Misleading Information: South County Hospital is in crisis and on the verge of closing.

Reality: The hospital is not closing. In fact, South County Health maintains a strong balance sheet and remains a high-performing health system that continues to exceed the performance of its peers at a state, regional, and national level.

Additional Detail: Over the last decade, Rhode Island has seen 50% of its acute care hospitals go through bankruptcy or experience a change in control, while two more sit again on the verge of insolvency (Roger Williams and Fatima). Rhode Island consistently ranks as the worst state for physicians to practice in and is in the bottom 5 of all states in keeping graduates of medical education. Fully one-third of physicians are at retirement age in Rhode Island with no physicians to replace them. Why? Decades of underfunding. The challenges of recruiting and retaining physicians is a Rhode Island issue. These challenges are not unique to us; they are being experienced by all healthcare systems across Rhode Island and is well represented in the most recent Boston Globe article explaining Lifespan’s strategic move to invest in hospitals across our border to tap into Massachusetts’s reimbursement rates versus saving two hospitals in Rhode Island.

Through all of these challenges, South County Health has just been reaffirmed as a 5 Star Hospital by CMS (Medicare), remains a Leapfrog A Grade for quality and safety, is a Press Ganey Pinnacle of Excellence awardee for leading the nation in patient experience, along with many other awards for quality, safety, and patient experience. CMS’ (Medicare’s) Value-Based Purchasing Program measures the quality, safety, and patient experience delivered in hospital settings nationwide. In the most recent performance period, CMS (Medicare) scored South County Hospital’s overall quality, safety, and patient experience 61% higher than Rhode Island’s average and 105% higher than national average. Visit our webpage here to see how our health systems delivers quality that is second to none. Further, and despite the extraordinary challenges of being the sole independent health system in the difficult RI healthcare environment, South County Health has staff turnover rates well below state, regional, and national averages, affirming a strong and vibrant culture.

At South County Health, the Executive Leadership Team (ELT) at the direction of the Board of Trustees (BOT) has charted an assertive financial sustainability plan to ensure the health system can continue its core service to the community. South County Health must continually assess how we provide healthcare services to ensure our enterprise remains sustainable, our patients receive the best possible care, and we are able to carry on our mission of being Rhode Island’s Most Trusted Health Partner.

• Westerly Hospital (2011-2016) — Out-of-State Control
• Our Lady of Fatima Hospital & Roger Williams Medical Center (2009-Ongoing) — For Profit Control
• Landmark Medical Center and Rehabilitation Center (2008-2013) — For Profit Control
• Memorial Hospital of Rhode Island (2016-2018) — Permanent loss of ED, ICU, and delivery beds in a community that already suffers health inequalities

Learn more about the state of Rhode Island Healthcare

Misleading Information: The financial challenges that South County Health faces are unique to this organization.

Reality: In Fiscal Year 2022, the three non-profit health systems in Rhode Island collectively experienced approximately $300 MM in losses, including non-operating losses. However, as Rhode Island’s last independent heath system, South County Health simply lacks the scale and associated benefits that other health systems in this state enjoy.

Misleading Information: South County Health is not willing to partner or merge with another organization, and is adamant about remaining independent.

Reality: We agree that we cannot do it all on our own. South County Health’s Board of Trustees has explored and continues to explore partnerships and strategic alignments to partner around the provision of some services with like-missioned organizations that intend to improve the quality, accessibility and sustainability of healthcare services to residents of Washington County and beyond.

Partnership is a core value of South County Health, and collaboration is always contemplated through the lens of benefit to the community. Though we have explored out-of-state (OOS) partnerships in the past, the rate parity challenges discussed in RI (RI receives approximately 20%-30% less reimbursement that for the same services than hospital-based health systems in Massachusetts and Connecticut) have created a barrier for high-quality not-for-profit systems to consider coming into RI.

Additional Detail: In taking the lead within the state in advocating for regional reimbursement rate parity, it has been perceived by many that this is a South County Health issue. This could not be further from the truth as displayed by the disproportionate amount of hospital bankruptcies, changes in control, and even closures of Rhode Island’s hospitals over the last decade. In Fiscal Year 2022, the three non-profit health systems in Rhode Island collectively experienced approximately $300 MM in losses, including non-operating losses. South County Health, like most hospital-based health systems in the region, continues to recover from the pandemic and while performing well compared to budget, has challenges in sufficiently reinvesting in infrastructure and technology that would benefit the community at the level that we desire.

