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CNE’s new leader- “I’m not scared of transparency”

June 20, 2011

I spent about 25 minutes today  on the phone with Dennis Keefe, the new CEO of Care New England.  In between discussing about his “11 year itch”- he worked at Morton Hospital for 12 years and has worked at the Cambridge Health Alliance for nearly 12 years- we talked about his plans for the hospital chain’s future.

On how Care New England can remain competitive against Massachusetts hospitals following the collapse of a CNE/Lifespan Merger

In MA, everyone’s talking to everyone. And if you’re not talking to  someone, you’re at great risk of coming to work one morning and finding that one of your major competitors is aligned with another major competitor down the road… Maybe there will be Massachusetts Hospitals crossing the border, maybe there will be opportunities with Massachusetts hospital systems as well… I think we’re looking at a new world of integration, coordination,  collaboration and cooperation in systems coming together in different ways and maybe even crossing state lines.  I think it’s going to be a very different world going forward.

Does that mean he thinks Rhode Island hospitals don’t need to see Massachusetts as a competitor?

Yes… It’s just kind of fascinating to me how things that you never thought would happen, and I’m seeing them in the state every day, have actually happened and people you thought would never be talking together are actually talking together. And I don’t think those conversations are going to rigidly happen within state boundaries.

Dennis Keefe is well versed in the controversy around inequities in hospital payments. The Boston Globe reports that Cambridge Health Alliance received less than $5,000 per caesarean section in 2009 and Mass General was paid more than $10,000 for the same procedures.

Now he’s on the other side of the issue.  A report by RI’s Health Insurance Commissioner shows on average,  private health insurers pay Women and Infants Hospital (A CNE Hospital) $4,012 for every day a patient spends at the hospital. It’s the highest amount in the state, more than $2,000 above the lowest paid hospital, St. Joseph’s– at $1,888 on average per day. How does Keefe feel now that he’s on the other end of the problem?

I’ve often said that we’re on the bottom of the food chain as a public hospital in Massachusetts, and that’s whether it’s government payments or payments from commercial insurers…I can only say that it’s a very complex issue… What happens  over time is you have certain organizations that are perceived as being the haves and you have the have-nots and a lot of people are in the middle. But when you really do the drill down, you really have to look at how much is related to academics, how much of it is related to teaching, research, how much of it is related to research, how much of it is related to populations that are being served… Behavioral health plays a role… You have to weigh all of those factors very carefully and then you get to the actual component of disparity… I’m just saying it’s not a simple answer.  Just because an organization gets paid a certain amount that it is absolutely related to some of the market factors that are readily apparent. I’m also not saying that that isn’t a component. I’m just saying it’s not as simple as people think.

But as a former “have-not” is Keefe more sensitive to increasing transparency around how much hospitals are paid?

I support transparency because that’s the culture that has developed in Massachusetts and without transparency you can’t have any kind of conversation around what the underlying factors are. Once you have that transparency you can do the rest of the drill down that I described. In our situation I have been able to use that information to improve our rates of payment… I’m not scared by the notion of transparency and that does drive the conversation.

But Keefe wouldn’t risk discussing CNE’s lawsuit  that objected to Health Insurance Commissioner Chris Koller’s restrictions on hospital contracts with insurers.

I learned a long time ago not to get out in front of the trustees.

Keefe joins Care New England on August 1st.  Let’s see what he does once he gets a sense of Little Rhody’s health care system.

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