RI's envisioned academic health system - who benefits?

Posted 4/14/21

There's a huge delta between the best-case and worst-case scenarios for Rhode Island's health care landscape. If a big out-of-state firm swallowed a major Rhode Island hospital group, more care would likely migrate elsewhere, with negative implications

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RI's envisioned academic health system - who benefits?


There’s a huge delta between the best-case and worst-case scenarios for Rhode Island’s health care landscape.

If a big out-of-state firm swallowed a major Rhode Island hospital group, more care would likely migrate elsewhere, with negative implications for Rhode Island’s economy.

On the other hand, the academic health system envisioned by Lifespan and Care New England, with Brown University, could bolster economic growth and have other benefits.

Still, there are a lot of unanswered questions, including whether this unified entity would cause higher health care costs for average Rhode Islanders. Brown University President Christina Paxson doesn’t believe that will happen, in part, she said, since Rhode Island is so small and since greater scale is needed to generate efficiency.

“You can’t provide effective low-cost care with this sub-scale health care system – it doesn’t work,” Paxson said on Political Roundtable at The Public’s Radio last week. “So I’m excited about this, because I think we're going to be able to provide better care to patients. I think it can be, bend that cost curve, keep costs from going up.”

The agreement announced in February between Brown, Lifespan and CNE still faces a series of regulatory hurdles. And there’s the matter of how Rhode Island’s two biggest hospital groups will resolve questions of governance and overcome the institutional politics that have scuttled this kind of amalgam for years.

Asked to outline the process for working this out, Paxson sidestepped the question, saying, “My sense now is that the two health care systems, and again I don’t sit in those boardrooms. But my sense is that they are in a very, very different place than they’ve ever been before. And the coronavirus, the COVID pandemic, taught them, really underscored how they can work together well. They can collaborate, and that coming together, you know, put the governance battles aside … And I really hope it works.”

Raimondo’s jobs record

On her way out of Rhode Island, Gina Raimondo released a 34-page report on her six years as governor. She claimed credit for making the Ocean State more equitable and strengthening its economy.

Rhode Island did make some gains on its business tax climate during Raimondo’s time in office, climbing in the Tax Foundation’s survey from 45 to 37. But Rhode Island still faces many of the same familiar economic challenges that existed before Raimondo became governor, including under-performing schools, the absence of a more diverse job base, and projected deficits of more than $300 million for each of the next four fiscal years.

As I reported last week, Raimondo put considerable focus on trying to foster high-wage jobs, although Rhode Island was one of just two Northeast states to lose so-called advanced sector jobs from 2015 to 2019.

Climate bill becomes law

Gov. Dan McKee signed the Act on Climate, billed by supporters as the most important environmental bill to emerge from the General Assembly in years, in Newport on Saturday. The legislation requires Rhode Island to get to net zero climate emissions by 2050.

Supporters, such as Sen. Dawn Euer (D-Newport), say it will boost the economy and help to create green jobs. Opponents say they still fear that the climate bill will spark big retrofit costs for consumers and give too much power to unelected state bureaucrats.

Meanwhile, the legislation got an assist from Attorney General Peter Neronha, who moved quickly to dismiss McKee’s concern that the bill could cause excessive litigation.

College and the 1 percent

A 2017 study that examined 38 universities, including Brown, found that they were more likely to admit students from the top 1 percent of income strata than the bottom 60 percent. So, are colleges like Brown perpetuating the power elite by not taking more aggressive steps to counter this imbalance? I put that question to Christina Paxson on Political Roundtable.

Here’s her response: “College access in America is a major issue. And we need to get more students from lower- and middle-income backgrounds into higher education. And when I say that, I’m not talking about privates, like Brown. I’m talking about the vast majority of students in America – college students are at public institutions. And I’m a big advocate for public education, too – that needs to be supported as well. So you know, what are we doing? We are need-blind; there are not many universities in the country that accept students regardless of their financial need. When we admit students, we meet their full need, which means you know, we don’t say, great, we’d love to have you, but we can’t afford to give you the scholarship that you need to come. Three years ago, we eliminated loans from financial aid packages. So those were all converted to grants. We’ve seen steady improvement in the breadth of students who are coming to the university. It’s in the high 40 percent received financial aid. And we’ll continue to make progress on that. It’s a really important issue.”

