis remained on the advancements in the quality of care provided.

"By maintaining an unwavering emphasis on quality, we are not only improving metrics — we are also providing families with invaluable time with their loved ones, which encapsulates the essence of our work," Sisodia expressed in the post.

For years, the health system had asserted that unifying its hospitals would enhance patient care by standardizing protocols and reporting practices. This article underscored that these efforts had culminated in significant outcomes.

This mortality achievement was reiterated in a July 2025 post, followed by further acknowledgment in the system's annual financial records in December 2025.

CEO Dr. Anne Klibanski reinforced the organization's accomplishments in a communication to staff, subsequently posting to the system's website, asserting that in terms of mortality, the Brigham ranked fourth while Mass General secured the 15th spot among 122 academic medical centers.

Mass General Brigham's leadership attributed this progress to years of incremental work. Their initial focus on enhancing quality began with refining the data they collected, which included ensuring accurate documentation of patient illness severity, as noted by Sisodia in an interview. Adjusting patient classifications on paper can influence expected mortality rates. Although the shift, initiated in January 2023, resulted in a favorable reduction in mortality ratios, Sisodia noted it was more about comprehending the health system's baseline.

Furthermore, the organization expanded its hospice services in September 2023 to offer improved support to dying patients and their families, recognizing that it had fallen behind peer institutions in providing such care.

According to Sisodia, these advancements aligned Mass General Brigham with national averages. Subsequent to this, the implementation of the early warning system in late 2024 further propelled decreases in mortality rates, facilitating timely clinician interventions based on patient metrics.

In October 2025, there was a notable focus on managing sepsis, which involved acquiring machines to conduct more blood tests and establishing workflows to pair appropriate antibiotics with specific infections, among other strategies.

Over the past year and a half, various units within the system's hospitals initiated weekly huddles where leadership, nurses, and clinicians collaboratively reviewed their performance against established quality metrics.

During a session in early May on a medical/surgical floor at Newton-Wellesley Hospital, hospital leadership and frontline clinicians analyzed the unit’s data, including a recent mortality case and initiatives aimed at reducing catheter-associated urinary tract infections.

"We don't rely on hope each week that our patients will avoid catheter-related infections," stated Kyle Dolan, nurse director at the hospital, while presenting metrics on a display screen. "It's about the diligent work we undertake daily."

Some clinicians asserted that these efforts were indeed translating to lives saved.

"These genuinely result in harm-reduction outcomes," stated Dr. Steven Pestka, an internal medicine physician at Newton-Wellesley Hospital. "There are tangible, meaningful changes in our practices that are benefiting patients."

Other medical professionals expressed support for the quality initiatives. A specialist at MGH remarked that the reduction in infections had genuinely enhanced quality and praised the improved collaboration among healthcare providers.

"It is the right thing to do for patients," said the specialist, who requested anonymity due to constraints around speaking to the media. "I would give the organization the benefit of the doubt. There is a genuine intent to enhance quality and reduce mortality."

However, the specialist also noted the challenge in determining precisely how many lives saved could be directly attributed to the institution's recent quality enhancements.

In reality, the reported mortality achievements had prompted eye-rolling among numerous clinicians for months.

Doctors' theories

From interviews with nearly ten doctors, several theories about the situation emerged. Few believed the quality improvements had genuinely resulted in over a thousand lives saved, and none credited MGB’s integration as a contributing factor. The interviewees largely chose to remain anonymous, citing concerns over professional repercussions.

One physician at Brigham speculated that MGB was increasing the enrollment of patients in inpatient hospice care. Deaths of these patients, which occur under the auspices of an external hospice agency while at MGB facilities, do not factor into the hospital's mortality statistics.

Indeed, internal MGB presentations have suggested increased hospice enrollment as a method to bolster mortality data, as gleaned from documents reviewed by the Globe. According to slides from an October 2024 meeting for MGH physicians, increasing hospice enrollment was categorized as a "priority," aiming to elevate admissions from two to three cases weekly to between 10 to 15. The hospital flagged enhancements in the ease of enrolling patients into hospice care, alongside aims to expand hospice capacity.

The advantages of these changes extend to patients, staff, and families, who could benefit from additional bereavement support. Of note, a final bullet triumphantly asserted, "Increasing [hospice] enrollment may also result in improved inpatient mortality performance — a [hospice] death does not count as an inpatient death," with that particular phrase noticeably emphasized.

The slides indicated that improved utilization of hospice correlates with lower mortality ratios at the Brigham. During the second quarter of 2022, only 15 patients were enrolled in inpatient hospice, with a mortality ratio around 0.9. A year later, hospice enrollment surged to 93 patients, accompanying a drop in the mortality ratio to nearly 0.7.

In response to inquiries, MGB stated that the Brigham's approach to hospice care in 2022 was not intended as a mortality initiative, deeming it simply an enhancement of patient care that preceded the quality improvement efforts.

Furthermore, during the period in which MGH’s mortality ratio decreased, internal MGB documents indicated a rise in inpatient hospice admissions at Mass General, from roughly less than a dozen each month during the first half of 2024 to 20 in July and 26 by August of that year. MGB noted it could not verify these figures, which organizational leaders presented to physicians.

The analytics firm, Vizient, has discussed the correlation between increasing hospice admissions and enhanced mortality outcomes in various presentations and podcasts.