In Fiscal Year 2023, while South County Health outperformed its operating budget generating revenues of $246.3 MM compared to $239.4 MM in expenses, we suffered approximately $6.3 MM in operating losses. In Fiscal Year 2024, according to unaudited figures, the Hospital lost $2.4 MM on a budgeted loss of $6.1 MM, achieving financial results $3.7 MM more favorable than budget.  While, our revenues have exceeded our expenses producing a positive EBIDA performance (Earnings before Interest, Depreciation, and Amortization), in FY23, interest and depreciation expenses were approximately $13.1 MM and for FY24 interest and depreciation expenses were approximately $9.7 MM, reflecting the $6.3 MM in operating loss in FY23.

Although South County Health has been able to maintain positive EBIDA, that metric does not consider the System’s obligations such as depreciation coverage and interest expense to meet financing commitments and continue critical investments in our system. To perform at a sustainable level that allows for replacing our end-of-life assets (HVAC, emergency generators, state-of-the-art equipment to support specialty service lines) and to retain competitive bank financing, we must generate operating income surpluses. Positive EBIDA is not enough.

Age of plant is a financial measure of a healthcare delivery system’s sufficiency of reinvestment. Nationally, the average age of plant of a healthcare facility is 11 – 12 years old. South County Health and Lifespan’s ages of plant are approximately 15 years old; Care New England’s is approximately 18 years - all significantly higher than the national average.

This underscores the importance for Rhode Island healthcare systems achieving rate parity with neighboring states. For South County Health, if rate parity was achieved in commercial payments alone, $20 MM would fall to the bottom line. This would allow for plant and equipment investment, enhancement of existing service lines and higher compensation of not just providers, but also for staff. That is why, with the support of our Washington County legislators, we have advocated for a phased in adjustment of reimbursement rates for Rhode Island health systems, physicians, and advanced practice providers.

South County Health, in a resource-limited environment, cannot do it all on our own. We simply lack the scale and associated benefits that other health systems in this state enjoy. That is why in parallel with our advocacy efforts to create a more sustainable health system, the Board of Trustees has explored and continues to explore partnerships and strategic alignments to partner around the provision of some services with like-missioned organizations that intend to improve the quality, accessibility and sustainability of healthcare services to residents of Washington County and beyond. These explorations are evaluated as partnership opportunities or community needs arise, and some of our most successful service lines (Orthopedics, Vascular, Gastroenterology, etc.) have traditionally been supported through partnerships with non-employed physicians and practices in our community.

Misleading Information: Quality of care has been negatively impacted by recent organizational changes.

Reality: Through all of the challenges that our current healthcare environment has presented us, South County Health has just been reaffirmed as a 5 Star Hospital by CMS (Medicare), remains a Leapfrog A Grade for quality and safety, is a Press Ganey Pinnacle of Excellence awardee for leading the nation in patient experience, and recently outperformed the Rhode Island and national average in our CMS (Medicare) quality programs (Value-Based Purchasing) for the most recent reporting period, reaffirming our position as a leader in quality and safe care in the Rhode Island market.

Additionally, we have a full team of emergency department, hospitalist and supporting specialist providers to care for you during your stay, along with nurses, pharmacists, laboratorians, and patient care technicians that will help provide you with the exceptional care you have come to expect from us. We are confident you will receive exceptional care with us during a stay at South County Hospital.

Additional Detail:

CMS’ (Medicare’s) Value-Based Purchasing Program measures the quality, safety, and patient experience delivered in hospital settings nationwide. In the most recent performance period, CMS (Medicare) scored South County Hospital’s overall quality, safety, and patient experience 61% higher than Rhode Island’s average and 105% higher than national average. Visit our webpage here to see how our health systems delivers quality that is second to none.

Misleading Information: Providers are leaving South County Health in worrying numbers.

