Former RI Health Director says state needs political will to improve healthcare system

With Lifespan hoping to absorb the Care New England network, and clearly dominate the hospital system in Rhode Island, a former state Health Department director is cautioning that without establishing a Hospital Regularly System, the takeover could be costly.

Dr. Michael Fine

Dr. Michael Fine, who served from 2011 – 2015 as director of Rhode Island’s Department of Health, cautioned that “the real trouble in Rhode Island isn’t Lifespan or Care New England, the real trouble is that we don’t have a healthcare system that takes care of everybody.”

Fine, a family physician and community organizer turned author, in a wide ranging interview, was critical of a hospital system that sees itself as too important, of overpaid hospital administrators,  of Brown University Medical School’s policy of admitting predominately out-of-state applicants, and, mostly, the state’s lack of political will.

At center stage is an ever-changing health care system, that has seen out-of-state ownership of Westerly, Landmark (Woonsocket), Roger Williams (Providence), St. Joseph’s (Providence), and Fatima (North Providence} Hospitals. Every hospital in Rhode Island, except South County, is part of a larger network. 

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Care New England closed Memorial Hospital in Pawtucket, while community health care centers, like South County’s Wood River Health, continue to expand, opening a new center in Westerly.

Partners, the huge Massachusetts hospital system, with the likes of Mass General, Brigham and Women’s with its Dana Farber Cancer Center, had been seeking to acquire Care New England. Its application was making its way through the system, when Lifespan objected.

“Torpedoed,” was how Fine described it. “They seem to be doing everything they can to slowing that down and stopping it if they can.”

Gov. Gina Raimondo called for talks to resume between Lifespan and Care New England. Partners withdrew, saying it would await the outcome.

The main impediment to a Partners takeover of Care New England, Fine said, is Route 95, the drive that many in Rhode Island would likely make for some services. 

The Partners system is recognized nationally for its quality. U.S. News and World Report has Mass General as the second-best hospital in America, and Brigham and Women’s is 20th. Dana Farber is the fourth best cancer hospital in the U.S. and McLean is first for psychiatry. Partners’ hospital is ranked in the top 45 nationally in more than 25 categories. Hospitals in Rhode Island did not achieve any significant national ranking.

But Fine sees potential for a Lifespan takeover, if, and it’s a very big if, the state finds the political will to create the regulatory authority, control administrative costs, and Brown, also a partner in talks, changes its admission policies.

Fine foresees a system that consolidates some specialized services, developing centers of excellence. “When you divide services, you lose skills.” Consolidation, he said, means bringing the best together, working as a team.

“One of the real things we don’t have is the public courage to force” some of these changes, Fine said.

On Administrative Salaries: “We have seen in healthcare the proliferation of people who don’t talk to patients,” Fine said. “One of the dirty little secrets is high salaries. High priced administrators are part of the burden we all carry. If we can make some of them go away, it doesn’t matter who owns the system.” According to the IRS 990 filing in 2017, the latest available on GuideStar, at least 12 Lifespan executives earned more than $500,000 annually, with at least nine of whom are not physicians. Another five executives at Care New England in the $500,000 plus group. The million plus club includes Timothy Babineau, president and CEO, who earned more than $2.5 million; Margaret Van Bree, MHA, DrPH, president of Rhode Island Hospital, $1,031,811; and Mary Wakefield, chief financial officer, $1,201,932. Crista Durant, president of Newport Hospital, earned $516,076. Care New England CEO, Michael Keefe, earned $1,322,223.

Lifespan Salaries*

  • Dr. Timothy Babineau, CEO $2,557,146
  • Mary Wakefield, CFO $1,201,932
  • Margaret Van Bree, MHA, DrPH, President RI Hospital $1,031,811
  • Ken Arnold, Secretary $  862,403
  • John Murphy, MD, Executive VP $  827,776
  • Fred Macri, Executive VP and COO $  765,569
  • Cedric Pnebe, CIO $  706,122
  • Richard Goldberg, sup. psychiatry $  666,646
  • Arthur Sampson, Miriam Hospital President $  674,371
  • Crista Durand, Newport Hospital President $  516.076

*Source: GuideStar, 2017 – Form 990 return filed by Lifespan

Care New England Salaries*

  • Dennis Keefe, CEO $1,322,223
  • Sandra Coletta, Executive Vice President $  806,335
  • Joseph Iannone, CFO $  763,331
  • Michael Dacey, MD, Pres. & COO Kent County Hospital $  640,602
  • Mark Marcantano, Pres. & COO Women & Infants $  637,401
  • Raymond Powkie, MD, Chief Medical Quality Officer $  598,422
  • Domenic Delmonico, former officer $  554,950

*Source: GuideStar, 2017 – Form 990 return filed by Care New England

On Community Health Centers: “If we provided primary care for every single Rhode Islander, hospital bed need would drop by 50 percent,” Fine said. “We probably have twice as many hospitals as we need…What we need is a well-developed health care system that is for people not for profit, to take care of everybody…community health centers are the jewel and the untold story.” He said there’s a need for a community health center in every community of 10,000 to 20,000. “If we could do that, we’d save a bunch of money, and we wouldn’t need as many hospitals…hospitals aren’t as important as they think they are, they just like to control things because that’s where the money is.”

On Brown University: Brown is part of the negotiations with Lifespan and Care New England. “If Brown wants to play,” Fine said. “it needs to commit itself to 50 percent of the class coming from Rhode Island. They need to support the state in a much stronger way by taking our students and training them.”

“The challenge for Rhode Island,” he said, “is to use the healthcare enterprise in an intelligent way, helping the population get healthier and save money at the same time.”

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Chris Electric