Clarity of Objectives on Rhode Island Healthcare Policy

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According to WPRI’s Bill Tomison and Perry Russom, “State regulators [are] considering free-standing ERs.”  These organizations would be centrally located 24×7 facilities that could provide emergency care to those paying cash or with private insurance.  The limit to private insurance is only because “the government has not figured out how to pay them” (as if transferring money from one account to another is an existential mystery).

Not surprisingly, the healthcare insiders of Rhode Island are lining up as “critics”:

Critics — including Dr. Michael J. Dacey, the president of Kent Hospital in Warwick — say it’ll drive up the overall cost of health care in the state by attracting patients who might have previously gone to lower-cost urgent care centers. The state also doesn’t require freestanding ERs to apply for a “certificate of need,” which hospitals must receive.

Here we are, again, with the notion that government should be concerned with “the overall cost of health care,” even for people who are willing to pay more for it.  What’s the problem, here?  On first glance, this is an illustration of how established players work to lock out new companies — especially innovative ones — by using government to block the doors, but this goes deeper than just that.

The WPRI reporters point to an article by Richard Asinof on ConvergenceRI, that elaborates a little on “what’s at stake”:

Much of the health care reform efforts in Rhode Island to achieve the triple aim, improve outcomes, reduce costs, and improve patient satisfaction have been focused on primary care practice transformation, spearheaded by the patient-center medical home model of the all-payer Care Transformation Collaborative.

It is also driven by an effort to change over the fee-for-service business model for health care to accountable care entities and bundled, global payments, promoting “value over volume” in the coordination of care.

The launch of a for-profit enterprise seeking to provide 24/7 emergency care in convenient “shopping” locations, catering to a more affluent clientele [not Medicaid or Medicare members], clearly poses a threat to those efforts.

Again: Why?  Why should higher-cost facilities that answer an obvious demand for expanded services among those with the financial means to purchase them threaten lower-cost organizations with gobs of government funding?  The Care Transformation Collaborative, after all, is supposed to be about Rhode Islanders with chronic problems, not everybody.  That’s why the federal Centers for Medicare and Medicaid Services (CMS) is funneling money to Rhode Island’s Executive Office of Health and Human Services (EOHHS), which then shuffles around $150,000 per year to the RI Foundation so it can organize the CTC, including grants to participating organizations.  What’s the problem with having small, private-sector care providers in the same market?

The problem, one can infer, is that all this talk about reforming care delivery is more about redistribution than innovation.  The “fee for service” model that government-centric health reformers so malign means that people who can pay more fees can get more services.  The reaction to the free-standing ERs shows that, even if more services for those with money and private services are additional, the establishment objects.

Turning the focus to “value over volume” means the same amount of services can be spread out to everybody, even as those who can afford more will pay more, anyway.  (And we’re not talking 1%, here, but everybody who isn’t poor.)  A narrow focus on those with chronic problems or the very poor is just a wedge to open the door.

Most advocates, administrators, and providers who are buying into this transformation are surely motivated by the desire to help people whose resources do not match their medical needs, but they should pause over the fact that the redistribution has to be so thoroughly disguised behind jargon, regulatory protectionism, and funding gimmicks.  In the end, we can be assured that restricting services and usurping control over families’ healthcare decisions will benefit a select few, whether through profit or power.



  • Rhett Hardwick

    “drive up the overall cost of health care in the state by attracting patients who might have previously gone to lower-cost urgent care centers. ” While I doubt that many emergency related visits are deliberated rationally, those “paying cash” will probably give thought to lower cost “urgent care” facilities. More likely the decision will be based on which is closer. Those covered by insurance will probably not give cost a consideration.

    My former brother in law owned several emergency rooms in Florida, those were located in hospitals. Is ownership of the emergency room severed here? They were apparently profitable, he bailed out for a substantial sum, left medicine and retired at 50.

  • Rhett Hardwick

    Has anyone given any real thought to the probability that robotics/AI will rapidly alter medical care? Probably far sooner than we expect, although those robotic cars don’t seem to be doing that well.

    • ShannonEntropy

      Wanna be the Test Pilot in the proto·type flying car
      I invented ??

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