Reality: First, we are extraordinarily sensitive to the community’s concerns regarding any physician that may leave for any reason. We understand the anxiety that patients may have and the recent resignations of the hematology and oncology providers are obviously not something South County Health wanted to occur.

Unfortunately, in our current healthcare environment, it is not uncommon for personnel changes to occur within an organization of our size, and this is not unique to just South Count Health in Rhode Island. South County Health currently has staff turnover rates well below state, regional, and national averages. Since 2020, our medical staff has grown 35% from 399 medical staff members to 539 today. Additionally, our yearly average South County Medical Group (SCMG) provider turnover rate is currently 8.7%, where the national average provider turnover rate for employed groups is ~7-11% per year.

Nevertheless, we understand the impact that it has on patients, and in the unfortunate event of providers leaving, South County Health makes every effort to 1) Fill their vacancy; 2) Transition patients to other providers within our organization; or 3) If necessary, help patients in seeking care outside our health system. Our top priority is to ensure all patients continue to receive the care that they need.

Additional Detail: In making the hard decisions necessary to carry on South County Health’s mission, invariably there will be those who disagree or have different perspectives. There are avenues available for those who disagree to voice their concerns, and they are entitled to a respectful hearing. However, when providers leave for any reason, South County Health deploys comprehensive strategies to ensure patients continue to receive uninterrupted, safe, and high-quality care.

While providers may no longer be employed or affiliated with South County Health for various reasons, the underfunding of all Rhode Island health systems resulting from disparately low reimbursement rates when compared to neighboring Connecticut and Massachusetts, has systematically created an unsustainable healthcare delivery environment through its current configuration and is the direct root cause of the challenges that all Rhode Island healthcare systems experience, not just South County Health in recruiting/retaining doctors, as well as their inability to fully invest in technology and infrastructure. These challenges often times have played a central role in providers’ decisions to leave South County Health and in some cases, decisions to no longer practice medicine in Rhode Island.

According to the Association of American Medical Colleges (AAMC), nearly one third of doctors in Rhode Island are nearing retirement age. Additionally, AAMC ranks Rhode Island 47 out of 50 (lower is better) in retaining graduates after medical school. Combined with primary care reimbursement rates, that according to the Rhode Island Office of the Health Insurance Commissioner, are significantly less than Massachusetts’ reimbursement rates for a typical primary care office visit, it is no wonder why Rhode Island continues to lose primary care doctors at an alarming rate, as many age out of the workforce and others simply choose to practice elsewhere in pursuit of equitable pay. In fact, the U.S. Health Resources and Services Administration (HRSA) projects that in 2025, Rhode Island will have only 62% of the family medicine doctors it needs to adequately provide primary care services. By 2031, HRSA further projects this figure eroding to only 59% adequacy.

Earlier this spring, a study commissioned in part by the Rhode Island Foundation verified that Rhode Island’s healthcare systems and providers are reimbursed approximately 20-30% less than in neighboring states of Connecticut and Massachusetts. Overall, Rhode Island receives the lowest private commercial and Medicare reimbursement rates in all of New England.

In an effort to create change at a legislative level, throughout the spring, during advocacy efforts led by South County Health for regional reimbursement rate parity, numerous doctors and nurses accompanied administration on two separate occasions to testify before the General Assembly about rate suppression, and its related harms. While the 2024 legislative session was the first step in our efforts to create change at a legislative level, we encourage you to visit our support page to learn more about how you can have your voice heard.

Misleading Information: All of South County Health’s Cancer Center providers have resigned.

Reality: The entire Cancer Center staff did not resign. Two part-time oncologists, one full-time oncologist, and one nurse practitioner resigned, and Dr. Chris Seidler has taken on the leadership role of Interim Medical Director. Additionally, we are accepting new patients under the care of locum physicians, including Doctors Alarcon, and McKinney. Dr. Joyce is providing radiation oncology services and accepting new patients as well. The transition to new providers has been conducted with great care, prioritizing direct communication with patients about their ongoing treatment. We are also actively recruiting additional oncologists and have secured a contractual agreement with a second radiation oncologist to join our team in the summer of 2025.

Misleading Information: South County Health’s Administration forced the Hematology and Oncology providers to resign.

