At South County Health, we believe in maintaining open and honest communication with our community, as well as our entire team. As we continue to manage the extraordinary challenges of the healthcare environment in Rhode Island, we want to provide you with a clear understanding of the challenging decisions South County Health’s Board and Administration continues to be faced with to ensure we deliver on our mission.
As the primary health system for residents of Southern Rhode Island, it is important that we provide details and facts behind the decisions we have made, and will need to continue to make in these challenging times. We need all of your help in achieving the best health system possible given the limitations we currently face. We value the input of our physicians, staff, and community members. Open communication and collaboration are critical to our success, and we are committed to fostering a culture where all voices are heard and respected.
We understand that not all will understand or agree with some of the difficult decisions, but they are necessary to ensure that we can continue to serve our community for generations to come. These decisions are often viewed by some as detrimental to the community, while others may conjecture South County Health is simply attempting to maximize profits. These assertions lack validity and seek to sow discord, community anxiety, and distract management from the challenge of ensuring sustainability of our health system despite extraordinary challenges. We simply ask for ongoing dialogue and to some extent, the benefit of the doubt before rushing to judgement or sharing misinformation that is a detriment to the community. Our unwavering focus is on ensuring the highest quality of care and the sustainability of our health system for the community that we are honored to serve. No matter the challenges we face, our true north remains quality and the well-being of our patients.
Below is additional information that offers insights into the current financial state of healthcare in our state, as well as the truth behind recent organizational changes. After reading each further, if you have any questions or concerns about the changes at South County Health, please use the form to the left to reach out to us. Your input is valuable, and we’re committed to providing the information you need.
Over the last decade, Rhode Island has seen 50% of its acute care hospitals go out of business or through bankruptcy, 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, 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. 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.
Learn more about the state of Rhode Island Healthcare
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 2021, 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. Through June 2024 (9 months of the fiscal year), SCH has experienced a $1.1 MM operating loss on revenues of $187.4 MM compared to $178.8 MM in expenses. While, our revenues have exceeded our expenses producing a positive EBIDA performance (Earnings before Interest, Depreciation, and Amortization). For 2023, interest and depreciation expenses were approximately $13.1 MM and for 2024 YTD interest and depreciation expenses are approximately $9.7 MM, reflecting the $6.3 MM in operating loss in FY23 and the current $1.1 MM operating loss in FY24.
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 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, Dermatology, etc.) have traditionally been supported through partnerships with non-employed physicians and practices in our community.
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, the challenges discussed in RI have created a barrier for high-quality not-for-profit systems to consider coming into RI.
South County Health is steadfastly committed to providing comprehensive community cancer care. Our organization has invested over $12 million over the last decade in enhancing cancer care and will soon be investing $4 million in the development of a comprehensive breast health center for the residents of Washington County. Despite our commitment to cancer care, Rhode Island’s chronic underfunding of the healthcare delivery system has strained the financial sustainability in this program, and due to the circumstances mentioned above, South County Health’s Medical Oncology and Infusion programs have experienced mounting losses projected at approximately $4 MM in FY24 alone.
This financial strain prompted a coordinated partnership with our oncologists to investigate opportunities to reduce increasing financial losses in this service line. Our oncologists brought forward a proposed partnership with a for-profit, Florida-based, and publicly traded company that Administration determined would be unaligned with the values and mission of South County Health while also placing this critical community service at risk over the long term.
Though we do maintain partnership in cancer care will be important for access to the most comprehensive cancer services, we do believe this care is best provided in a not-for-profit, charitable status. 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 a perfect storm of staffing challenges at the provider level.
In response to the entirety of the events, South County Health has recently accepted the resignations of Drs. Danish, Smythe, Taber, and Caroline Kinney, FNP-C. We thank them for their collective years of dedicated and exceptional service to our patients. They have improved and even saved the lives of many leaving a lasting impact on the community they served.
