WARWICK – R.I. Attorrney General Peter Neronha had a home-cooked meal awaiting him at home in Jamestown, but following the awards ceremony where he had been honored by the Childhood Lead Action Project in a ceremony in the Atrium at the Crowne Plaza, he delayed his departure in order to accommodate a request for a brief 15-minute interview with ConvergenceRI.

In late June, Attorney General Neronha had sat down with ConvergenceRI for an in-depth, in-person interview, where he detailed his plans to create a roadmap for how Rhode Island might solve its health care crisis. [See link below to ConvergenceRI story, “RI AG Neronha….”]

Neronha finds himself embroiled in the continuing saga of Prospect Medical Holding’s attempts to sell off its two Rhode Island hospitals, Roger Williams Medical Center and Our Lady of Fatima Hospital. A new buyer, The Centurion Foundation, is attempting to purchase the two hospitals, but the Foundation’s initial applications under the state’s Hospital Conversions Act has been rejected by regulators twice as being incomplete. A third attempt at an application is expected in November.

Earlier in the evening, ConvergenceRI  interviewed Deputy Attorney General Adi Goldstein, a key member of the Attorrney General’s legal team. [See link in this edition of ConvergenceRI, “A matter of life and death.”

In his interview, Attorney General Neronha revealed new details about his ongoing efforts to prescribe a solution to the ongoing health care crisis in Rhode Island, including the difficulty Rhode Island residents have in gaining access to primary care providers, recognizing that it may require a regulatory overhaul and new legislation.

Attorney General spoke with confidence, often sparring with ConvergenceRI, teasing him about the reporter’s alleged feistiness in asking questions, a quality that Attorney General Neronha said that he respected – as well as respecting ConvergenceRI’s ability to get the story right.

ConvergenceRI: You have assembled a great team.
NERONHA: I have

ConvergenceRI: They seem to put up with your spontaneous jokes and humor.
NERONHA: [laughter] They do.

ConvergenceRI: When we talked in June, you were busy preparing a document about how you were looking toward finding solutions…
NERONHA: Yes…

ConvergenceRI: …to what’s going on in health care.
NERONHA: Not so much a document, more a plan, I guess.

ConvergenceRI: It could be a Powerpoint. I am not sure how to describe it.
NERONHA:  I can tell you where we are. I’m sure you are going to ask: Where are we?

ConvergenceRI: Yes. Where are you?
NERONHA: We are… The plan has a number of components. The first one is: Restructuring health care regulation. It won’t happen this year. It may not happen next year.

But we feel like health care regulation in Rhode Island is too siloed. There are too many components in too many different places. Generally, you can appreciate it. You’ve got OHIC over here, doing their thing. We’ve got the Medicaid office within EOHHS.

But it has its own silo. And then, you’ve got [the R.I. Department of] Health, which, in theory, has a regulatory, strategic planning role. When we look around the country at where health care regulation is done the best, meaning, it’s not just saying yes or no to a transaction, it’s about coming up with strategy. And also, recommendations and analyzing costs. The model is different.

I don’t have them to name, off the top of my head. But the team has put together some good examples.

That’s sort of Tier One. But we also recognize that if we come in with a proposal to change how government is structured, without all the other pieces, then it will look like we are just trying to restructure government.

The plan has much more to do beyond that. At the same time, we are working on primary care, network adequacy, for example. I think you know what I mean, but when I buy insurance, [asking the question]: Is the network of providers that is handed to me in the book actually one where I can find a provider?

ConvergenceRI: Is the answer, “No?”
NERONHA: We strongly suspect that the answer is no. Anecdotally we know, we are confident that the answer is no. I want to find out definitely whether it is no. And then, do something about it.

Because if you think about it, when you buy insurance, it’s not just to have insurance, but to have someone treat you when are sick. And, if there are no providers to treat you, then your insurance company is selling you a product that is unusable. It’s sort of like selling me a car without any wheels. A car without wheels is not going to go anywhere.

So, we are working on that. Why? Let’s say we find [health insurance] to be inadequate. What’s the endgame here?

The endgame there is that insurance companies, in my view, have an obligation to help fix the shortage of primary care providers here. Right?

If they have a network without any primary care providers who are actually taking patients…Well, that’s the part that is selling me a car that is no good because it has no wheels. [The insurance company] has to help me find some wheels.