Redistricting RI

The decennial process of redrawing legislative and congressional districts is getting under way, with House Speaker Joe Shekarchi’s introduction of a bill last week to create an 18-member special commission. Two-thirds of the slots are reserved for lawmakers, reflecting the controlling stake that legislative leaders have over a process that has traditionally rewarded friends and punished enemies.

During the White House briefing last week, Commerce Secretary Raimondo – whose agency includes the Census Bureau – said redistricting data is expected no later than Sept. 30. John Marion from Common Cause of RI parsed the RI House bill; he reports that lawmakers are optimistic that the Ocean State will be able to maintain two congressional seats (!). Time will tell.

Infrastructure in RI

With the Biden infrastructure plan offering a potential windfall for states to use in reimagining their transit systems, I asked Scott Wolf of Grow Smart RI to share thoughts on what he would like to see happen. Wolf said the state is well positioned to compete for discretionary federal grants and infrastructure stimulus thanks to the completion of the long-range Transit Master Plan. (“The controversial RIDOT-led multi-hub proposal for downtown Providence was neither conceived nor vetted as part of the RIPTA-led transit master planning process,” he added. “Advocates continue to call on the governor to withdraw that proposal and explore transit-friendly alternatives.”)

Here’s Wolf’s wish-list for the potential use of transit in RI: “Today, 77 percent of Rhode Islanders live within a 10-minute walk of a transit stop, yet less than 3 percent commute by transit. Building a system that gets more people where they’re going more quickly and efficiently holds great potential to reduce transportation emissions while saving Rhode Islanders money. Among the transit initiatives we hope the state will consider prioritizing with new federal transit funding are additional Bus Rapid Transit routes like the popular one currently in operation along Broad and North Main streets, a general increase in the frequency of RIPTA service, development of an in-state light rail line between Central Falls and Green Airport, improved, speedier commuter rail service between Providence and Boston, additional funding for bike and pedestrian infrastructure that is in greater demand than ever as a result of the public heightened appreciation for outdoor activity associated with the pandemic, and funding for more ‘Complete Streets’ projects that ensure new and repaved streets are safer and more user friendly for all users, including pedestrians, bicyclists, children, the elderly and the disabled.”

Economy and the sense of place

In assessing former Gov. Raimondo’s economic record, state Sen. Sam Bell (D-Providence) – a critic of tax incentives – said more focus should have been put on place-making and infrastructure designed to spur growth and attract people.

“It’s why we moved the highway, it’s why we reopened the rivers and created WaterPlace Park,” he said. “Those real investment approaches to economic development continue to drive growth in Providence today. Yet the Raimondo administration vetoed and stopped the main effort to do a similar vision that would have unlocked an enormous amount of jobs and growth when they blocked a proposal to remove the 6/10 and unlock enormous areas of Providence for economic development.”

The Taricani lecture series

URI alum John King, who cut his teeth in the Providence and Boston bureaus of The Associated Press, is set to open the inaugural lecture series honoring the late WJAR-TV investigative reporter Jim Taricani. It’s on for 5 p.m. on Wednesday, April 21.

Via URI: “As a URI junior and Associated Press intern, King met Taricani in 1984, the same year New England organized crime boss Raymond L.S. Patriarca died and Providence Mayor Vincent ‘Buddy’ Cianci was forced to resign from office. ‘So much has changed in the nearly four decades since,’ said King. ‘We live, learn and work now in the Age of Disruption: breathtaking technological innovation and equally breathtaking assaults on truth, science, and common sense. But a lesson learned then is just as relevant now, perhaps more so: The First Amendment and the freedoms it protects, and the fairness and responsibilities it demands, remain a best friend and best compass in challenging times.’”

