Consolidation is the name of the health care game right now – but is it good for patients?
Let's review what's in the works in our state right now:
The United Nurses and Allied Professionals union is suing Care New England now over its plan to close the obstetrics and intensive care units at Memorial Hospital and consolidate care at Women and Infants and Kent Hospitals. The union says CNE is violating the state’s Hospital Conversion Act by winding down these services effectively before winning approval, and that the organization is stripping Memorial down to the bones, such that it’s barely a community hospital anymore. CNE says it’s doing nothing of the sort, and that it will maintain Memorial as a community hospital. But it’s not clear how long the organization can sustain it, losing as many millions as it is.
Care New England is still in talks with South Coast Health System about a partnership. Lifespan had explored a partnership with Care New England but it didn’t work out. A group of physicians – Community Physicians Partners Inc. - just banded together to work with Lifespan and insurers, to improve the care they deliver to patients, they say, but I imagine it won’t hurt their bargaining power, either. Lawrence + Memorial Hospital, which owns Westerly hospital, wants to partner with the Yale New Haven Health system. And we’ve heard that South County Health System would be interested in a relationship “of equals.”
Consolidation, in a way, is hitting health insurance, too. Neighborhood Health Plan has just won approval to coordinate care for patients called “dual eligibles,” people who receive both Medicaid, the state-run program for the poor and disabled, and Medicare, the federal health insurance program for the elderly. What will intertwining these programs do for patients? Hopefully make life less confusing, and care a little more seamless. It's no different than what's been happening with Medicaid for quite a while: moving patients into managed care programs that are supposed to offer more coordinated, seamless care for less money.
What do these moves have in common? They’re all bringing like-minded providers and patients under one roof to use resources more effectively, save money, and ostensibly provide better care.
But they’re also a sign that the future is here: it’s all about managed care, narrower networks of providers, and fewer actual hospitals. That doesn’t mean you’re going to get worse care. It just means you might not always have that MRI down the street, or an unlimited number of doctors to choose from. That could save money in the end, if it works. It could mean your electronic health records are more accessible, and under one roof. It could mean you don’t always get an appointment as quickly as you’d like – unless your particular health care provider decides to focus on convenience and access (like a patient-centered medical home).
So there’s all this consolidation. What about the proliferation of MinuteClinics and freestanding ERs? I think it’s a side effect of consolidation, a response to long waits, overburdened primary care doctors and emergency departments. And I think it’s a recognition that hospitals are changing. Not everything has to be done in hospitals – witness the growth of outpatient surgery, imaging centers, and more. And as community hospitals struggle and shut down, we’ll see more of these freestanding clinics or chains popping up to fill in the gaps. Of course, I don’t believe big trauma center/teaching hospitals are going anywhere any time soon. You still need catheterization labs and surgery suites and specialties. But maybe you don’t need as many of them within a small radius. Or at least, it’s turning out to be too expensive to maintain some of the same specialties at so many different sites.
Then again, it could be that consolidating so many services or hospitals under one roof leads to higher prices – we have yet to see what happens in the next couple of years in Rhode Island. With the consolidation that’s already taken place, spending has not risen as fast here as everyone thought it had.
Consolidation clearly has its up and down sides. Upsides include perhaps an easier-to-navigate system, maybe lower costs. The downsides include less patient choice, and, most importantly, the loss of jobs. But in a state that’s getting older and sicker, let’s hope there’s room for growth in health care jobs to take care of us.