health services

R.I. providers offer views on health care reform

Posted 3/27/12

PROVIDENCE – More than 70 members of the Rhode Island business community gathered today to hear “Health Care Providers and Your Insurance Rates,” the third installment of discussions focused on health insurance rates for small businesses organized by R.I. Health Insurance Commissioner Christopher F. Koller.

Discussion focused on the ways in which providers and hospitals are moving forward to reduce medical costs, cut inefficiencies, and lower insurance premiums, from four perspectives – the hospital president, the emergency room physician, the primary care physician practice and the specialist.

The panel featured Dennis Keefe, president and CEO, Care New England, Dr. G. Al Kurose, president and CEO of Coastal Medical, Dr. Gary Bubly, director of The Miriam Hospital’s Emergency Department and the University Emergency Medicine Foundation, and Dr. Peter S. Margolis, president of University Gastroenterology.

Keefe said that health care reform needed to be supported by payment reform. “The incentive system needs to be changed,” he said, making the point that the current Rhode Island health care delivery system was “unsustainable.” What was needed, he continued, was for health insurers to design insurance products that put the emphasis of primary care.

Margolis, who defined his practice as a sub-specialist, said that savings could be found in better coordination with primary care providers. Margolis said that he has a “compact” and not a contract with Coastal Medical, to build an ongoing relationship for coordinated care of patients. Margolis is hopeful that the new relationship will grow into a contract, which would break new ground in terms of defining the role of specialists within payment reform and health care reform.

Bubly said that he felt emergency room physicians were unfairly blamed for high medical costs, and based on national data, the physicians’ component was 0.2 percent of the national health care budget. And, multiplying that by the national figure of 6 percent of unnecessary, avoidable ER visits, that it still amounted to 1.2 percent of the overall budget. In Rhode Island, Bubly continued, 42 percent of the patients using emergency rooms are self-paid or on Medicaid. “We don’t have the choice not to provide care,” he said.

Kurose talked about the new contract that Coastal Medical, Rhode Island’s largest private group practice, recently signed with Blue Cross & Blue Shield of Rhode Island, with global payments and shared costs savings. He described the way in which the patient-centered medical home model responded differently to a patient with a suspected broken wrist, able to coordinate care between imaging and orthopedic treatment.

Vivian G. Weisman, executive director of the Mental Health Association of Rhode Island, asked the panel members what they thought government should be doing.

In response, Kurose pointed to the important role that Koller has played in mandating that affordability and primary care investments be built into contracts between health insurers and hospital contracts.

Audience members praised the content and inclusiveness of the discussion.

“If you’re not heard, it’s your own fault,” said Jim Borah of Borah Associates, a Providence-based insurance brokerage firm. Borah also serves as spokesman for Coalition for Affordable Health Care Choices and president of the Rhode Island Business Health Advisors Council, a coalition member.

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