Public hearings are expected to begin in January on the proposed merger of Rhode Island’s two largest health care systems: Lifespan and Care New England. Rhode Island Attorney General Peter F. Neronha notified the companies earlier this month that their merger application was complete. Now, his office and the state Department of Health have until March 16 to accept or reject the deal. 

Nerohna spoke about what’s next with Health Reporter Lynn Arditi. 

The interview below has been edited and condensed. To hear the broadcast version of this story, use the audio player above.

Arditi: This is not the final decision; this is the decision on whether they’ve completed the [merger] application.

 Neronha: Yeah. As we pointed out to the parties in our letter to them, telling them that it was complete, there’s more information that they need to provide us. And in fact, in the letter, a letter attached a set of supplemental questions that we need answered. So, you know, it’s not like the application is completed in the sense that we have all the information we need; there’s going to be plenty of interaction with the parties over the next 120 days to get additional information as it becomes necessary.

When we finally get that application, when it’s public, and we want to know, ‘Gee, I wonder what the attorney general’s office was looking for that they provided here,’ what are the additional things that might not have been in that application we will see?

We view it as really understanding what this means for the future. What will this look like one, two, three years from now? What’s included in this transaction? What isn’t?  And then of course, there are all the things that bear on once you understand what’s proposed, what’s the potential impact of that on healthcare in Rhode Island? What does that mean, for cost? What does that mean for quality? And what does it mean for access? That’s at the very heart of what the Hospital Conversion Act asks us to ensure: A safe, quality, accessible, affordable health care system. It’s right in the statute. This is a transaction, which I don’t  think you have to be an expert to recognize, when there is the potential for two large hospital systems to come together, that you have to take into account what impact that might have on competition, and whether that impact would be a negative thing for the state of Rhode Island. If it can be addressed in some way, what ways can it be addressed? 

Obviously with this merger, the fact that you have the two largest health systems combining and the potential antitrust concerns, and the potential for this being a very kind of powerful, forceful company in the market, [that leads to] concerns about state regulators having to cope with how to control prices. In Rhode Island, we have two for-profit hospital systems I would suspect might be very interested in getting a bigger chunk of the market. And I’m wondering what you think about that?

If Care New England and Lifespan want to merge, then they have to convince me as a regulator, and I don’t want to speak for the Department Health but I imagine them as well, that the plan that they’re proposing is consistent with the law and will be in the best interest of Rhode Islanders. That’s on them to produce that plan. It’s not for me to craft a plan for them. But the question you’re asking is a good one, because that goes to what I think we don’t talk enough about the state of Rhode Island, which are the structural underpinnings of our healthcare system. What’s our health care strategy? What do we want health care to look like here? I am not convinced that we are doing top level, high level strategic thinking about health care in this state. I don’t think that the best way to do that is on a transaction by transaction basis. And I think it’s incumbent on those who lead our state, including me, to do a better job of coming up with that kind of strategy.

You have a certain payer mix in Rhode Island that is pretty challenging. We have a large Medicaid population. And we do not have the number of sort of high-end specialty services, or demand for high-end specialty services, that a place like Boston does or New York.

The question we have to ask is how much are we going to invest in healthcare? You know, why are the reimbursement rates for that payer mix so low? When was the last time we had a written healthcare strategic plan on the state? It was written in 1989. I’ve seen it: 1989. That’s when I graduated from law school. And so until we as a state, and until we as a country grapple with that issue, we’re not going to solve our long term health care problems.

What do you think the state should be doing to try to address this?

I think it should always lie in the executive branch. The executive branch is where you can bring together great talent. There’s certainly enough brilliant health care minds in the state. We have terrific educational institutions here, many of them in the areas of health care. The URI School of Pharmacy. Brown medical school’s School of Public Health. We have lots of people who are bright and are interested in this space, and can be led by government to get around a table and start to figure some of this out. But I don’t know sometimes whether or not that kind of on-the-ground thinking is making its way all the way all the way to the policy level. The governor has the ability to pull together the various schools of thought public and private to get him in a room and start coming up with a real plan. Not just meetings but real plans to improve this situation. I think we need to do that as we do need to do in so many other areas.

Health reporter Lynn Arditi can be reached by email at larditi@thepublicsradio.org. Follow her on Twitter @LynnArditi