The announcement on Thursday stunned Brigham\u2019s leaders, who say they were negotiating with Dana-Farber for the past 15 months \u2014 including just this past weekend \u2014 to extend the relationship and jointly invest in new cancer facilities. Brigham\u2019s brass were confident they could seal a deal within weeks, according to people with direct knowledge of the situation.<\/span><\/p>\n

\u201cWe were thunderstruck,\u201d one of the Brigham people said. \u201cWe knew they had initial conversations with Beth Israel but we didn\u2019t take it seriously.\u201d<\/span><\/p>\n

In other words, Brigham executives <\/b>never entertained the notion that Dana-Farber would break up with them <\/b>after nearly 30 years to build a future alongside a hospital with less prestige and wealth.<\/span><\/p>\n

As recently as five years ago Dana-Farber would not have risked spurning Brigham and its parent company, Mass General Brigham. The state\u2019s biggest health system had unrivaled clout with doctors and insurers, guaranteeing a steady of flow of patients.<\/span><\/p>\n

And as the country\u2019s second largest recipient of National Institutes of Health research funding, Mass General Brigham could support the clinical trials vital to Dana-Farber\u2019s scientists.<\/span><\/p>\n

But MGH Brigham is no longer quite as powerful. Dana-Farber\u2019s decision to change partners only underscores that.<\/span><\/p>\n

The setback for Brigham is very much the product of two ambitious chief executives.<\/span><\/p>\n

Dr. Kevin Tabb, chief executive of Beth Israel Lahey, is on a mission to build a big, lower-cost competitor to Mass General Brigham and its elite hospitals, which include Massachusetts General Hospital, Mass Eye and Ear, and McLean Hospital.<\/span><\/p>\n

He scored big with the 2017 merger with Burlington-based Lahey Clinic, a deal that eventually included New England Baptist Hospital in Boston, Mount Auburn Hospital in Cambridge, and Anna Jaques Hospital in Newburyport.<\/span><\/p>\n

Secretly luring Dana-Farber away from Brigham will go down as one of the most audacious moves by a Boston hospital leader \u2014 even if Tabb did, as some people I spoke to believe, agree to give Dana-Farber a bigger cut of patient revenue than Brigham did.<\/span><\/p>\n

Meanwhile, Dr. Laurie Glimcher, Dana-Farber\u2019s CEO since 2016, wants the storied cancer institute <\/b>to have its own hospital like other top-rated cancer centers. But many in the industry, including Brigham leaders, believe cancer treatment works best when tightly integrated within a general hospital.<\/span><\/p>\n

Glimcher is also said to be leery of Mass General Brigham\u2019s ongoing consolidation of Brigham\u2019s and MGH\u2019s clinical departments to improve care and reduce costs.<\/span><\/p>\n

As part of its agreement with Dana-Farber, Mass General Brigham has kept the two hospitals\u2019 cancer operations separate. Glimcher was worried that the \u201cfirewall\u201d would eventually come down, according to the people I spoke with, who said there was little love lost between her and some Brigham leaders.<\/span><\/p>\n

Glimcher said Dana-Farber\u2019s deal with Beth Israel is \u201csolely driven\u201d by its desire to give Boston a hospital dedicated to adult cancer patients.<\/span><\/p>\n

Dana-Farber\u2019s contract <\/b>with Brigham runs through 2028. That\u2019s ample time for the institute to put together plans for Glimcher\u2019s coveted new hospital while soothing concerns among patients about what the change will mean for care.<\/span><\/p>\n

Don\u2019t be surprised if Mass General Brigham leaders try to stoke such worries and speculate loudly on what happens to patients if the new hospital \u2014 planned for where the Joslin Diabetes Center now stands \u2014 isn\u2019t ready in five years. (Joslin says it will relocate.)<\/span><\/p>\n

They will raise doubts that the Beth Israel deal will lower the cost of cancer care. And they will try to recruit Dana-Farber doctors who might not like the change.<\/span><\/p>\n

\u201cThis gives us time to leverage the reputation of Mass General Brigham, our incredible staff and researchers, and our balance sheet to build a world-class cancer center,\u201d said the thunderstruck Brigham honcho. \u201cWe\u2019re going to build the number one cancer program in the country, if not the world.\u201d<\/span><\/p>\n

Tabb and Beth Israel got the best of Mass General Brigham this time. The deal with Dana-Farber shifts the balance of power in Boston health care.<\/span><\/p>\n

But Mass General Brigham is still the force to be reckoned with. Its executives are mad \u2014 and determined to get even.<\/span><\/p>\n

\n
Larry Edelman can be reached at la***********@gl***.com<\/span>. Follow him @GlobeNewsEd<\/a>.<\/p>\n<\/div>\n