Reality: The resignations of Dr. Angela Taber, Dr. James Smythe, Dr. Matthew Danish, and Caroline Kinney, FNP-C from employment with South County Medical Group, were obviously not something the providers or South County Health wanted to occur. South County Health’s Medical Oncology and Infusion programs have experienced mounting losses that were projected at approximately $4 MM in Fiscal Year 2024 alone. Due to the financial strain, and South County Health’s commitment to providing comprehensive community cancer care, we collectively investigated opportunities to reduce increasing financial losses in this service line. The departure of some oncologists in part stemmed from a disagreement over the direction of the Cancer Center. These oncologists advocated for turning the center over to a national, for-profit organization, but South County Health prioritized maintaining a community-focused, long-term solution that aligned with our values and missions.

This decision created a divergence in perspectives regarding partnerships that might potentially bridge the ever-widening financial gap. Additionally, a recent convergence of coverage issues, provider transitions, and support-staff turnover created staffing challenges at the provider level that providers felt were untenable.

Misleading Information: Most of South County Health's Cancer Center's patients have left for other oncology practices.

Reality: South County Health has worked diligently to ensure the continuity of care for all oncology patients. Of the more than 1,700 oncology patients, only 40 have chosen to leave the Cancer Center, representing 2.3% of the total patient population. While we view the loss of any patient as a concern, we are grateful that more than 97% of our patients have continued to receive care at South County Health, under the leadership of interim Medical Director Dr. Seidler. This demonstrates the confidence patients have in our commitment to high-quality, community-based care. We remain dedicated to providing locum physicians to ensure that the transition is as smooth as possible, with the goal of reaching a permanent solution.

Additional Details: It is important to recognize that the staffing of the Cancer Center is only part of the equation. Our oncology infusion therapy program, a significant revenue source, is currently experiencing a financial loss of $3.5 MM per year. That deficit is composed of $2 MM in subsidizing drugs and $1.5 MM in underwriting operational losses.  To address this, we are exploring potential partnerships with organizations that could eliminate drug-related losses while improving access to sustainable, high-quality care for our patients.  However, South County Health is steadfastly committed to providing comprehensive community cancer care. Our organization has invested over $12 MM through the last decade in enhancing cancer care and have committed investing $4 MM to the development of a comprehensive breast health center for the residents of Washington County. 

Misleading Information: In an effort to maximize profits, South County Health decided to stop offering infusion therapy treatments at the Cancer Center.

Reality: South County Health’s Infusion program has experienced mounting losses projected at approximately $2 MM in FY24 alone. The difficult decision to no longer offer certain infusion therapy treatments was made on certain non-cancer treating drugs because insurance companies and governmental payers were no longer reimbursing South County Health the full cost of these medications, leading to unsustainable financial losses, which over time, would have had a negative impact on our ability to continue to deliver exceptional care and the overall sustainability of the program.

Misleading Information: South County Health receives the same reimbursement on infusion therapy drugs as other Rhode Island cancer hospitals.

Reality: South County Health’s situation is slightly different to other Rhode Island health systems, including Lifespan and Care New England, who enjoy not only enjoy some higher reimbursements than South County Health, but qualify, like many physician offices, to purchase their drugs at a much lower cost when compared to South County Health due to the structure of certain governmental programs (340B Drug Pricing Program and various clinical models of drug purchasing) that systematically weaken community hospital-based healthcare systems. The 340B program was designed to enable rural hospitals and inner-city hospitals the ability to continue to care for patients. The criteria for a hospital to be eligible for the program is to have a minimum of 28% Medicaid patients and any affiliate within 39 miles of the main campus. We do not qualify for the 340B program.

Additional Details: It remains our priority to ensure those affected patients continue to receive the care that they need, and we have partnered with their referring providers to assist with the transition by providing options for one or more alternative arrangements including:

1. The first option called “White Bagging,” that allowed some patients to continue receiving infusion therapy treatments at South County Health’s Cancer Center. White bagging is an arrangement between a patient’s insurance company and their preferred specialty pharmacy that allows the pharmacy to ship the medication directly to South County Hospital where the Hospital receives the shipment on the patient’s behalf and then administers the drug to the patient; and
2. The second option was to arrange through provider’s office a referral to an alternative infusion center that is not affiliated with South County Health.

