Delivery of Care

When it comes to health care, the Senate President delivers

An interview with ConvergenceRI, following the release of a package of 25 bills to the R.I. Senate. The Senate President thanked ConvergenceRI for the in-depth coverage of all things health in RI

Courtesy of Senate President's office

Senate President Dominick Ruggerio introduces 25 health care bills on Tuesday, March 5.

By Richard Asinof
Posted 3/11/24
An in-depth interview with Senate President Dominick Ruggerio by ConvergenceRI provides an insightful look into the thinking behind the package of 25 bills introduced to the Senate to address the health care delivery system in Rhode Island, a patient deemed to be in critical condition.
How can patients be able to voice their concerns about their own experiences in navigating the labyrinth that is the state’s health care delivery system? Should ConvergenceRI consider offering an advice column, such as “Dear Abby” for health care in Rhode Island, given the difficulty that patients have in getting accurate answers and the rightful wariness that many folks have with the misinformation and disinformation being disseminated on the web? In a world where the truth about health care is often elusive – such as interpreting the relative value of data presented by health care authorities – is there a way to fact check the data around rates paid to primary care providers in Rhode Island, compared to rates paid to primary care providers in Connecticut and Massachusetts, and Vermont? Would PBS’s “A Lively Experiment” ever consider having Steve Ahlquist, Frank Carini, and ConvergenceRI on as guest panelists together?
For all the coverage about the lack of mental health and behavioral health services in Rhode Island, the latest delays in implementing the pilot programming to establish Certified Community Behavioral Health Clinics [CCBHCs] in Rhode Island are perplexing at best. The program, funded by the federal Substance Abuse and Mental Health Services Administration, was supposed to launch in February of 2024, then April, and now is apparently being delayed until October, putting more than $40 million in federal grants at risk, according to numerous sources.
Equally perplexing to behavioral health care advocates was the seemingly “stealth” appointment of Richard LeClerc to serve as the new director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals [BHDDH]. Several community advocates described it as indicative of the McKee administration’s penchant to hire people for loyalty rather than competence.
The apparent baffling behavior of the McKee administration when it comes to behavioral health care raises the broader issue that needs discussion: What is public health? And, who gets to decide the answer to that question? Further, is there a way to separate the state from its over-dependence on consulting firms and instead, build out its own internal competence within state government?
Many of the conflicts between Attorney General Peter Neronha, the state’s public health advocate by law, and Gov. Dan McKee can be viewed through the lens of public health – such as the Attorney General’s advocacy to enforce lead poisoning protection laws vs. the Governor’s apparent willingness to delay their enforcement.

PROVIDENCE – Last week was a huge week when it comes to breakthroughs in the news narrative around health care, housing, and climate change. Three journalists who have been pushing to change the status quo – Steve Ahlquist, Frank Carini, and myself – broke through the protection barriers guarding the status quo.

  •   Frank Carini, co-founder and writer-at-large with ecoRI, was the invited guest of Sen. Sheldon Whitehouse to attend the State of the Union speech given  by President Joe Biden.
  •   Steve Ahlquist, who has been a constant thorn in the side of the status quo narrative when it comes to housing policy in Rhode Island, was given a shout-out by Speaker of the House Joe Shekarchi when he unrolled his array of 15 new proposed bills to boost housing production in Rhode Island.
  •   And, I, Richard Asinof, the founder, editor and publisher of ConvergenceRI,was given the opportunity to interview Senate President Dominick Ruggerio about his introduction of 25 proposed bills in the Senate to save health care delivery in Rhode Island, deemed to be in critical condition.

Translated, there was a growing recognition by the powers that be among elected officials – a U.S. Senator, the Speaker of the R.I. House, and the R.I. Senate President – that the courage, honesty and integrity of three journalists who cannot be bought by corporations are now the go-to sources when it comes to telling the truth about climate change, housing, and health care in Rhode Island. That is deserving of a rating of three wowswow, wow, wow!

The email dialogue with Senate President Dominick Ruggerio, who discussed the intent and details behind the package of 25 bills he introduced on Tuesday afternoon, March 5, represents the kind of insightful reporting that Rhode Islanders deserve when it comes to the future of the delivery of health care in the Ocean State.

One-on-one with Senate President Dominick Ruggerio  
Here is the ConvergenceRI interview with Senate President Dominick Ruggerio. [Editor’s Note: I give full permission to eco-RI News and the substack publication of Steve Ahlquist to republish the interview, with credit to ConvegenceRI, as a way to foster a more collaborative approach in promoting a news narrative that creates a change from the traditional status quo.]

ConvergenceRI: Have there been conversations with the House Speaker about the package of 25 bills and whether a consensus can be achieved on a joint package between the House and the Senate.  
SENATE PRESIDENT RUGGERIO: A number of the bills in our health care package already have, or soon will have, House sponsors as well. As always, we look forward to collaborating with our partners in the House of Representatives, and to continued communication with the Speaker, to move this package of bills forward for the good of all Rhode Islanders.

