We are now seeing the predictable twisting in the wind as our state leadership struggles with what to do about Roger Williams and Fatima Hospitals, which are bankrupt. Nobody in state government likes to see hospitals close, in part because people work at hospitals and those people vote, and their unions have lobbying power. That said, more hospitals and more hospital administrators cost the state money, which we pay for in our health insurance premiums and our state taxes, which pays for Medicaid — so the closure of hospitals may actually lower the cost of health care, as painful as that closure may be.
But Roger Williams and Fatima are zombie hospitals. They have been dead from a business perspective for years, having been drained by private equity but also made redundant by changes in health care itself. Even so, no one has the courage to tell them, their labor unions, the legislature, or the mayors of Providence and North Providence, because no one wants to see anyone lose their job.
Unfortunately, we don’t need these hospitals from the perspective of public health. The demand for hospital care has been falling for years because of new technologies which allow many more medical services to be outpatient, without a hospital at all.
We do appear to need the emergency rooms of these two hospitals, which together see 50,000 visits a year. We need the geriatric and substance use disorder treatment beds at Roger Williams Hospital, which help patients with specific problems. We also needs beds for the 6000 patients who are admitted to both patients every year, at other institutions, which, when you run the numbers, means we need something like beds for 65-75 hospitalized patients a day.
If national numbers apply, about 88 percent, or 44,000 of those ED visits, don’t require hospitalization, which suggests many of those people could be seen in primary care practices, if we invested in primary care instead of pouring more money into zombie hospitals.
Most of the health professionals at these hospitals – doctors and nurses, x-ray and lab techs– could move to other hospitals if these two hospitals closed, to the extent that their services are actually needed elsewhere. But administrators, buildings and grounds people, cafeteria workers and transport folks would be put out of work. Which is sad, and very unfortunate for them, so we can and should find ways of retraining them or finding them other jobs.
That said, the closure of Memorial Hospital, without adequate planning, caused tremendous unnecessary hardship, even if it didn’t impact the public’s health. Nearby emergency rooms were (and to some degree, still are) overwhelmed. The EMS systems of the involved communities were stressed, as EMS runs that used to take moments began to take longer – longer distances over congested highways — stressing the mutual aid system — and brought new costs to the involved cities, by causing wear and tear on EMS staff and their ambulances.
So what’s a little state like Rhode Island to do?
First, we need to tell ourselves the truth. These two hospitals are going to close. If not this year, then next year or the year after, not because anyone did anything wrong, but because health care has changed and we don’t need that many hospitals anymore. It’s dumb or crazy or both to put more good money after bad.
Then, we should carefully and collaboratively plan for these closures. We’ll need to keep the EDs open in the near term, perhaps by getting Rhode Island Hospital to run one and Care New England to run the other, so we don’t further overwhelm the Emergency Departments we have. And we’ll need to contract with another hospital to run the geriatric psych and substance use disorder treatment units at the Rog.
We can actually fix health care in Rhode Island by careful study and courageous action, using the skills and people we have and building on those skills and people. But we’ve got to stop deluding ourselves about the world that used to be, and everyone involved – nurses, doctors, administrators, board members and leadership of hospitals and of the Rhode Island Health and Education and Building Fund, the Governor, the Senate President, the Speaker and the Attorney General – all need to have the courage to tell it like it is, plan, and act, instead of telling people what we think they want to hear.
We probably won’t plan and act responsibly. Which is crazy.
(The rumor on the street is that a fix is coming next week. One rumor is that the bankruptcy judge will remove the pension obligations and other liabilities and then sell or transfer the hospitals to Prime Healthcare, which owns Landmark Hospital and runs Landmark as a nonprofit. Time will tell. But it doesn’t matter who owns and runs these hospitals. They are the source of unnecessary cost in health care, a cost burden we all carry. It’s crazy to keep them open now.)
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com