South County Health continues to assess the situation, and will make any necessary adjustments based on medication prices and reimbursement.

Misleading Information: Recently the new Director of Radiation Oncology services, after dramatically increasing patient volume, resigned and now less qualified Radiation Oncologists will be caring for the community thereby negatively impacting quality of patient care.

Reality: The Director of Radiation Oncology services came out of retirement in 2022 as an interim physician for South County Health. Knowing the physician was not a long-term option, South County Health explored partnerships with organizations that could ensure full coverage over the long-term. The Director of Radiation Oncology services objected to this exploration and tendered his resignation. The Radiation Oncology Department is currently fully staffed with highly experienced physicians and support staff, including well-respected physicians from the local market.

Misleading Information: South County Hospital does not have adequate coverage of cardiology and other specialists.

Reality: Last year, South County Health entered into a partnership with Care New England when our former group of cardiologists were exploring options in the market for greater pay, a broader continuum of cardiovascular subspecialists and a more modernized medical record system. South County Health met with the cardiologists to mutually explore options that would keep these physicians deployed in the South County community to continue to serve their patients while achieving the goals they articulated for their practice. This was successfully achieved through the current partnership with Care New England. The Cardiologists are no longer employed by South County Health, but they continue to practice here.

Misleading Information: South County Health forced the cardiologists out of their space, and the cardiac rehab clinic was forced to close prior to separating from hospital.

Reality: Contrary to the false assertions of closure, we have recently and fully renovated the cardiopulmonary rehab gym that is co-located with cardiology and other cardiovascular-related services within our Wakefield Medical Office Building. The relocation of the cardiology office in Wakefield originally took place to provide convenience for all cardiovascular patients as the space is conveniently co-located with The Vascular Experts RI, across from the cardiopulmonary rehab gym, and down the hall from South County Health’s Wound Care clinic. Care New England was again offered the opportunity to move back up to old cardiology office space (currently the top floor of the Medical Office Building), but chose to remain.

Additional Details: In 2023, after discussions with employed cardiologists regarding technology and additional practice support, South County Health partnered with Care New England/Care New England Medical Group for the provision of cardiology professional services. Through this partnership, the South County Cardiology providers were able to continue to see patients in their existing East Greenwich and Wakefield office locations while continuing to treat patients admitted to South County Hospital. This partnership, along with Care New England’s clinical affiliation with Brigham and Women’s Hospital, provides patients direct access to a more comprehensive cardiovascular care, considered among the best in the nation, and close to home.

Misleading Information: Providers in the Urology Department left to go to Yale-New Haven due to disagreements with administration.

Reality: From time to time, South County Health engages in term-limited leases for physician coverage, as we did in urology and currently do in general surgery. The duration of these leases often varies, and sometimes, the leasing organization, chooses not to extend a leased physician agreement as we experienced in the past with urology. Despite efforts to extend the leased physician agreement with Yale-New Haven Health, Yale made the decision to redeploy the leased physician to other hospitals within the Yale-New Haven Health System at the end of our initial lease term. When the lease ended, South County Health took assertive measures to bring highly credentialed physicians to South County Health from other well-regarded regional programs. This included 4 physicians and new advanced robotic technology that we first introduced to Southern Rhode Island earlier this year.

Misleading Information: In an effort to maximize profits, South County Health decided to eliminate sleep lab services.

Reality: The decision to discontinue offering sleep lab services was made after careful consideration of various factors. Over the last several years, reimbursement and site of care for sleep studies has shifted dramatically out of the hospital and into ambulatory and at-home settings. This shift has been enabled through technological advancements in sleep study equipment and payor requirements, while our reimbursement rates continued to fall below all other New England states.

As our in-hospital sleep lab equipment aged into the end of its life requiring replacement through capital investment that substantially eclipsed operating income, the difficult decision was made to discontinue this service offering, so resources could be re-directed to other areas of critical community need, like replacement of our cardiac catheterization and interventional radiology labs and equipment slated for replacement beginning in 2025.

