Following nine months of discussion, Care New England and Partners HealthCare announced a definitive agreement to merge Jan 25. The agreement raises questions about the state of Rhode Island’s health care system and Brown’s relationship to it.
“Right now what we’re focusing on is helping people understand the issues,” said President Paxson P’19 in response to the merger. “They are complicated. There’s a lot of uncertainty.” Brown previously announced an alternative merger proposal with CNE and Prospect Medical Holdings, The Herald previously reported.
With the CNE-Partners merger, Partners has the opportunity to weaken CNE connections to the Warren Alpert Medical School and reduce resources for research, said Ira Wilson, professor of health services. Partners could also move super specialities, like rare infant care or high-risk cancer treatments, out of state.
“In the worst scenario, all those things happen,” Wilson said. “We really have no idea what Partners’ intentions are.”
There is a possibility that Partners could invigorate Rhode Island’s health care system and economy by saving CNE from financial collapse, Wilson conceded. But Partners’ unwillingness to speak to the University suggests otherwise, he said.
With Partners’ large-scale presence in Massachusetts, the company is able to set high prices, according to Wilson. If they become a bigger part of the Rhode Island market, Partners can impose the same costs on Rhode Island residents.
“The larger (Partners) gets, the more market power it gets, the more advantageous, i.e. higher prices it can negotiate,” Paxson said, adding that lower reimbursement rates in Rhode Island might cause Partners to bring speciality care to Massachusetts, where rates are much higher.
Rhode Island Senator Sheldon Whitehouse has taken to Twitter to express his concern over Partners’ involvement in R.I.. On Jan. 22, Whitehouse tweeted, “When we lost bank headquarters, R.I. economy took a big hit, downtown (Providence) emptied. In health care, there’s even more need for local control. Hard to move as a state if hospital CEOs heed only out-of-state corporate HQs. However this turns out, local control should be a priority.”
When we lost bank headquarters, RI economy took a big hit, downtown Prov emptied. In health care, there's even more need for local control. Hard to move as a state if hospital CEOs heed only out-of-state corporate HQs. However this turns out, local control should be a priority. https://t.co/squG806tPL
— Sheldon Whitehouse (@SenWhitehouse) January 22, 2018
Although inquires into a merger between CNE and Partners have caused a media buzz this month, Paxson and others say health care experts have been worried about this state of affairs for a while.
CNE and Partners have worked together for years, according to the joint statement the two health care organizations released last week. “Care New England has maintained a close working relationship with Partners HealthCare since 2009 through a clinical affiliation with Brigham and Women’s Hospital,” the statement said, also mentioning “a long-standing collaborative and collegial relationship between McLean Hospital (a Partners hospital) and Care New England’s Butler Hospital.”
Andrew Cohen, nephrologist and professor of medicine at the Med School, agrees that the consolidation has been a long time coming. Although opposed to the Partners merger with CNE, Cohen recently vocalized his discontent with the “Brown Proposal" — the University’s own proposition with the California-based Prospect Medical Holdings to merge with CNE.
“My concern about the Brown proposal is that it’s a day late and a dollar short,” Cohen told The Herald. Cohen, who spent a lot of his career at the University of Massachusetts Medical School, is familiar with and advocates for a unified health care system, which would allow for patient information to be available to all the doctors in the system.
Stanford, Harvard and Partners (which includes Brigham and Women’s and Mass General Hospitals), as well as Tufts and many other major healthcare organizations across the country have these unified systems, called “single physician group practices.” However, in Rhode Island, physicians are a part of many different health care groups. For example, doctors within Rhode Island Hospital belong to different companies and practices.
As a kidney specialist who sees patients that often have complicated medical histories, Cohen said it’s been“almost impossible to get all the information I need,” which includes basic information like a patient’s prescriptions. Brown Physicians Inc. is attempting to bring together some of these smaller groups into one group, but it still leaves many entities out, Cohen said.
Cohen expressed concern about a lack of consolidation and “the growing presence of (the) Partners system in Rhode Island” in a 2009 letter to Edward Wing, then dean of the Med School, and Timothy Babineau, current CEO of Lifespan, the state’s largest health care provider. “We got no reply from either party,” he said.
Only in the last few years has anyone seriously considered making changes, Cohen said. Resistance to consolidation has come from many parties, including larger specialties and Lifespan.
“I’m not saying this purely out of speculation: Lifespan has a stake in keeping things as they are,” Cohen said, adding that monetary incentives and a desire to keep control have prevented change.
With Partners becoming a player in the state, “it makes it much harder for the state to maintain control of its own destiny with respect to what kind of health care system it has,” Paxson said.
As to the effect the merger will have on Rhode Island and the Med School, Cohen is not sure. “CNE makes up a minority of teaching faculty,” he said.
Cohen hopes that the CNE-Partners merger “may compel Lifespan and other groups to come to the table” to find a solution that will benefit the state as well as the hospitals.
Paxson welcomes the idea of further discussion.
“I would love to have other groups engage in the conversation,” including Lifespan, she said. “Partners coming into the state, there’s a risk to Lifespan … It’s been a little bit surprising that Lifespan hasn’t been more concerned about the impact of Care New England’s decision on its ability to continue to be a thriving academic health care system.”
The University tried to talk with Lifespan about potential mergers, “but they weren’t interested at the time,” Paxson said.
Lifespan remains open to discussion moving forward, Babineau wrote in an email to The Herald, acknowledging that the merger could have a large effect on Rhode Island’s health care system.
Both Paxson and Wilson warn that the CNE-Partners deal is not guaranteed to happen just yet.
“There’s still a chance this could flounder because of regulatory issues,” Wilson said. “This purchase still has to go through the Rhode Island Department of Health.”
Antitrust issues within Massachusetts have slowed Partners’ growth there, but similar regulatory problems in Rhode Island have yet to be tested.
“Rhode Island is a really special state because it’s small enough that we can do things that are innovative and interesting,” Paxson said, adding that she’d like to see the people of Rhode Island come together to make an affordable health care system that has both a strong academic medical backbone and strong primary care.
