PROVIDENCE – Lifespan’s attempt to add as much as a $400 co-payment for employees who deliver their babies at Care New England’s Women & Infants Hospital has encountered a major stumbling block. United Nurses & Allied Professional Local 5098, representing about 2,200 employees at Rhode Island Hospital, about one-sixth of Lifespan’s entire workforce, strongly opposes it.

Under Local 5098’s current contract, which doesn’t expire until June 30, 2015, Women & Infants Hospital is listed as an in-network, tier one provider for union members, Helene Macedo, president of Local 5098, told ConvergenceRI.

“Because of our negotiated language, our UNAP members still have Women & Infants as [an] in-network [provider], which means no co-pay,” Macedo said. “In our next contract, I will continue to advocate for no change to the network because it is the right thing to do for women’s health,” she continued. “Since there is no equivalent service offered within Lifespan, it is wrong and not acceptable for Lifespan to charge a co-pay.”

Women’s health is very important, Macedo emphasized. “It’s wrong and not acceptable to penalize [employees] for services that are not adequately provided by Lifespan.”

In adopting its new policies on co-payments for “out-of-network” births, Lifespan did not communicate with its non-union employees that its nurses who are UNAP members have different health insurance benefits precluding such co-payments, according to numerous sources.

The additional co-payments sought for out-of-network health care include eye care, ob-gyn care, and mental health visits, among other health services.

In addition, the claim by Lifespan’s Mark Montella, senior vice president of External Affairs, that the hospital system’s strategy of higher co-pays for out-of-network services was a way to keep the employee’s share at 15 percent for health insurance benefits was refuted by a number of Lifespan employees, who said they have seen their share rise much higher.

Cost-cutting or competition?
As reported in last week’s ConvergenceRI, beginning on Jan. 1, Lifespan had sought to charge co-pays for Lifepan employees who chose to use out-of-network providers for medical care as a way to trim the hospital system’s $140 million annual health insurance costs. [See link to ConvergenceRI article below.]

The move, discussed by Dr. Timothy J. Babineau, president and CEO of Lifespan, at a forum on April 23 with other hospital CEOs, had been framed by Babineau as an effort to cut down on medical reimbursements being paid to Boston providers.

However, the $400 co-payment, if a Lifespan employee chose to deliver at Women & Infants instead of at Newport Hospital, the only facility within the Lifespan network with a maternity service, appeared to be driven more out of growing competition with Care New England for share of women’s health market.

Last week, Lifespan also began publicizing its new “women’s hospital within a hospital,” a newly created 14-bed wing at Jane Brown, part of Rhode Island Hopsital, a few hundred yards from Women & Infants. The director of Lifespan’s Women’s Medicine Collaborative, Dr. Karen Rosene-Montella, took to talk radio, appearing twice on WPRO last week, to promote the new facility.

The lack of conversation and consultation with nurses on both these decisions – the $400 co-payment and the new 14-bed “women’s hospital within a hospital” was problematic, Macedo said.

Creation of that new facility was done without any consultation with the nurses who will be staffing it, according to Macedo.

“They don’t come to us before they enact these policies,” Macedo said, in response to a question by ConvergenceRI about the claim that Lifespan had adopted continuous improvement and LEAN methods. “When they opened up this new unit at the hospital, they didn’t look to us [and ask us] what we would need. They just opened up this women’s health unit [without consulting us] and are going from there,” she said.

Statewide coordination, regulation lacking
The larger issue – whether the competition that Lifespan has entered into with Care New England to grab a greater share of the women’s health care market improves health care for women and serves as a good use of hospital resources – underscores the lack of coordination, planning and regulation at a statewide level.

The R.I. Office of the Health Insurance Commissioner has no authority to regulate self-insured companies, according to R.I. Health Insurance Commissioner Dr. Kathleen Hittner. “OHIC does not have any regulatory authority over self-insured [health] insurance plans,” Hittner told ConvergenceRI. “In the case of Lifespan, Blue Cross & Blue Shield of Rhode Island serves as the TPA, or third-party administrator of the Lifespan plan. We have no regulatory authority over TPAs.”

Unless either Lifespan or Blue Cross is willing to share the numbers regarding dollars spent on compensating out-of-state providers for such self-insured plans, there is no way to validate any of the costs and costs controls claimed by Lifespan, because OHIC does not track or analyze those numbers.

“We do not track the numbers of patients who leave the state for care,” Hittner said. “We do not have need for that data to accomplish our responsibilities.” As far as Hittner knew, a former president and CEO of Miriam Hospital in the Lifespan hospital system, “The hospitals are the ones who track that data, as it is important when they analyze their market share.”

Hittner said that OHIC has not current plans to track this data. “If we see future benefit to our work in the future, we would do the appropriate thing,” she added.

The only statewide health care planning group now functioning is R.I. Health Care Planning and Accountability Advisory Council, chaired by Hittner and Steven Costantino, head of the R.I. Executive Office of Health and Human Services.

Its members are a veritable who’s who of Rhode Island’s health care delivery and regulatory establishment – the top regulatory officials from state government, the top leaders of the state’s three largest hospital systems, the heads of the state’s two largest private insurers, among others.

But the Council has no authority to implement policy, only make recommendations to the R.I. General Assembly. The ongoing assumption has been that somehow the weight of who is at the table will be as important as what is discussed.

The competition between Lifespan and Care New England over share of the women’s health care market is not on the Council’s agenda, according to Hittner. “The statewide health planning council has not addressed such a specific issue as this in the past,” she said. “The planning is more general; for example, we will be looking at the total cost of care and getting a better understanding on costs, and what we might do to bring costs down, or at least [achieve] better control.”

Without any effective health insurance regulation for self-insured companies, or statewide planning for health care to better manage coordination of care, the only pushback on policies regarding women’s health care in Rhode Island is coming from unions representing its employees. The news media has been AWOL in covering the conflict.

Legislation pending
Two separate bills, one by Sen. Joshua Miller, another by Sen. Gayle Goldin, which would establish a statewide health care authority are in the process of being melded together as one bill. Hearings on the revised bill are expected to be held in the near future, according to sources. The prospects of such legislation being enacted this year are unclear.

In the meantime, consolidation of hospitals in Rhode Island continues apace. On Friday, May 16, the R.I. Attorney General approved the new merger of CharterCARE – which owns Roger Williams Medical Center and Our Lady of Fatima Hospital – with Prospect Medical, a California-based private equity firm. It is the second for-profit buyer to enter the Rhode Island health care landscape; on Dec. 31, 2013, Prime Healthcare Services purchased Landmark Medical Center in Woonsocket.

On the other end of the health care spectrum, the R.I. Department of Health approved seven CVS Minute Clinics last week. Planned Parenthood also announced that it would be offering more services at its clinic on Point Street related to general care, including common skin conditions such as acne, fungal infections, work and physical exams, musculoskeletal complaints, such as back pain, and gastrointestinal conditions.

These new business models are a response to demands by consumers – who are demanding better access to care in a more convenient manner at a lower cost.

Coming next week: Care New England’s response to Lifespan’s competitive challenge in women’s health