Consistent with partnership comments above, there remains multiple options available for ambulatory and at-home sleep studies available in the community.

Misleading Information: South County Health is not staffing certain specialty services appropriately, including their Pulmonology practice, and is not a priority of South County Health’s administration.

Reality: Contrary to the false assertions that South County Health’s Pulmonology practice is not staffed appropriately for providers or a concern of SCH administration, the pulmonary sub-specialty is staffed in excess of American Medical Group Association (AMGA) benchmarks for providers and remains one of the most difficult specialties to recruit to employed practice in Rhode Island. Rhode Island as a state is critically underserved with pulmonary physicians. South County Health’s current administration, in fact, is the first to successfully recruit two pulmonary physicians to the community. One of those physicians left to pursue higher out-of-state reimbursement, while South County Health was able to retain the additional pulmonologist.

Additional Details: South County Health has a long history of growing South County Medical Group practices. As an example, after a failed attempt to employ a pulmonologist occurred back in 2016-2017, South County Health seized on another opportunity to employ a pulmonologist in 2021 to address the community demand. South County Health has also added physicians and advanced practice providers to our Urology, General Surgery, and OB-GYN programs over the years, including plans to add two new OB-GYN providers and several new APPs for urology and general surgery. Although community demand for services may continue to eclipse access, as is commonplace in the Rhode Island market, we are proud to be able to support these important services at the levels we currently do.

Even though South County Health still loses approximately $14 million annually on employed physician practices, those practices are staffed with direct provider support staff in alignment with American Medical Group Association (AMGA) benchmarks. In fact, this year to date, South County Medical Group in totality remains staffed 5% above the median AMGA benchmark for direct provider support staff when compared to other system-affiliated provider offices.

Misleading Information: South County Health closed their Cranston office, limiting access to primary care services.

Reality: Earlier this year, South County Health made the decision to consolidate our primary care services with the closing of our Cranston office, and relocated the providers to Warwick and East Greenwich offices. These practice locations are separated by less than 15 miles. In July, Dr. Stephanie Krusz, and Julie Carroll, AGNP relocated to our Warwick Primary Care office located within the South County Health Warwick Medical and Wellness Center. While Dr. Brian Pickett relocated to our East Greenwich Primary Care office located within South County Health’s East Greenwich Medical and Wellness Center. This decision was made in an effort to streamline operations and improve access to care. By bringing together our resources, we are able to provide a more cohesive and coordinated experience for our patients, ensuring that healthcare needs are met efficiently and effectively.

Additionally, with the relocation of their offices within our Medical and Wellness Centers, the patients of Dr. Krusz, Dr. Pickett and Julie Carroll, AGNP, have greater access to a host of other services including Center for Women’s Health, Diagnostic Imaging, Express Care, Gastroenterology, Pulmonology, and Outpatient Lab. Additionally, in East Greenwich, our Medical and Wellness Center is home to Care New England Cardiology's, South County Dermatology’s, and The Vascular Experts RI’s East Greenwich offices.

Misleading Information: A group of primary care physicians employed by South County Medical Group all left the organization’s Woodruff Avenue location due to irreconcilable differences with management.

Reality: At the time, two physicians left the practice after the medical director of the practice retired. Facing the assumption of the Medical Director’s patient list and the extraordinary demand for primary care physicians in Rhode Island, one physician changed their practice to a university setting at URI treating students, and the other faced with mounting coverage demands pursued employment elsewhere.

Misleading Information: South County Health no longer offers Trial of Labor After Cesarean/Vaginal Birth After Cesarean (TOLAC/VBAC) services.

Reality: South County Health remains fully committed to supporting each family's birth plans, including TOLAC/VBAC procedures at South County Hospital, whenever it is safe to do so.

Misleading Information: South County Health no longer offers lactation services or support to the community.

Reality: Many insurance companies now cover lactation consultation as part of newborn delivery and care services. As a result, we are unable to offer outpatient lactation consultation appointments on a fee-for-service basis. However, all new moms and families, after they deliver on South County Hospital’s award-winning Women and Newborn Care Unit, are offered lactation consultation services as part of their inpatient stay with us. Additionally, South County Health also routinely offers a 2-hour Prenatal Breastfeeding class to women in the community, irrespective of where they plan to deliver or delivered, free of charge.

