“The layoffs may well have been appropriate,” said Dr. John Freedman, CEO of Freedman HealthCare, a Massachusetts-based national health policy consulting firm. “Even though they are profitable, they may have needed them. Sometimes it’s good to organize. But it does call into question the alarm they shared at the time that they had to do that or they would be in big trouble.”
Friday’s financial report not only shows the maneuverability of the state’s largest employer, but stands in contrast to some other Massachusetts hospital groups, several of whom reported multi-million dollar operating losses in the last year.
“MGB (is) spending a lot of money on building and investing in stuff despite (headwinds) and are able to show a robust bottom line, which is incredibly impressive,” Freedman said. “I wish that were able to be true for the rest of our providers.”
Construction last year on two new patient towers at Massachusetts General Hospital.David L. Ryan/Globe Staff
Revenue from patient activities grew nearly 8 percent this year to $14.5 billion, as the hospital saw more patients and reduced the length of time each patient was in the hospital. Additionally, the system grew health plan revenue and diversified other areas of revenue growth, contributing to a $22.8 billion operating revenue.
Employee compensation and benefits expenses also grew 8 percent — which included the cost of restructuring, alongside higher pharmaceutical expenses, contributing to an operating expense of $22.7 billion.
Mass General Brigham declined to make an executive available to talk about the results, but chief financial officer Niyum Gandhi said in a statement that the organization would continue to invest in innovation, patient care and community health.
“Healthcare is transforming — and Mass General Brigham is helping define what’s next,” Gandhi said. “In 2025, our system advanced care, strengthened research, and invested in its people, all while navigating complexity across healthcare.”
The organization downplayed its non-operating margins, saying the gains and losses on investments vary due to the volatility in the market. While the system said it relies on operating revenue to pay for things like staff, equipment, maintenance and medical supplies, investment returns typically fund capital projects and major renovations.
There is no shortage of those. The system has undertaken a $2 billion expansion of Mass General Hospital, which is expected to open in 2027, and announced this year it would replace the main building at Brigham and Women’s Hospital.
While this year’s $1.8 billion in investment income may largely exist on paper, Freedman said he viewed those gains as identical to earnings, as investments can be liquidated and used for whatever the health system wants.
“I think it’s disingenuous when they minimize it when the numbers go up,” Freedman said. “When the numbers go down they say, ‘oh my God, we got slaughtered and look how much money we lost.’ They can’t have it both ways. They have had two years of outrageously positive returns. They are able to generate them because they have enormous reserves that no other provider has. Some other providers can’t even come anywhere close. That’s not really fair. That counts.”
The different finances and outlooks of the hospitals in the state are mirrored nationwide, said John McDonough, a professor at the Harvard T.H. Chan School of Public Health.
“We’ve got two definite tiers,” McDonough said. “The high fliers — what some people call the mega providers — who are doing in general pretty well. And the others — the independents, safety nets, rural (hospitals), who are more than struggling. They are, in some cases, desperate.”
Those differences will dictate how providers fare in the years ahead. And there are no shortage of challenges.
MGB recently announced plans to replace the main building at Brigham and Women’s Hospital in Longwood Medical Area.Pat Greenhouse/Globe Staff
Research revenue has been increasingly imperiled. Changes to subsidies for health insurance may increase the number of uninsured individuals in Massachusetts in the years ahead, pressuring providers. Medicaid cuts may present further challenges further down the line.
Some poorer systems may not survive, McDonough said. For those who do, it may be a bumpy ride, but one with immense promise.
“Whenever a rocky period like this happens, there is a shakedown,” he said. “It’s tough for everybody to get through. The ones that do will find life to be even better on the other side. The rich get richer, and the poor get poorer.”
Paul Hattis, a senior fellow at the think tank the Lown Institute, said part of how the rich stay rich is staying ahead of anticipated changes. He pointed to MGB’s layoffs as a proactive step amid a tighter financial outlook.
But Freedman noted that Mass General Brigham will likely face less pressure than some other providers from Medicaid cuts and growing ranks of uninsured patients. And as hospital providers writ large enter a period of uncertainty, MGB is in a considerably stronger position.
“It’s a good thing for the Commonwealth they are doing well, don’t get me wrong,” Freedman said. “But I’m worried about the others. And I fear as the others get disproportionately harmed by federal policy, that that may either overtly or covertly encourage more consolidation … When a hospital system gets weakened and the docs have to run somewhere, it’s convenient to run to MGB.”
Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.