There’s that. We’re looking at that. What else are we looking at? We are pulling together groups of everyday providers. Primary care, surgeons….

[Attorney General interjects, waving at Kim Kalunian: “Goodbye, Kim! We’ll talk soon! Tell Ted and Samantha we said, ‘Oh.’”]

What will all this look like, in the end? It will be a road map. So, it is not going to be a road map that I’m going to go out and market, in the first instance.

I don’t view it as my job to point to this one [aspect] or that one. If it’s a plan that I think will actually work, it can’t be so watered down that it won’t work. That doesn’t mean I don’t want input; I do. But I want that input to be as objective as possible, and, after we have done enough research.

We know that what we are hearing comes from a certain perspective that may have an element of bias, conscious or otherwise. It is a work in progress. The regs that we are going to propose… By that I mean, we need this kind of restructuring which can only be done by legislation. I don’t’ believe we are going to introduce this [this legislative session].

ConvergenceRI: Is there a guestimate on the timeline of when you’ll be ready to share this publicly?
NERONHA: The team is working really hard and we are already briefing state leaders. So, we have briefed Sen. Jack Reed. We are halfway through a briefing of Part One with the Speaker.

And so, we’ll eventually get to constituent groups. Labor, for instance, has an important voice here. For example, I just had a meeting with UNAP recently. It was more about workplace safety than anything else, in that particular meeting.

I was glad to see that Lifespan came out with a workplace safety plan. But whether it will be adequate, remains to be seen. I found it stunning that, for some large health care organization, the top of management has not yet met with labor. I think it’s important that they do that, just for relationship building, if nothing else.

But, we’ll see. We are working on a lot of fronts.

ConvergenceRI: I am concerned about the latest iteration of the announced collaboration between Brown and Lifespan, because I don’t truly understand what they are trying to do. In many ways, Lifespan appears to be a bad actor, in my opinion. There is nothing that they have done in the past five or six years that has made me feel comfortable about what their motives are.

 And, the latest move, to brand the hospital with Brown’s name on it, doesn’t resolve any of the big issues that they face. Dr. Al Kurose, he says he left on his own [at the end of July]. I’ll take him at his word, until I hear otherwise. But, I don’t necessarily believe that. Someone who worked so hard to set up Coastal Medical, and then get it acquired by Lifespan…
NERONHA: I agree. In the interests of full disclosure, Al Kurose was one of the first people I met with in 2017 when I began to run for Attorney General, because I knew from Sheldon [Whitehouse] and from my wife [who is a physician] that Al was arguably the best thinker on health care in the state. And still is.

ConvergenceRI: I don’t know what he is going to do. I suspect that he has close ties to Neil Steinberg [Editor’s Note: Kurose serves as chair of the Rhode Island Foundation board of directors.]

I don’t understand what Neil himself is doing, because [the folks behind the new $45 million R.I. Life Sciences Hub] have seemingly ignored what actually happened in Massachusetts. [Editor’s Note: Steinberg was nominated to serve as chair of the board of directors of the R.I. Live Sciences Hub. See link below to ConvergenceRI story, “Will Neil Steinberg be a good listener as he champions life sciences in RI?”]

 As much as I have pointed out numerous times that they don’t have any good data source for how they are measuring the [performance] of the Rhode Island Innovation Economy, that they have no data or metrics on it. They are flying blind. And, until they create that index of metrics…

NERONHA: That’s true in health care, too, Richard. I think data really, really matters. When I was in the federal government, we had data on everything. We don’t really do that here.

ConvergenceRI: Neil Sarkar, who is the head of the R.I. Quality Institute, I just interviewed him last week. He has a good understanding of the data. But we’re flying blind. We don’t have the data. And, there seems to be no appetite for the health care reporters to document how we are flying blind.
NERONHA: More than that… [at this point, Neronha goes off the record.] …and you can go back on the record now. What really bothers me, is that when I read in the newspaper, it’s all sugar and doughnuts, when I know that it’s not.

Like this past week, there were two articles about energy that are all sugar and doughnuts on climate, and it’s bullshit. Don’t tell me that we are hitting our goals, when we’re not.

ConvergenceRI: I do my best to try and keep people on their toes.
NERONHA: I know.

ConvergenceRI: As I said, I’m concerned. I’m only one person.  
NERONHA: You want me to comment on Brown and Lifespan?