South County Health continues to offer support to expecting and new moms and families with additional classes and support groups, such as our Preparing for Birth class and our New Baby Support group – all free of charge. To learn more about South County Health’s commitment to supporting new mom’s and families all stages of pregnancy and early parenthood, please visit our dedicated webpage HERE.

Additional Details: Miscommunications circulated in early 2024 regarding the availability of Trial of Labor after Cesarean (TOLAC) and Vaginal Birth after Cesarean (VBAC) deliveries at South County Health. South County Health remains fully committed to supporting each family's birth plans, including TOLAC/VBAC procedures at South County Hospital, whenever it is safe to do so.

At South County Health, through our Center for Women’s Health and Women and Newborn Care Unit, we strive to provide a comprehensive range of medical services tailored to meet the unique needs of our patients. In line with this commitment, this year we conducted a routine evaluation of our TOLAC/VBAC care pathways and protocols to ensure they align with the latest best practices and guidelines set forth by the American College of Obstetricians and Gynecologists (ACOG). South County Health obstetricians, midwifes, and anesthesiology providers, in collaboration with administration, have evaluated and remain committed to continuing to offer TOLAC/VBAC deliveries at South County Hospital.

We want to emphasize that decisions regarding TOLAC/VBAC procedures are made on a case-by-case basis by our experienced team of doctors and midwives. Factors such as medical necessity and patient preferences are carefully considered to ensure the safety and well-being of both the mom and the baby.

While it came to our attention earlier this year that that there was some miscommunication internally regarding our ongoing commitment to TOLAC/VBAC deliveries, we want to reassure you that this commitment remains strong. Below are some key points we'd like to highlight on the comprehensive women’s health services South County Health currently provides:

• South County Hospital continues to offer TOLAC/VBAC deliveries, and our team works closely with each patient to develop a birthing plan that aligns with their medical needs and preferences.
• We are committed to improving access to women's healthcare within our community through investments in our Center for Women's Health, recruitment of new providers, and the development of state-of-the-art facilities. We look forward to making more announcements of our recruitment efforts soon.
• Our Center for Women's Health is currently accepting new patients, including expecting mothers and those with gynecological concerns. We are working to recruit additional providers in order to accommodate new well patient visits.
• We are excited to offer comprehensive childbirth education and support classes to our community, including non-South County Health obstetric patients, as a free resource.
• South County Health remains the only inpatient birthing facility in Washington County, RI.

Misleading Information: Nephrology and other practices have been told by the administration to limit time with patients to 10 minutes, impacting the quality of care provided, in an effort to increase volume and profits.

Reality: South County Health is committed to initiatives geared towards increasing access to high-quality care for more of the community, while aligning with and often exceeding, industry standard best practices for length of appointments. From October 2023 to present, Nephrology appointments at South County Health for our two providers averaged 46.7 minutes and 54.6 minutes for new patients respectively, and 24.6 minutes and 28.6 minutes for established patients respectively. According to a survey of local nephrology practices and national benchmarks, the industry standard for this particular service line is 30 minutes for new patients and 15 minutes for established patients. In a spirit of partnership and compromise, South County Health has offered Nephrology providers 40 minutes for new patients and 20 minutes for established patients.

Additional Details: Recent changes that have been implemented in most of our South County Medical Group (SCMG) practices are specifically designed to benchmark against healthcare standards, ensuring that patients receive the highest level of care.

Dr. Kevin Charpentier, Chief Medical Officer, along with other physician leaders at South County Health have worked with South County Medical Group providers on a variety of access, quality, and patient experience performance improvement initiatives aimed at generating improved access and financially sustainable performance.

In large part, these initiatives have been successful, with some SCMG practices opening their schedules and achieving watermark quality and patient experience scores in the process. However, misinformation has been circulated in the community that SCH administration is asking providers to limit patient appointment times in medical practices to 10 minutes. That is false. Most typically, South County Health’s appointment times follow industry standards of 15-30 minutes or longer for established and new patient appointments, respectively.

