No Middle of the Night Deals for Hospitals, Redux: Guest MINDSETTER™ Dr. Michael Fine
Saturday, May 25, 2019
In a bill introduced at the end of the legislative session two years ago, the legislature rushed to modify The Hospital Conversions Act to allow the fire sale of Memorial Hospital to Prime Health Care, a for-profit company based in California. Do the Memorial deal quickly, legislators were told, or we risk losing both Memorial and Care New England, which wants to merge with Partner’s Health Care in Boston. A tiny change in the emergency conversion section of the Hospital Conversions Act was supposed to allow both deals to go through quickly.
So much for that critical legislative effort. Memorial closed and the Partners deal hasn’t been finalized.
Now Lifespan is campaigning to stop the Partners deal all together. Experienced observers have their eyes peeled for more late introduction legislation to make the Partners deal impossible.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTAll this hue and cry is evidence of the on-going failure of health policy and health policy leadership in Rhode Island. Ad hoc, deal by deal legislation is no way to understand or improve health spending, policy or public health outcomes.
There is some evidence that hospital competition helps keep hospital costs down, an argument for the acquisition of CareNewEngland by Partners, which would provide for that competition meaningfully. Keeping hospital costs down is critical for the state’s economy, since 64 percent of hospital revenue is public money, in the form of Medicare, Medicaid, and public employee insurance payments.
But that said, selling CareNewEngland is a bad deal for Rhode Island. The Hospital Conversions Act is twenty years out of date, and needs urgent reform.
Moving control over a significant portion of the hospital system out of state is fraught with risks. No one knows how regulators in Boston will approach problems unique to Rhode Island. No one want to be trapped on Route 95, trying to get a sick loved one or friend to chemo on time or to see a specialist who is only in Boston because we’ve allowed a divide and conquer approach. Worse, the sale of CareNewEngland will allow the consolidation of administrate functions, which is a good thing, but the benefit of that consolidation will accrue to our colleagues in Massachusetts, and not to Rhode Island taxpayers. The sale of CareNewEngland to Partners represents the worst sort of medical colonialism, and in, its own way, a modern version of taxation without representation.
The only sensible pathway forward for the Rhode Island is to merge CareNewEngland and Lifespan. And the only way to do that is to take meaningful public control over our hospital system for the first time, since we are paying for it anyway.
It’s necessary to merge CareNewEngland and Lifespan in order to construct a single clinical entity that is large enough to be medically meaningful and that can achieve meaningful efficiencies by having a single administration. We are a million people. We only have so many heart attacks (thank goodness) so many strokes, so many people with pancreatic cancer or lung cancer, and so many babies (though that number is shrinking, year over year). Putting all our resources together helps our clinicians build and maintain their expertise by working together to take care of all these diseases and conditions. And having multiple sets of administrators, boards, and bean counters only adds cost. All those extra people do is get in the way of clinicians doing their jobs.
The strength of hospital medicine in Rhode Island has always been the tunnel that connects Rhode Island and Woman and Infants Hospitals. Our clinicians have always collaborated, even then their leadership and our politicians don’t. Having one entity means one set of surgeons, one set of anesthesiologists, one set of critical care clinicians and one set of obstetricians. Years of experience teaches the critical mass is necessary for clinicians to achieve the best outcomes. For the last twenty years, we’ve allowed politics and personalities to stand in the way of those best outcomes.
But to merge those entities without creating robust public oversight invites fiscal disaster. A monopoly hospital system without public governance and a publically determined budget will allow that system to use its monopoly power -- and drain the public treasury dry. And to merge those entities without putting all the savings from merging them into a system of primary care practices and community health centers that provides primary care to all Rhode Islanders misses the opportunity to create the best health care system in the nation and the world.
Of course, there are roadblocks to a merger of this size, roadblocks that have to do with egos and with Federal Trade Commission rules. Egos need to be addressed by the leadership of our elected officials, and by using all the many public policy leavers that leadership has as its disposal. Antitrust concerns can be addressed by the creation of a Hospital Regulatory Commission, and by giving that commission oversight of hospital budgets, hospital quality outcomes, and charitable assets, so we make sure hospital function in the public interest, and so don’t find ourselves with another mess like the pension disaster that followed the merger of St. Joes with Chartercare.
I call on the Attorney General to sit down with the Health Insurance Commissioner and the Director of the Rhode Island Department of Health tomorrow --to draft legislation creating a Hospital Regulatory Commission and submit it the legislature as soon as possible. I call on the Speaker and Senate President to pass that legislation forthwith, after a vigorous and open public debate, now, in open session, not in the middle of the night. I call on the Governor and the President of Brown to use all the many policy levers at their disposal – Medicaid spending, state employee insurance spending, support of grant funded research and pathways to academic advancement -- to incentivize and encourage a merger of CareNewEngland and Lifespan, starting tomorrow.
This mess has been allowed to fester too long. Now it’s time for doctors to care for patients, and for leaders to lead.
Michael Fine, M.D. was the Director of the Rhode Island Department of Health 2011-2015
Related Slideshow: 7 Implications and Unintended Consequences of a Care New England and Partners Merger
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