BOSTON (State House News Service) — Hospitals in Boston and on Cape Cod won regulatory approval Wednesday to add dozens of beds to their operations, changes that hospital leaders say will relieve pressure amid a sustained capacity crunch.

The state Public Health Council gave Massachusetts General Hospital in Boston permission to tack another 94 beds onto its license, and similarly allowed Cape Cod Hospital in Hyannis to expand with 32 more beds.

In both cases, officials from the facilities and their associated health care systems described facing substantial challenges that have often pushed occupancy above traditional industry standards.

"We started the day, for example, with 62 patients in our emergency department who would spend the night waiting for a bed [and] another 20 in the post-anesthesia care unit waiting for a bed," David Brown, president of Mass General Brigham's Academic Medical Centers, told the council. "We are forced to refuse requests for transfer from hospitals across the region for care that is deemed can't be delivered at those referring hospitals."

MGH and its parent system, Mass General Brigham, will be allowed to increase the number of licensed beds in the hospital's main campus medical and surgical rooms from 900 to 994, according to the PHC.

The move amends a determination the Public Health Council awarded MGB in 2022 for a massive, $1.9 billion expansion project, following through on conditions regulators attached to hospital's desire for another 94 beds.

Although the council signed off on much of the expansion two years ago, they said at the time they did not find a "clear and convincing need" for an additional 94 licensed beds, according to Dennis Renaud, director of the determination of need program at the Department of Public Health. He noted a Health Policy Commission review in January 2022 found that increase in capacity could boost MGB's market share by 2.7 percent to 3.8 percent, "resulting in increased health care spending, increased commercial insurance premiums and a negative impact on health care market functioning, including access and equity."

As part of that 2022 process, Mass General was required to submit data on the number of patients waiting for beds and other factors if it wanted to pursue the 94-bed growth.

Much of that information landed before regulators in the buildup to Wednesday's vote. MGH told the state that in fiscal 2023, more than 24,000 patients boarded in the emergency department while waiting for an inpatient bed.

In fiscal year 2019, about 85 percent of the main campus's inpatient beds were occupied, which is roughly around the industry standard, according to data presented at Wednesday's meeting. By fiscal year 2023, that had increased to nearly 96 percent.

Over the same span, the wait time for people boarding for a medical or surgical bed increased from about 12 hours to 20 hours, according to information presented to the PHC.

"We've done a lot to try to make sure that we can decrease the number of patients who leave without being seen," said Ali Raja, the executive vice chairman of MGH's department of emergency medicine. "The fact is that when patients are boarding in the emergency department, they're occupying spaces that could otherwise be used for patients who are waiting in the waiting room, and sometimes sadly, out of frustration in that wait, patients leave and hopefully go somewhere else for care. But in some cases, they just don't get care at all, which is exceptionally unfortunate."

"This past calendar year, we had about 5,000 patients leave without being seen," Raja added. "We estimate that about 10 percent of those patients would have been admitted, so we're talking about 500 patients who ended up potentially deferring [care] or hopefully getting care elsewhere."

Some providers and facilities have been sounding the alarm in recent months about a lack of available capacity, one of several pressure points that Beacon Hill must weigh as policymakers consider a wide range of health care reforms.

House Speaker Ron Mariano has targeted addressing "serious problems in health care" as a priority, especially amid upheaval at Steward Health Care. While the Quincy Democrat has long had his eye on overhauling the determination of need process and subjecting large hospital expansions to greater scrutiny, his branch has not put major legislation on the table yet this term.

At MGH, the hospital was in either "Code Help" or "Capacity Disaster" status -- which refers to times when there are too few beds to serve patients for whom admission to the hospital is deemed clinically appropriate -- on nearly one in four days in fiscal 2019. In fiscal 2023, that share rocketed up to 93 percent of days, system leaders told the PHC.

Mass General officials estimated that they will not incur any notable new costs by adding the new beds other than the one-time expenses of moving patients, suggesting that the physical and staffing infrastructure already exists and they need permission to update their license. The larger expansion project involves shifting hundreds of beds to the under-construction building, and with the PHC's approval Wednesday, the hospital will keep more existing beds online after the change.

"The patients are already here on our campus. They're in our hallways, in our emergency departments, and we've deployed teams of care providers to care for them," Brown said. "Those care providers will migrate with the patients to the expanded capacity beds upstairs if this amendment is approved and when those beds come online."

The Cape Cod Hospital expansion will carry about $14.6 million in capital costs and $8.9 million in annual operating expenses, according to a summary Renaud provided. New beds will be installed by building out "shell space" that regulators previously approved.

Cape Cod Healthcare officials said the beds will help them better manage a sharp uptick in demand that has created headaches.

Cape Cod Hospital reported an average medical and surgical occupancy rate of 91 percent -- several points higher than the 85 percent industry standard -- from fiscal 2021 through fiscal 2023. The number of patients who boarded in CCH's emergency room for 12 hours or longer increased from 1,490 in fiscal 2021 to 2,403 in fiscal 2022, Renaud said.

Mike Lauf, CEO of Cape Cod Healthcare, said the system needs the additional 32 beds "to take care of our community."

"As I speak to you this morning, we're in 20 beds over our licensed occupancy," he said. "We've run that way for over 33 percent [of] this past year alone, and in the last six months, almost every day."

Written by Chris Lisinski/SHNS.