Scott MacKay Commentary: Is Rhode Island's Hospital Establishment Overbuilt?

Jun 3, 2016

Memorial Hospital in Pawtucket is cutting back services and closing its maternity service.
Credit RIPR

Memorial Hospital is cutting back services and closing its maternity service. RIPR political analyst Scott MacKay says Rhode Island’s health care system needs more consolidation.

As is the case with public pension systems, fire services and water systems, Rhode Island has too many hospitals.  Hospital executives have known this for years and have tried, unsuccessfully, to combine. The largest of such attempts was the proposed merger of the Lifespan and Care-New England chains. That one crashed after millions were spent on legal fees and consulting studies.

After that failure, Care New England and Lifespan tried again, but the merger talks floundered. Then Care New England went across the Massachusetts border and linked up with the Southcoast system, a move that is awaiting regulatory approval.

Since, one of Care New England’s hospitals, Memorial in Pawtucket, has fallen into financial trouble and has cut services.  Surgical, intensive care and birthing services are being slashed. This has provoked an outcry from unionized hospital workers and state lawmakers as well as lawsuits from the cities of Central Falls and Pawtucket.

Some of the florid reaction is all too typical of that toxic Ocean State mix of parochialism and provincialism. OK, so you can’t have your baby in Pawtucket. This inconvenience will cost you all of the dozen minutes it takes to get to Woman & Infants Hospital in Providence.

This silliness rises to the surface just about every time anyone in Rhode Island proposes consolidating any service, from police dispatching to health care. A similar kerfuffle erupted when Landmark Hospital, in Woonsocket, which has a history of financial trouble, was threatened with closure several years back.

One of the difficulties faced by Landmark was self-inflicted. Years back, management invested big time in cardiac care and heart surgery. The program bled red ink and was closed. It was no wonder. Have you ever heard anyone say, ``I’m having my open heart surgery in Woonsocket.’’

Anyone north of Attleboro or south of Westerly would scratch their head at the cries of doom and gloom from the Woonsocket community over the hardship that would have been wrought by Landmark’s demise. It would have meant patients traveling 16 miles to Providence to Rhode Island or Miriam hospitals, both fine teaching hospitals affiliated with Brown Medical School.

What we have now in Rhode Island are  too many high-cost hospitals that were built or expanded after the 1946 Hill-Burton Act, the federal law that pumped billions into hospital construction across the nation. What we don’t have is sufficient emphasis on primary care and treating chronic disease in smaller medical communities, as advocated by Dr. Mike Fine, the former state health director who was ousted  last year by Gov. Gina Raimondo.

What Raimondo ought to be doing if the Care New England – Southcoast  partnership fails is to get Lifespan and its teaching hospitals back in negotiations with Care New England. (Full disclosure: My spouse, Dr. Staci Fischer, an infectious disease specialist, once practiced at Rhode Island Hospital, but no longer does). That would create a strong Rhode Island hospital network that could compete with the big Boston hospitals that are poaching Ocean State patients with Cadillac health insurance coverage. Hospitals make money on these patients for elective surgeries, such as hip and knee replacements and advanced cardiac care.

What makes no sense is that Women & Infants hospital, and  Rhode Island Hospital, which share a campus  on Providence’s south side, are in two different health care groups. (RIH is part of Lifespan; W&I is with Care New England).  And, in what appeared to be a snit-like turf battle, Rhode Island applied for state approval to deliver babies after the failure of the latest Care New England Lifespan merger talks.

A 2013 study by the state Health Care and Accountability Advisory Council projected that Rhode Island would have an excess or roughly 200 staffed hospital beds by 2017.

Most Rhode Islanders have likely never heard of anyone saying they are going to Woonsocket or Westerly for a serious medical procedure. But all of us know someone who went to Boston, a world renowned medical mecca, for surgery.

Obamacare has helped hospital bottom lines, but has yet to cut significantly into soaring medical costs. That may need a federal solution, such as moving toward a Canadian-style single payer program. In the meantime, Rhode Islanders need to wake up to the need for combining hospital services and building better primary care networks. It’s way past time that we heard from such crucial players as Raimondo, Dr. Nicole Alexander-Scott, state health director, and Elizabeth Roberts, the state human services secretary.

Scott MacKay’s commentary can be heard every Monday at 6:40 and 8:40 on Morning Edition and at 5:4r4 on All Things Considered. You can also follow his political reporting and analysis at our `On Politics’ blog at RIPR.org