Attorney General Peter Neronha told the Warwick Rotary Club Thursday “I want to see what it’s going to look like,” before he acts on the application of the state’s two largest heath care groups to merge.

And regardless of a merger, Neronha believes the state should have a plan addressing the state’s health care systems.

“What kind of health care strategy do we have?” Neronha asked in a follow-up conversation to his presentation.

He said as far as he knows, the most current strategy dates back to the 1980s.

So, is there a strategy? “No, in my judgment,” he said.

In his presentation, Neronha pointed out that a merger of Lifespan and Care New England would account for 80 percent of the state’s hospital beds and 50 to 60 percent of the physician practices.

“So that’s a lot of market share in one place,” he said. “And so the question becomes, can that market share be managed in such a way that it is to the benefit of the people of the state of Rhode Island?”

The largest of the two groups, Lifespan, is comprised of Rhode Island Hospital, Miriam Hospital, Bradley

Hospital, Newport Hospital, Gateway Healthcare, Lifespan Physicians and Coastal Medical.

In fiscal year 2020, Lifespan had operating revenues of $2.52 billion and expenses of $2.46 billion,15,860 employees and 1,165 licensed beds. For the year it discharged 55,732 patients, had 22,532 emergency visits and performed 862,648 outpatient visits.

Care New England operates Butler, Kent and Women & Infants hospitals, as well as The Providence Center and the VNA Care New England. For the 2020 fiscal year, on an operating budget of $1.2 billion, it lost $9.9 million, or 0.8 percent. CNE employs approximately 7,500 people. CNE has medical school affiliations with the Warren Alpert Medical School of Brown University and New England College of Osteopathic Medicine.

Neronha said that soon after taking office he pushed for a change in the Hospital Conversions Act that puts the burden of paying for expert analysis of a merger on the parties rather than his office.

“Otherwise, I’d have to pay for those experts out of my own budget, and my budget just can’t sustain it,” he said.

What Neronha is looking to determine is whether the combination of the health care groups with such a large share of the market can deliver quality health care that is accessible and affordable.

Outlining the process, Neronha said, “you can’t just take one three ring binder and another three ring binder, put them next to each other and put a seal down between them. It’s got to be more integrated than that.”

He went on to pose a series of questions: What does this look like? Where will you be expanding? Where will you be drawing back, if anywhere? What about these physician practices? What physician practices will be part of the new organization? Which ones won’t? What are the long-term or short-term expansion plans?

“So the first question for us is understanding what is proposed.

Because until we fully understand what’s proposed, we don’t really know much at all about what the impact will be on Rhode Islanders,” he told the Rotary Club.

Asked if Neronha would ask for a comprehensive review of state health care needs, his spokeswoman, Kristy dosReis, responded in an email, “AG Neronha does think there should be a statewide strategic plan for healthcare but a development process for one would not impact the Lifespan/CNE application review, which is going on now.”

She said there would be a public hearing on the Lifespan/CNE application as part of the HCA process, but that a hearing would not take place until after the application has been deemed complete.

On the Lifespan/CNE/ Brown University website HealthierRI.com, the group reasons the merger will “complementary health system operations with leading-edge research and renowned medical expertise will improve the quality of medical care for patients across Rhode Island and surrounding regions.

The uniting of health care with medical education and research serves to advance biomedical discovery, educate future physicians, nurses and health practitioners in medicine and health care, and create a vibrant economic nexus in the region based on the health care industry.”

It goes on to read, “This vision is closer to becoming a reality with recently signed agreements to create an integrated academic health system that brings together a merger of the Lifespan and Care New England health care systems into a new entity, with The Warren Alpert Medical School of Brown University as an intertwined affiliated partner.”

Earlier this month, Lifespan and CNE submitted a revised Hospital Conversions Act application to the Rhode Island Department of Health and the Rhode Island Office of Attorney General in their quest to merge the state’s two largest health care organizations.

The terms of the revision were not released, however, in a joint release the two groups said, “We anticipate completing responses to the FTC’s information request over the coming weeks, having submitted many thousands of pages of information to the FTC to date, with more to come.”