Rhode Island Academy of Family Physicians

Submitted by Matthew Burke, MD

Merger:

The hot topic at the most recent Primary Care Physician's Advisory Committee was the impending merger of the Lifespan and Care New England, a move that would administratively enjoin Rhode Island (including Hasbro), Woman and Infant's, The Miriam, Kent, Newport and Butler Hospitals. This merger would unite nearly half the hospitals in the state and the majority of inpatient beds and ancillary medical services. As the merger has progressed it has gained janitorial blessing and has passed federal antitrust investigations enhancing the likelihood of successful passage. As this occurs it is imperative to evaluate the potential impact this merger will have on the landscape of primary care in the State of Rhode Island.
In summation a long and diplomatic, but passionate, back-and-forth occurred at the Primary Care Physician's Advisory Committee between a regular panel of internists, family physicians, pediatricians and obstetricians directly querying the CEOs of Lifespan and Care New England. Scant evidence exists regarding the impact of hospital consolidation on access to care, but this evidence does support reduced access to care, which disproportionately affects minority citizens. Many of the questions asked of the individuals helming the merger probed issues of "balanced co-development" with the recognition that the merger is all but impossible to block at this stage. Hope towards the viability of primary care was instead directed at ensuring the leaders of the merger were made aware of the utility of primary care as the proven best modality of reducing cost and improving outcomes in the health care world and the marginalization of our field in planning the consolidation of tertiary and quaternary care centers will negatively effect all of us engaged in health. And we will not only be endangering the quality of patient care by reducing access, but this very reduction in access will further shift care to tertiary centers driving up cost and making the very merger that is proposed potentially less financially viable than intended.
If I may be so bold as to editorialize, I am not exclusively anti-merger. The merger will streamline administrative costs, and I believe objectively and diligently search for redundancy and waste in the system thereby saving cost. However the above noted implications for primary care are concerning and would potentially move us in a backward direction. Only through the "balanced co-development" of institutional focus and teaching of primary care, financial support and teaching in outpatient primary care centers (especially those engaged in GME) and increased cooperatively with the only remaining Brown University residency program (Family Medicine at Memorial Hospital) will the merged entity responsibly offer due diligence to a community of primary care physicians without whom continued reform and improvement in health care cannot be achieved.