ConvergenceRI: The package of 25 bills presents a number of thoughtful approaches and solutions to address the patient — the health care delivery system in Rhode Island — that is, as you described it, in critical condition. The bills seek to stabilize the patient, moving forward. Is that an accurate description? If not, how would you describe it?  
SENATE PRESIDENT RUGGERIO: The package of bills seeks to move the entire health care industry in a positive direction.

As Majority Leader Ryan Pearson mentioned during his remarks at the news conference, this package is not meant to be a “silver bullet” to address the multitude of concerns Rhode Islanders face in accessing care. But we hope that these pieces of legislation, once passed, will create a more equitable, cost-effective, and fairer health care system for patients and providers.

ConvergeneRI: Increasing the number of primary care providers through financial incentives – and increases in rates to be achieved by strengthening the OHIC regulatory authority to do so – are perhaps long overdue. 

The numbers speak for themselves: a deficit of 100 or more primary care providers was diagnosed by Brown’s Dr. Jeff Borkan in September of 2023, and the expectation is that this gap will grow.

 Questions: Will that translate into increases in Medicaid rates for providers? I did not see that specifically addressed in the package of 25 proposed bills? Did I miss it? Do you have a position on the OHIC proposal to raise those Medicaid provider rates by $45 million in the FY 2025 budget?  
SENATE PRESIDENT RUGGERIO: First, the Senate would like to thank Commissioner [Cory] King and the entire OHIC staff for their diligent work in reviewing the rates that have been presented and placed in the Governor’s proposed budget.

The review of rates has been long overdue and, as one of our bills proposes, we believe that OHIC should have the dual mandate to ensure that our premiums are of value to consumers, but also that our rates remain competitive regionally.

As part of the package announced Tuesday, S-2722 [see link to legislation below] provides for this dual mandate for OHIC to include rate review, and S-2723 [see link to legislation below] specifically requires a rate review for primary care providers. Although not part of this package of bills, Senate Finance Committee Chair Lou DiPalma has recommended that we accelerate the implementation of the full rate amount for FY 2025.

We look forward to having fruitful discussions during our annual budget review and working with our partners in government to address one of the most serious concerns in our healthcare system.

ConvergenceRI: What is the best way to reach consensus on the dataset concerning primary care providers in Rhode Island? How many providers are there? How many practices? How many are open to seeing new patients? [A survey conducted by Attorney General Neronha found that out of some 2,500 practices within 30 miles of Boston who were listed on the Blue Cross and Blue Shield of RI provider network, only about 50 percent were actually seeing new patients, and of those that were seeing new patients, most could not see new patients for six months. See link below to ConvergenceRI story, “AG Neronha weighs in on future of health care.”]  
SENATE PRESIDENT RUGGERIO: We have heard from primary care providers that their rates are of paramount concern to patient access and quality of care. The Attorney General’s survey, although not scientific, still provides a startling picture of the current state of primary care in our state.

We have presented what we believe to be a starting point to address many of these concerns. As these bills go through their respective committees, we hope that providers, patients, and all involved come to provide verbal and written testimony about their experiences and their solutions. That way, we are able to take that input and amend legislation to ensure that we are addressing the issues for those providing and receiving care in our state.

ConvergenceRI: Who needs to be keeper of such data to ensure that it is accurate and reliable and up to date? Is that OHIC?  
SENATE PRESIDENT RUGGERIO: OHIC has shown that they are able to be the proper agency to keep and analyze this information, but we are open to working with all in state government to see where this information should best live.

ConvergenceRI: What is the best way to measure and compare the rates for primary care providers practicing in Rhode Island? In your package of 25 bills, there is language, if I am reading it correctly, which would give OHIC authority to do so.  

Currently, there are, by my count, four separate initiatives underway to develop a dataset for comparison costs of primary care providers — one by the RI Foundation, being conducted by Manatt, a consulting firm, another by the AG’s legal team, a third by your proposed legislative package, if I am reading it correctly, and a fourth by the CTC-RI strategic primary care task force. A potential fifth would be [whatever emerges] from the Governor’s Planning Cabinet, but what they will actually be working on is vague. 

What is the best way to achieve consensus on the data around costs moving forward?  
SENATE PRESIDENT RUGGERIO: Based on our legislation, the Senate believes that rate review should be conducted by OHIC. We do not want to diminish the work being done by other great partners, like the Rhode Island Foundation, and we look forward to seeing their final products. The information and insight that they provide can definitely inform Senators and staff as the package moves through the legislative process.

ConvergenceRI: There are both internal and external threats to the current health care delivery system. One of the biggest threats is posed by private equity firms [such as Medical Properties Trust] and by for-profit hospital groups [such as Steward Health Care]. [Editor’s Note: At the very same time that the Senate President was introducing the package of 25 bills, the Federal Trade Commission was hosting a workshop on Tuesday, March 5, entitled, “Private Capital, Public Impact: An FTC workshop on Private Equity in Health Care.” See link below to a video of the workshop.]