Dr. Seidler has expressed his commitment to South County Health and its community, and will remain employed by South County Medical Group assuming the role of Interim Medical Director for Hematology and Oncology. Additionally, South County Health recently introduced three new hematology-oncology physicians, Dr. Jean Lee, Dr. Nancy McKinney, and Dr. Sylvia Alarcon Velasco, for coverage to ensure patients have continuity of care. Two of the new providers have agreed to one-year contracts, and the third has agreed to a six-month contract, each with options to extend. These outstanding physicians will bring exceptional credentials and talent to our cancer program. In addition to ongoing discussions with these new physicians about permanently remaining at South County Health, we are actively recruiting permanent hematology-oncology physicians through several different channels.
The resignations are obviously not something the providers or South County Health wanted to occur. Unfortunately, in making the hard decisions necessary to carry on South County Health’s mission, invariably there will be disagreements or different perspectives on how best to accomplish that goal. Please know, it remains our top priority to ensure all patients continue to receive the care that they need.
We understand the community’s concerns, and the impact of losing a provider can have on patients, but please rest assured that South County Health and our new hematology-oncology physicians are committed to offering comprehensive cancer care to the community, and South County Health is taking assertive steps to make this transition as seamless as possible including providing details on where the departing physicians will be practicing:
As the primary health system for residents of Southern Rhode Island, South County Health is fully committed to ensuring that our patients continue to receive high-quality, uninterrupted care. This includes the same elements of medical, radiation, and surgical oncology, along with the supportive and ancillary services, we have always offered.
It is not uncommon for personnel changes to occur within an organization of our size.
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.
In 2023, after discussions with employed cardiologists regarding technology and additional practice support, SCH 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.
Contrary to the false assertions of closure, we have recently fully renovated the cardiopulmonary rehab gym that is co-located with cardiology and other cardiovascular services, including vascular surgery and wound care within our Wakefield Medical Office Building.
In urology, there has been misinformation shared within the community on the reason why some urologist left South County Health.
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, South County Health does not enjoy the benefit of a corporate partner willing to offer an extension of leased physician time, as we experienced in the past with urology. Despite efforts to extend the leased physician agreement with Yale, Yale made the decision to redeploy the leased physician to other hospitals within the Yale New Have Health System at the end of our 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.
Beginning on January 1, 2024, a decision was made by South County Health to no longer offer certain infusion therapy treatments at South County Health's Cancer Center.
This difficult decision 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.
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 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 that systematically weaken community healthcare systems.
It remains our priority to ensure those affected patients continue to receive the care that they need, and we partnered with their referring providers to assist with the transition by providing options for one or more alternative arrangements including:
South County Health continues to assess the situation, and make any necessary adjustments based on medication prices and reimbursement.
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.
Consistent with partnership comments above, there remains multiple options available for ambulatory and at-home sleep studies available in the community.
As the in-hospital sleep lab equipment aged into the end of its life requiring replacement through capital investment that substantially eclipsed operating revenue, the difficult decision was made to discontinue this service offering, so resources could be directed to other areas of critical community need, like replacement of our cardiac catheterization and interventional radiology labs and equipment slated for replacement in 2025.
South County Health also 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. 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.
Contrary to the false assertions that pulmonology is not staffed appropriately or a concern of SCH administration, the pulmonary sub-specialty is staffed in excess of AMGA benchmarks and remains one of the most difficult specialties to recruit to employed practice in Rhode Island.
Earlier this year, South County Health made the decision to consolidate our primary care services with the closing of our Cranston office. 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.
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 Health is committed to aligning with, and often exceeding, industry standard best practices for length of appointments in an effort to generate improved access to care. 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.
Advanced Practice Providers (APPs) Delivering High-Quality of Care
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. 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 doctors 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.
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If you have questions or concerns about the changes at South County Health, please use the form below to reach out to us. Your input is valuable, and we’re committed to providing the information you need.
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