While the interviewed physicians did not allege inappropriate hospice enrollment, they acknowledged that patient access to hospice can provide essential support, albeit without necessarily leading to a reduction in mortality. They emphasized that the shift appears superficial.

"This transition is deceptively superficial," asserted the Brigham physician. "It's an administrative alteration that doesn't compromise patient care; rather, it constitutes a sleight of hand."

MGB contested the claim that the increase in hospice utilization significantly influenced the observed decline in mortality scores. The health system opted not to disclose the proportion of hospital deaths occurring in hospice settings over time, which some doctors suggested had risen, stating it did not track such metrics.

A general medicine physician at Mass General Brigham concurred that the integration or the quality improvements resulting from it were unlikely to be the primary reasons behind the reduced mortality. Beyond hospice enrollment, this physician highlighted enhanced clinical documentation practices, commonly referred to as coding, as contributing to elevated expected mortality figures.

An internal presentation from 2022 on coding noted that Mass General Brigham had developed tools to efficiently extract diagnostic information from its electronic medical records. One of the primary benefits mentioned was the potential for improved mortality statistics.

Such strategies have been employed in other health systems and advocated by Vizient.

MGB executives recognized that improved coding contributed to enhanced mortality scores at the outset. Nonetheless, some physicians expressed concerns that it played an outsized role in the reported outcomes.

"Either they believe we are uninformed, or they simply misunderstand," commented the general medicine physician. "If integration truly led to such a significant drop in inpatient mortality, it should be headline news in the New England Journal of Medicine, not just a story in the Globe."

A fourth anonymous physician from MGH critiqued the mortality figures, likening them more to an exaggerated marketing claim rather than a reflection of scientifically grounded medical work.

"The disheartening aspect is that this phenomenon reflects a broader societal trend — inflated statistics presented by authorities to promote an agenda," remarked the doctor. "This fundamentally undermines the trust we place in our system."

An integration reason

Beyond the crucial goal of saving lives, executives at Mass General Brigham emphasized that mortality metrics are vital for various reasons, including their link to reimbursement models from federal and state insurance programs. This framework incentivizes health systems to prioritize quality care over mere volume of services provided.

Other health systems have connected these metrics to employee compensation. Although Sisodia noted that she was not privy to the pay structures of all MGB staff, employees are incentivized to meet systemwide quality objectives, a key component of which is the mortality ratio.

While MGB officials claimed to analyze numerous statistics, including actual clinical deaths across units, they maintained that the mortality ratio is their most effective metric, as it adjusts for patient illness severity and permits comparisons to other hospitals.

Their primary takeaway is that clinicians are learning from their practices to spur improvement.

"I understand some voices argue, 'This is merely about hospice or data manipulation.' That narrative is simply inaccurate," Sisodia stated. "And that perspective is appealing because it allows people to avoid confronting the fact that we may not have performed as well as we should have in the past."

Recently, Sisodia indicated that hospice enrollments across the system held steady from January to March; however, MGB's mortality ratio nonetheless declined from approximately 0.65 to 0.46.

One physician attributed this decrease to a normalization following a seasonal flu spike, with negligible differences observed relative to the previous year.

Several physicians suggested that MGB might be more focused on marketing around the integration of its hospitals than on actual patient care.

In many of the communications celebrating the mortality metrics, organizational leaders have pointed to the success of merging hospital teams and services as evidence of effective integration. They assert that the system now operates with a cohesive strategy, with all members aligned toward common goals.

However, concerns over the shift toward a more centralized system have left many clinicians frustrated, feeling their insights have been overshadowed by corporate decision-making. Among the controversial decisions was a 2024 announcement to consolidate clinical services across flagship hospitals, resulting in departments that some physicians argue have become too large, hindering their access to leadership. The integration has also been cited as a contributing factor to significant layoffs in 2025 that reportedly affected about 1,500 employees.

"MGB is invested in promoting a narrative that the merger is advantageous for all parties, claiming success is linked to patient benefits," noted the Brigham physician. "Absent such a narrative, coupled with the difficult decisions made, motivating employees becomes increasingly challenging."

The general medicine physician contended that MGB ought to prioritize resolving its lengthy appointment waitlists.

"You are promoting your services nationally to attract new patients while neglecting access for those already within your care," the doctor said. "This is highly concerning. When they assert that integration is beneficial — for whom is it truly advantageous?"

The discontent surrounding the mortality statistics reflects broader dissatisfaction with the health system's leadership. A 2025 employee survey indicated that only half of the respondents expressed confidence in leadership, echoing a similar sentiment from a survey conducted two years earlier.

Mass General Brigham's experience is not unique; other health systems also closely monitor and advertise success in improving mortality metrics.

Dr. Eric Dickson, CEO of UMass Memorial Health, stated that all hospitals strive to reduce mortality rates.

However, Dickson has refrained from publicly celebrating improvements as significant lives saved. He referenced Harrington Hospital, where patient care factors remained constant, yet the mortality ratio saw a drastic reduction from 2 to 0.5 following UMass's acquisition and subsequent implementation of technology to ensure comprehensive documentation of illnesses.

Ultimately, Dickson affirmed that mortality ratios serve as critical indicators for assessing hospital performance; they should be considered alongside other metrics. Administrative adjustments may improve these scores, but they cannot transform a poorly performing hospital into one that excels.

"You can only manipulate [quality measures] to a certain extent," Dickson emphasized. "You can’t fabricate excellence from abysmal standards."