I did not see any legislation as part of the 25-bill package that specifically addresses the need for improved regulations here in Rhode Island to protect hospitals and nursing homes from the excesses of private equity firms purchasing facilities and then locking those hospitals and nursing homes into debt packages that are impossible to repay. Have you discussed any potential legislation with the AG’s office?  
SENATE PRESIDENT RUGGERIO: I have been among those raising alarms about the financial condition of Fatima and Roger Williams [hospitals] under their current, for-profit ownership group, calling for an Attorney General investigation into their finances as far back as 2017.

Working with the Attorney General, I have been proud to sponsor and support laws that further strengthen the tools regulators have when conducting these reviews. I believe these updates to the statute provide the Attorney General very strong tools to ensure rigorous review under the Hospital Conversions Act [HCA], and will continue to work with the Attorney General if further action is required.

ConvergenceRI: There are a number of progressive pieces of legislation proposed regarding pharmacy practices to protect consumers as part of the 25-bill package. Would any of them be able to rectify the current mess created by the cyber attack on Change, the for-profit pharmacy benefit manager owned by UnitedHealth/Optum?  
SENATE PRESIDENT RUGGERIO: We are keeping a close eye on the very recent events regarding the Change Healthcare cyber-attack and its impacts on Rhode Islanders.

The focus of our “Consumer Protection” pillar of our health care package is to ensure that we increase access, provide relief for those experiencing medical debt, and protect Rhode Islanders from future potential debt. As alluded to during the press conference, no Rhode Islander should experience debt or bankruptcy solely based on a catastrophic medical event.

ConvergenceRI: Another potential threat, more inside the system than outside of it, is the way that “prior authorization” has been used by insurers to limit utilization of needed procedures by patients. [Editor’s Note: I myself had a needed surgery cancelled not once but twice by a third party authorization firm, until those decisions were overturned on appeal, requiring me to wait an additional six months for surgery to relieve pressure on my spinal cord between C-6 and C-7, which had resulted in my fingers and hands going numb and acute pain in both arms, among other symptoms.]

I did not see anything in the 25-bill package that would address prior authorization abuses. Why not?  
SENATE PRESIDENT RUGGERIO: The challenges around our health care system are numerous and complex. Ultimately, we had to limit the number of bills in the package we introduced to “just” 25, but they are by no means the only worthwhile ideas that we will consider to improve our health care system this session.

Just yesterday [Thursday, March 7], the Senate passed legislation to end the practice of “white bagging,” for example. Separate legislation to address prior authorizations has also been filed.

For the Rhode Island HEALTH Initiative package of bills, we focused on legislation we believed would have the most impact across the healthcare industry. The Senate Health and Human Services Committee, under the leadership of Chair Joshua Miller, will be reviewing many important additional pieces of legislation to address a multitude of topics, including the one presented in your question.

Currently, the Committee has before it three bills pertaining to pre-authorization/prior authorization: S-2380 [Sen. Bissaillon]; S-2393, and S-2614 [Sen. Ujifusa].

ConvergenceRI: Finally, thank you for allowing me to reach out and ask these questions; the access is much appreciated. If there are questions that I have not asked, that you would like to address, please do so!  
SENATE PRESIDENT RUGGERIO: Thank you, Richard, for reaching out, and for your continuous, in-depth focus on these critically important issues. The following is adopted from my remarks on Tuesday, which is what I would most like to highlight: As you know from first-hand experience, our health care system is in critical need of help.

Health care absolutely must be accessible and affordable for all Rhode Islanders. But, for too many people in our state, care is too expensive or too difficult to get. And we know, many health care providers are feeling enormous strain as well, due to many factors.

I want to recognize the outstanding work of my colleagues in the Senate in the development of this package of bills. Majority Leader Ryan Pearson, Chairman Josh Miller, Chairwoman Alana DiMario and Senator Pam Lauria, among many others, worked tirelessly to organize the Rhode Island HEALTH Initiative.

These are issues that the Senate has focused on for a number of years. And this package of legislation represents just some of the ongoing work on these issues. Each and every member of the Senate has worked, and continues to work, on these critical issues.

The challenges we face are numerous and complex. These bills move us in the right direction, and we will need to continue to work together to address them.

  • It is essential that as a state, we focus on ensuring the strength of our community hospitals.
  • Attracting and retaining primary care physicians.
  • Making sure Rhode Islanders can access quality, affordable care.

I hear about these issues often from my constituents in North Providence, where many are rightly concerned about the stability of Fatima Hospital, which is a critical employer and care provider for so many people.

The RI HEALTH Initiative is far-reaching, and the bills are a first step to help stabilize and strengthen health care across our state.

I look forward to continued focus not just on these important bills, but many others, as we work to address the challenges facing our health care system.

Thank you again for your attention and in-depth coverage of these important issues.

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