ConvergenceRI: If you want to, yes.
NERONHA: We’ll see what the proposal is. I do think, you and I may have a slight disagreement here. I have a son who is attending Washington University School of Medicine in St. Louis, which is a really strong medical school

ConvergenceRI: I am familiar with it.
NERONHA: They and Barnes Jewish Christian Hospital are joined at the hip. From a person who has visited many, many times, they’re doing pretty well. There are more cranes in the sky on the Wash U-Barnes Jewish Christian campus, and it truly is a campus, than there are in Providence.

There are cranes in the sky, and they say: Wash U. Medical School/Barnes Jewish Christian. Why? Because it is a brand. And, whether we like it or not, Brown’s brand is what Brown’s brand is.

If it can keep people from going to Boston for no reason… When I had my spinal surgery, do you how many people told me to go to Boston. Go to Boston. I had seven hours of surgery. This was not a laminectomy; it wasn’t a disc issue. It was a big deal.

[A pause]. I do believe that branding can help a health care system.  And, I think it is done elsewhere. Yale New Haven, for example. And Stanford. Their hospital is really something. It’s built to withstand an 8.5 earthquake.

[A pause] You’re not interested when I go off on a different direction. I can tell.

ConvergenceRI: I am interested. But, I have my own… [trying to find the words to talk about my own health conditions].
NERONHA: Bias? Viewpoint?

ConvergenceRI: No. My health conditions have gotten worse, rather than better. I was scheduled to have neck surgery to relieve some of the symptoms. I have a lot of things that are going on. But in this case, my neurosurgeon wanted to repair a disk, I have had disks fused C-3, C-4, C-5, C-6, and I need to have additional work done on C-7 in my cervical region

 But two days before the surgery, my insurance company cancelled the surgery, because of “prior authorization.” EviCore cancelled it…
NERONHA: Who’s EviCore?

ConvergenceRI: EviCore is the third-patty authorization firm used by the insurance company. I couldn’t get a straight answer from them, except to say that the decision by my neurosurgeon in Boston was made using an MRI that was done 8 months ago, and the protocol said it had to be an MRI within 6 months. I’m trying to get the surgery rescheduled. In the meantime…

NERONHA: So, you went to Boston?

ConvergenceRI: For good reason. I have worked with the same neurosurgeon since 2008; he has done all my previous surgery, so I have a level of trust.
NERONHA: I understand.

ConvergenceRI: And the surgeon whom I went to earlier, locally, in 2007, did a really terrible job, and I had to have the surgery redone.
NERONHA: That’s terrible.

ConvergenceRI: Given my health condition, my time is limited; it is precious.
NERONHA: You told me that the last time we spoke.

ConvergenceRI: Yes, I am still persevering.
NERONHA: You look good.

ConvergenceRI: Thank you. I am still keeping on keeping on.
NERONHA: By the way, were you this surly with Adi?

ConvergenceRI: What? No!
NERONHA: I thought maybe I bring out the worst in you.

ConvergenceRI: No, I am not surly. Peter, I am trying to be very honest with you. It is very difficult for me these days. What I said to Adi Goldstein was that you are the last great voice in Rhode Island when it comes to serving as the public health advocate
NERONHA: Ha!

ConvergenceRI: You are the one person who has taken on private equity when it comes to Prospect. You’re the one person who’s taken on lead poisoning. You’re the one person who’s taken on the energy systems. You’re the one person who fought back against the drug companies and won huge legal settlements. You’re the one person who has stood their ground against the merger between Lifespan, Care New England, and Brown. And, you’ve assembled a great legal team and you are looking at health care. And, no one else has had the courage or the vision to really look at what’s going on.
NERONHA: It is hard. You know, politicians don’t want to do what’s hard, because when something is hard, you risk failure. And, one thing a politician never wants to do is risk failure. But you know, I’m not wired the way most people are. Mostly, because I don’t view myself as a politician. Maybe it’s because I came to it late; I don’t know.

ConvergenceRI: I’m giving you a direct compliment and you need to accept it. My guess is that you have a hard time accepting compliments. I realize that you want to change the subject when I give you a compliment. And that’s OK. And in turn, you criticize me, and call me surly, which is not true. I am feisty.
NERONHA: I love it. There is no one feistier than me. Richard. I love it.

ConvergenceRI: You’ve assembled a great team. I’m impressed. My apologies if it appears that I am on the feisty side.
NERONHA: You’re not. I’m teasing you.