Ian Donnis can be reached at idonnis@ripr.org. For a longer version of this column, visit www.thepublicsradio.org


1 comment on this story | Please log in to comment by clicking here
Edward Fontaine - Patient Safety Advocate

Rhode Islanders are being duped, and unfortunately no one cares about quality of healthcare until it is too late. We take quality for granted yet the Healthcare Industry IS the most deadly.

Lifespan, Care New Englad and Brown are presenting a great "marketing" picture of the merger, buy do not provide ANY facts, but their speculation for their own benefit.

Do not be fooled, healthcare is NOT charitable, it IS a business, whether labeled for profit or non-profit. Healthcare in the US is a $2.2 trillion enterprise, 3 times our defense budget, and it is ripe for abuse, waste, fraud and corruption. The US has the highest per capita spend in the world, yet ranks last in quality and mortality.

Estimates of over 1000 patients die every day in the US from preventable harm. As studies mention, much higher since accurate records are difficult to obtain. This is only deaths from preventable harm, not medical errors.

The world ground the 737 for 20 months after 2 crashes in 132 days killed 346 people. In those 132 days over 1.7 million people died from preventable harm in Healthcare. Why do we except these deaths and brush them away? As healthcare costs increase, quality is not increasing with it.

Statistics show you will experience at least one adverse adventure in your lifetime, whether it is a delayed or inaccurate diagnosis, missed diagnoses, medication incidences, etc..

Merging Lifespan and Care New England, affiliated with Brown, will not produce world class care. Neither entity has Excellence in safety ratings.

RI ranks 31st for the percent of A safety rated hospitals, according to Leapfrog.

Brown Medical School ranks 36th in the country for quality of medical research and 19th in overall med school rankings.

Merging the two entities will NOT address the issue that RI ranks 50th, the worst state for doctors to practice, for opportunity & competition, and medical environment.

In 34. States, for profit in patient care is less than nonprofits, 12 states nonprofits are less than for profit and 5 states do not have for profit.

According to Health Affairs, despite tax breaks, nonprofit hospitals are not matching charity care of for profit counterparts. For every $100 in spend, nonprofits provided $2.30 in charity care while for profits provided $3.80, 65% more.

The spin on the merger is not based on actual facts, but speculation. RI will always need healthcare, Brown will work to advance their research, with or without a merger, Jobs WILL be lost with a merger. A merger does NOT, and will NOT create a center of academic and research excellence since neither entity has an existing model or record of excellence.

RI, with leadership, can and will attract more biotechnology and research based on its proximity to Boston and New York. It will not dissappear with a merger.

Care WILL NOT be sent out of state if Care New England were purchased for profit. RI learned a lesson with Prospect, venture capital firms are vultures. Partners had already begun investment in care in RI with the new Brigham and Women's cardiac center at Bulter Campus and Spaulding Rehab. I have spoken with numerous healthcare professionals and they are NOT for the merger.

Had Partners purchased CNE, just as Babineau, Finale and Paxton say their prices will not increase, they spread nonfactual information that Partners would increase prices and send care to Boston. I am a patient with MassGeneral and Brigham, I spoke with numerous doctors and in no way were they going to send care to Boston. The only patients for Boston would be situational cases based on a number of medical factors.

The facts are that a merger of Lifespan and CNE, is not only illegal, violating antitrust laws captivating 86% of RI's population, eliminating choice and taking away a patients ability to obtain an independent, OBJECTIVE second opinion.

With the new bonused payment models, this merger is anything but the holy grail Babineau leads you to believe. Healthcare IS changing, and since Babineau has NOT focused on quality and change, it is his own doing for Lifespans lack of vision.

How is RI better off with an average rated, mega-monopoly in healthcare without choice? How is this merger financially better than the offer by actual hospital administrator executives that put forth a $550 million dollar deal of investment into RI?

They would have fully funded the $150 million pension fund, retired CNE debt AND invested $300 million in capital improvements.

How is Brown giving $25 million a year for 5 years a better deal? How is the pension being funded? How is debt being addressed? What will be capital investments?

With for profit acquisitions of nonprofits, (the right organization) ongoing capital commitments are more common than nonprofits. Capital investments are not big hurdles for profit organizations. It is proper due diligence that will find the best for profit organization for CNE.