Misleading Information: A rise in Advanced Practice Providers (APPs) offering care due to physician shortages is a detriment to the community.

Reality: In a state that is facing a growing primary care workforce crisis, APP’s are essential to meeting the healthcare needs of our community. South County Health is committed to initiatives geared towards increasing access to APP’s who have delivered equivalent outcomes compared to their primary care physician colleagues.

Additional Details: In a misrepresented publication, a local newspaper last year negatively insinuated a lower/detrimental level of care that Advanced Practice Providers (APPs) could provide in primary care settings in relations to physicians. Many APPs and community members took offense to this article and submitted their own letters to the editor. In response to the false assertions that were published in this piece, South County Health, along with other healthcare system, academic, and professional organization stakeholders vehemently expressed our collective concerns to the author and publishing editor. Despite following appropriate channels, no correction was ever issued. To set the record straight, South County Health is providing factually true information on APP’s and their vital role below:

APP’s are and will remain an integral part of the healthcare delivery system.

APP’s include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, among others. According to an article recently published in The BMJ, nationwide in the U.S., during 2013 to 2019, the proportion of health care visits completed by APP’s increased from 14 percent to 26 percent. As per the BLS Occupational Outlook Handbook, APP roles are expected to grow as much as 40% by 2031, with nearly 160,000 new APP jobs projected. And, according to the Medical Group Management Association, 65% of medical practices surveyed nationally planned to add new APP roles during 2023 compared to only 35% of medical practices that did not.

In the State of Rhode Island, APP’s are often registered nurses who have additional graduate-level education at the masters or doctoral level, certification, and State licensure enabling them to practice caring for a specific patient population autonomously (i.e. not under the direction of a supervising doctor). Physician assistants, who may not have a registered nursing background, maintain similar educational, certification, and licensure requirements. All APP’s play a vital role in providing patients access to health care services, especially in non-procedural settings and in areas where there may be an insufficient number of doctors to meet population-based demand.

Nowhere is this reality more evident than in primary care practices in Rhode Island. According to the Association of American Medical Colleges (AAMC), nearly one third of doctors in Rhode Island are nearing retirement age. Additionally, AAMC ranks Rhode Island 47 out of 50 (lower is better) in retaining graduates after medical school. Combined with primary care reimbursement rates, that according to the Rhode Island Office of the Health Insurance Commissioner, are significantly less than Massachusetts’ reimbursement rates for a typical primary care office visit, it is no wonder why Rhode Island continues to lose primary care doctors at an alarming rate, as many age out of the workforce and others simply choose to practice elsewhere in pursuit of equitable pay. In fact, the U.S. Health Resources and Services Administration (HRSA) projects that in 2025, Rhode Island will have only 62% of the family medicine doctors it needs to adequately provide primary care services. By 2031, HRSA further projects this figure eroding to only 59% adequacy.

The divergence of APP and doctor workforce trends is clear. Nationally, regionally, and locally, APP’s are filling the ever-widening gap between the demand for health care services and the insufficient amount of physicians available to deliver them. But why are APP’s so adept in filling the gap? The answer to this is has been clearly established in decades of reliable peer-reviewed literature. APP’s both in primary care and in medical specialty practices are just as capable of delivering high-quality, safe and effective treatments that fall with their scope of practice as their doctor colleagues, and often do so more efficiently.

In A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions recently published in Sage Journals, McMenamin et. al. established, “Overall, most studies showed reduced or similar costs, equivalent or better quality, and similar or lower rates of emergency department use and hospitalization associated with [nurse practitioner] primary care models for patients with [multiple chronic conditions], compared with models without [nurse practitioner] involvement. No studies found them associated with worse outcomes.”

At South County Health, we have observed similar findings among our own APP’s practicing in South County Medical Group primary care practices. A systematic evaluation of APP-managed primary care outcomes, including patient compliance with recommended breast cancer screening, colorectal cancer screening, controlling high blood pressure, diabetes management, and patient-reported experience of care demonstrated that South County Health APP’s delivered equivalent outcomes compared to their primary care doctor colleagues.

Click here to learn more about South County Health’s spectacular and award-winning team of APP’s.