Thousands in RI Could Lose Primary Care Services as Multiple Groups to Disaffiliate

Thousands in RI Could Lose Primary Care Services as Multiple Groups to Disaffiliate

Thousands of Rhode Islanders are now learning that their primary care doctors' offices are disaffiliating with their current healthcare group. 

The group of primary care physician offices is associated with CharterCARE. Letters and emails began being sent out last week by the practices to patients.

The change may cause disruption for thousands of patients.

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CharterCARE Medical Associates, located at 851 Main Street in Warren, wrote to patients, “In the coming few weeks, CCMA staff members will be available to assist you to follow up on this letter, to answer any questions, and to assist you however possible with this transition. We ask for your help and patience as these changes take place. We will assist with the transfer of your records to any newly selected provider.”

“We greatly value our relationship with you, and it is our sincere hope that you maintain your care relationship with CCMA,” said the letter.

 

CharterCARE Confirms “Disaffiliation”

Otis Brown, spokesperson for CharterCARE, tells GoLocal in an email, “CharterCARE has made a strategic decision to disaffiliate with four provider groups.”

“In each case, patients are given the option to seek care at other CharterCARE Medical Associates practices in close proximity. In most cases however, these practices will remain open with existing providers under a new practice group,” said Brown.

Brown added, “The office staff do have the option of applying for open positions across the CharterCARE system.”

 

CharterCARE Facing Merger and Major Financial Challenges

Presently, CharterCARE is under review by the Rhode Island Department of Health (RIDOH) and the Attorney General’s office for a proposed proposed sale by Prospect Medical Holdings to the Centurion Foundation.

According to the foundation's most recent tax documents, Centurion is Georgia-based — with just one full-time employee.

 

Financial Issues - Unpaid Bills

Prospect, who has owned CharterCARE for more than a decade, is facing significant financial issues.

In November, RIDOH issued an Immediate Compliance Order requiring the owners — Prospect  — of Roger Williams Medical Center and Our Lady of Fatima Hospital to ensure the continuity of health services and care at the facilities by acting immediately to stabilize the two facilities financially. 

According to the department, bills for supplies are going unpaid, and a result, nearly 20 surgeries had to be cancelled in October.

This Immediate Compliance Order was issued to Prospect Medical Holdings and related entities after a review by RIDOH determined that Prospect’s underfunding of the hospitals is impacting operations.

 

Primary Care Issues Across Rhode Island

According to the Rhode Island Office of the Health Insurance Commissioner (OHIC) in a report issued in December of 2023, "The evidence is clear. Primary care is the foundation of an equitable and high-performing healthcare system.OHIC recommends specific actions in the domains of primary care payment, reduction of administrative burden, and targeted incentives to attract and retain primary care providers in the state. The themes we heard most consistently from primary care providers related to workforce capacity, fears about the future trajectory of the workforce due to retirements, and administrative burdens due to utilization review practices and use of electronic health records that lead to clinician burnout.

 

OHIC Issues a Range of Recommendations

Some of OHIC's recommendations include:

1. Increase insurer payment for primary care so that it more closely approximates other medical specialties and is more competitive with neighboring states.  Increased payments should be achieved through increased reimbursements for evaluation and management and other medical services when provided by primary care providers and through capitated payment arrangements

2. that support team-based, high-quality patient panel care. The increase in primary care payment should be effectuated while constraining total medical spending growth to the State of Rhode Island’s per capita cost growth target.

a. OHIC will amend the agency’s primary care expenditure target in 2024 to better align the agency’s legacy measurement methodology with emerging consensus definitions of primary care expenditures and establish new targets for commercial insurers that will support the achievement of necessary increases in primary care payment.

b. OHIC will publicly report primary care expenditure data using the new methodology and enforce compliance with the commercial expenditure requirements through prior approval health insurance rate review and other means.

c. OHIC will work with EOHHS and others to promote the positive role Medicaid can have in this process, similar to the exemplary work EOHHS has done for the primary care of children and adolescents.