Also, other facts from Commonwealth Fund, are that when mergers of nonprofits take place CEO/Executives have seen a 93% increase in compensation while staff 8% and prices increase while quality declines.

As a Patient Safety Advocate with NOPQ, National Patient Safety Movement and World Health Organization, I am providing FACTS and not marketing someone's vision. Healthcare IS dangerous to patients and the disparities in Healthcare will become greater with a merger and as the bonused payment system is gamed for personal benefit.

Those who receive poor quality care in order of worst quality to better is: Poor, People of Color, LGBTQ, Medicaid and Medicare. Privately insured receive the best quality care, and EVERY person FOR the merger has PRIVATE insurance and experiences best quality, not perfect quality.

I have had over 200 appts in less than 18 months and while they had me taking $5000+ in medication a month, they said nothing was wrong. When I pointed out an error from a misdiagnosis and treatment from 2017 which has left me with numerous conditions and most significantly, damage to the executive function portion of my brain from that error. I was not angry and wanted to help address how it happened so it does not happen to anyone else, Lifespan not only ignored me, but blackballed me with inaccurate information saying my conditions were somatic. I have spent, and continue to research every single day, healthcare quality, safety and how I can help make patients aware there are ways to protect themselves. I have over 15000 research paper and subscribe to American Radiology, NEJM, Mayoclinic, Johns Hopkins, Researchgate, CDC, NIH, Oxford, Academia and numerous others while helping get to

As a former executive with a technology, data and root cause analysis background, I have made it my mission to help improve healthcare for YOU.

As I was denied SSDI numerous times, I finally obtained a hearing, and when I had a call with my attorney, first time in my 15 months of hiring, he really frustrated me when he had NO idea, and did not care what was wrong with me. They never even provided my records obtained from Lifespan with the error. I wrote a letter to the judge, not caring what his response was going to be but more to clear my name and that I DID not WANT disability, I NEEDED IT.

I sent him only my actual records and blood tests going back to 2012 showing there has been chronic autoimmune disease, tissue disease, anemia, leukopenia, chronic inflammation, all from their blood tests. Lifespan and all doctors basically HID behind the WHITE WALL and said nothing was wrong.

The judge canceled the hearing and awarded me FULL SSDI back to the error. While yes it has relieved stress financially, it has not improved my physical health nor emotional health. I have always worked and NEVER used public assistance with the exception of periods of my unemployment. I now spend much time in bed due to physical pain, shortness of breath, erratic HBP, headaches and crippling back pain.

I know first hand how ONE system has taken away my ability to obtain quality care. I had to completely leave EVERY Lifespan doctor and specialist and switch to South County Health and Brigham & Womens, and finally have begun to get ACTUAL DIAGNOSES, error somewhat addressed, but the stigma from Lifespan is still present.

RI NEEDS PEOPLE who have influence like journalists to actually understand the dangers and daily deaths from preventable harm, the well documented disparities in care for certain groups across the country and not just produce "fluff" journalism, actually get THE FACTS on the dangers the merger would expose RI'ders.

I sent questions AND facts to Governor McKee and Gene Valicenti for the town hall Tuesday night. That was such a disgusting use of journalism and was a disservice to REAL substantial matters.

New license plates got plenty of time yet NOT EVEN A MENTION ABOUT THE MERGER! It is RI politics as usual! The one thing is that while quality of care is specific to groups, PREVENTABLE HARM IS NOT. I do not wish ill on anyone, but if it takes someone of influence or wealth to experience a life threatening event, so be it.

Rhode Islanders need a voice and need protection from the most deadly industry! The time it took me to wrote this, another 100+ people died in the US from Preventable Harm.

I have a friend who lost her life due to a missed diagnosis which was completely diagnosable on her first visit, she was on Dr Oz and he saw it in imaging and the symptoms all were present. She could have survived had it been properly diagnosed and treated.

You have a voice, use it! It is your life, protect it! Do not take a doctor on blind faith, be an educated patient, there are.resources and apps to help protect against preventable harm.

An invested patient advocate


Wednesday, April 14