The finding on extra beds comes at a time when Rhode Island's hospitals are already undergoing tremendous change—two are in receivership and four mergers or acquisitions are underway. There is also uncertainty about how implementation of the federal healthcare overhaul, including a requirement starting Jan. 1 that all people have health insurance, will affect the delivery and cost of care.
Rhode Island, which has a population of just over 1 million, has been losing population faster than any other state; it lost 24,000 people since 2004, the largest decline ever.
Inpatient stays have also fallen. Inpatient stays per 1,000 patients fell in Rhode Island from 665 in 2007 to 592 in 2010, an 11 percent decline, the report said. By contrast, other New England states, including Massachusetts, Maine and Vermont, had a 1.4 percent decline. The national drop was 4.6 percent.
The council's report didn't recommend how best to address the overcapacity, but Costantino said the panel will continue to deliberate what he called a critical issue.
"We want to match the number of beds out there to what the need is. You want a system that financially is sustainable and that also is producing the best-quality public health outcomes," he said. "I think there needs to be a full vetting of all the options."
The Rhode Island Business Group on Health, which has a seat on the council and voted against the report, wants the General Assembly to create a commission to make binding recommendations on closures or consolidations.
Donald Nokes, a small-business owner who is the group's president, said it could be modeled after a state panel in New York tasked several years ago with addressing a glut of beds. The special commission in 2006 called for the closure of nine hospitals and seven nursing homes—some 4,200 beds, or about 7 percent statewide. It also recommended dozens more for merging or downsizing. Savings were estimated at $800 million.
"We need to come together now to address this excess hospital bed capacity in the system through a thoughtful process, where all affected parties can have a hand in the solution and can help create a system which provides quality healthcare, in the right location, at the most effective cost," the group said in a recent letter to Gov. Lincoln Chafee and lawmakers.
"There's just a lot of money, we think, sitting here in this overcapacity," Nokes said in an interview.
Edward Quinlan, president of the Hospital Association of Rhode Island, called it "extremely premature" to talk about eliminating beds at the state's 12 acute-care hospitals. He said the estimate contained in the report, from a study by the Lewin Group, is not definitive and that hospitals can't be defined just by inpatient care.
"Hospital inpatient services are a part of the broader healthcare delivery system in our state, and we need to examine the entire healthcare delivery system in the state," he said. "This report represents a good start. We are in the early innings of a process."
The Lewin Group said the number of beds needed in Rhode Island could range from a deficit of 64 to a surplus of 338 but called the 200-bed surplus the "most likely set of assumptions." It also said that eliminating excess beds "piecemeal" from individual hospitals would result in limited savings of about $12 million. Closing a whole facility—and getting rid of all its fixed costs—could save $27 million to $116 million.
The report also found that Rhode Island brings in more patients from out of state for hospital care than it sends to other states, but the gap is narrowing.
