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Navigating healthcare

By Diane L. Marolla, LICSW

Is bigger always better?

This monthly article comes from a place where I want to plant small seeds in the minds of anyone who reads it. My hope is you; the reader will think differently about your healthcare and how you manage it. Since the beginning of my healthcare career in 1987, I have been on a path of accumulating information about our healthcare system. I am not a fancy high level graduate from an Ivy League school, nor have I ever been a high level executive. What I know and what I share, is that over the years our healthcare system in general has eroded into a greed driven industry. The patient, has been left behind in the equation. Our doctors and other healthcare professionals have also been left behind. Our healthcare decisions are not being made necessarily in the best interest of the patient.

In recent weeks, for those of us who pay attention about what is going on locally in healthcare, Lifespan and Care New England have been in the news. At first, Care New England was moving forward with their relationship with Partners Healthcare in Boston. Lifespan launched an extensive media campaign to stop the relationship. Now, we have learned Lifespan and Care New England are looking at partnering together and the Partner’s deal for now, is dead. Lifespan and Care New England have attempted a partnership in the past without success.

I found Lifespan’s media campaign against the Care New England, Partner’s deal intriguing and aggressive. To me, Lifespan’s media campaign was an intentional scare tactic to get Rhode Islanders and our elected officials into believing that they would not be able to access local, quality, affordable healthcare. The media campaign ultimately was done to bring a sense of panic and urgency to the matter, which worked. Why would Lifespan go to these measures? In my opinion, Lifespan wanted to stop the relationship from going forward because the Care New England/Partner’s relationship would affect them from controlling every aspect of the delivery of healthcare in Rhode Island.

Some overall facts about Lifespan according to their website lifespan.org

Employees: 15,674
Licensed Beds: 1,165

Patient Care

Patient Discharges: 62,368
Emergency Department Visits: 257,281
Outpatient Visits: 794,539
Outpatient Surgeries: 25,458
Inpatient Surgeries: 15,750
Home Health Care Visits: 2,495

Financial Performance

($ in thousands)

Total Operating Revenue: $2,290,391
Total Operating Expenses: $2,272,475
Income from Operations: $17,916
Excess of revenues over expenses: $23,801
Net Patient Service Revenue: $2,037,907
Total Assets: $2,505,062
Research Funding Revenue: $86,661

In the research I have done for this article related to healthcare mergers and acquisitions, I found the following:

In Sara Heath’s 2018 article “How do Healthcare Mergers and Acquisitions Impact Patients?”, “ A hospital merger would increase access to capital and other resources for many healthcare organizations, which would in turn improve costs for patients, according to a 2017 report from The American Hospital Association (AHA). This same article reports that Dr. Gregory Curfman, MD, assistant professor of medicine at Harvard Medical School states the “consolidation of healthcare organizations can create limited competition. Foremost, this creates more bargaining power for healthcare organizations with payers. When individual hospitals merge into larger systems, they gain a larger share of the consumer market. That puts them in a position to ask health insurance companies to pay more for medical care and procedures. These higher prices are not born by the insurers, but by the consumers in the form of greater premiums. Thus, some economists argue, mergers drive up health care costs and place added financial pressure on consumers.”
In Emily Gee and Ethan Gurwitz’s 2018 article “Provider Consolidation Drives up Health care Costs”, “Consolidation is one of the major forces driving hospital prices up.” This same article goes on to say “Healthcare industry firms involved in merger activity often claim that consolidation will result in greater efficiency, lower costs, and more coordinated patient care. However, research shows that such efficiency does not materialize; even when it does, savings are not passed on to consumers.”

Rhode Island is a small state. It has always been my belief that because of our size, we should have the best and most affordable healthcare system in the country. New England has the best medical schools. We have many smart, talented doctors and healthcare professionals outside of Lifespan who day in and day out deliver quality services to Rhode Islanders. They do not have the money, the resources, or the time to bring to everyone’s attention how they struggle to get paid every day for the services they provide. Few seem to be aware that most of them have been reimbursed the same fees for years without any increases from the managed care companies, Medicaid, or Medicare.

I ask you, as a healthcare consumer, do you really want just essentially one entity in RI owning every level of healthcare? Is a monopoly good for a consumer? Don’t you want choice in healthcare? What is going to happen to the other hospital systems in RI, and will they be able to compete? What about all of the independent outpatient practices in Rhode Island who are not associated with a large healthcare entity? Will they survive? I guess, for now, we will all have to wait and see.