A proposal to close a sleep center in North Haven drew fire from New Haveners, including the mayor, who made her first foray into a growing debate over expanding hospitals — with a warning that the trend could spell danger for the city budget.
Mayor Toni Harp (pictured) entered the discussion Wednesday afternoon in a meeting room at Gateway Community College, where the state Office of Health Care Access (OHCA) was holding a public meeting.
At issue: Should North Haven’s Gaylord Hospital be allowed to close its 12-bed sleep center, where conditions like sleep apnea are diagnosed and treated?
That seemingly narrow question is tied to a more complicated debate over changes to the state’s health-care landscape.
Yale-New Haven Hospital (YNHH) plans to purchase the sleep center that Gaylord is closing, part of a recent trend of buying up individual physician practices and even other hospitals. YNHH acquired the Hospital of St. Raphael in 2012, making it one of the country’s largest hospitals. And YNHH a not-for-profit, moved to join forces with a large hospital management company that’s looking to buy four hospitals in Connecticut and convert them to for-profit institutions.
Proponents of this kind of consolidation say it leads to more efficient and better care, at a time when older institutions are having trouble making ends meet. Critics warn that the trend leads toward “segregation” of care between private and publicly supported patients, along with higher fees and less convenience.
Public officials are increasingly weighing in on the discussion. The state legislature recently passed bills requiring more oversight of hospital takeovers and mandating the disclosure of new fees. Ted Kennedy Jr., candidate for senator, launched his campaign with a critique of so-called “facility fees.”
On Wednesday, Mayor Toni Harp stepped into the fray, criticizing the increased patient costs associated with hospital takeovers, and raising concern about what it might mean for the city’s bottom line. The mayor has asked city human resources chief Stephen Librandi for an estimate of what the impact of new “facility fees” might be on the budget, according to city spokesman Laurence Grotheer.
“This is one more example of a major, overall policy concern in the health care field,” Harp testified. “Even as insurers and employers are asking workers to take on a greater share of healthcare costs, and even as patients are encouraged to seek treatment in more cost-effective settings, hospitals are absorbing these facilities and imposing inflated hospital rates for services provided there.
Harp’s testimony came amid similar sentiments expressed by numerous members of Yale University’s UNITE HERE Local 34, which represents blue- and pink-collar workers, including 900 clinical staff in the Yale medical system.
Local 34, which has been granted “intervenor status” in the matter, called on OHCA to look at the Gaylord sleep center closure more broadly, including YNHH’s role in the transaction, and as an expanding force in the region’s health care system.
OHCA’s Kevin Hansted and Kaila Riggott (pictured), who presided over the hearing, did not make a decision on Gaylord’s request to close its sleep center. Hansted, the hearing officer, said he will make a recommendation within 60 days from the last filing on the matter. He said the final decision will be up to Jewel Mullen, state commissioner of the Department of Public Health.
Harp Weighs In
Mayor Harp raised three concerns about the sleep center closure.
First, she said, Gaylord isn’t simply closing its sleep center; it’s transferring it to YNHH. Without more information about the details of that transaction, “it is difficult for me to imagine how OHCA can effectively render judgment in the best interest of the public.”
Second, changes will have a disproportionate impact on “low-income residents of New Haven,” particularly with regard to transportation, Harp said. A bus trip from YNHH to the North Haven sleep center takes an hour, and transportation assistance is “no substitute for the ready access to services on Temple Street at the old university sleep center.”
“Severe sleep disorders such as narcolepsy often result in medical restrictions or prohibitions on driving to ensure the safety of the patient and the public. These restrictions force patients to rely upon public transportation,” Harp noted.
She note how the state’s notorious bus system worsens the situation.
“The state Department of Transportation says a trip from Yale-New Haven Hospital to the 6 Devine St. location takes at least an hour, using buses that run only once every half hour in the middle of the day. The fastest route requires significant walks at either end of the ride. Since sleep medicine patients often have significant co-morbidities including pulmonary conditions, these transportation obstacles pose real barriers to access.
“Yes, as the Applicant notes, there are public programs to help low-income patients pay for taxis or rides. But these programs are no substitute for the ready access to services on Temple Street at the old University sleep center. Navigating public transportation all the way up to Devine Street poses challenges, especially for people on low-wage jobs who often don’t have time off. Approval of this application without taking this into account would result in a hardship for these patients. ..
“Even for those able to deal with transportation, I am also very concerned about the possibility that patients and insurers will face much higher costs if this application goes through. As you know, the University’s sleep lab was not hospital-based. Patients who used to receive care at the Temple Street site could well face much higher out-of-pocket costs than they did previously, depending on specifics of their health insurance coverage.”
Third, Harp argued patients may face higher costs if the deal goes through. The New Haven sleep center was not hospital-based; the North Haven sleep center under YNHH would be. “Patients who used to receive care at the Temple Street site could well face much higher out-of-pocket costs than they did previously,“ Harp said. “I do not want New Haven residents to have to pay unreasonable fees for service.”
This last reason is part of a larger area of concern, one that could hit the city budget hard, Harp said.
“New Haven is self-insured with regard to healthcare coverage for its employees and still, these costs comprise the city’s largest single line item in the budget. We cannot control these costs if hospitals are suddenly allowed to impose higher prices each time they absorb the next doctor’s practice.”
Wednesday’s meeting drew over 100 people to Gateway Community College on Church Street downtown, where the hearing took place at the request of Yale University’s Local 34.
The union has taken up the hospital-expansion issue in the wake of the university’s closing of New Haven’s sleep center. That closure, the union argues, is related to the proposed closure of the North Haven sleep center. Here’s how, according to the union:
In January, Yale closed its sleep center, where a number of Local 34 members were employed, along with doctors who are part of Yale Medical Group, the practice of Yale medical school doctors who comprise many of the physicians working at YNHH.
The New Haven sleep center closure is part of a complex three-way transaction involving Gaylord Hospital, YNHH, and the university. YNHH is essentially transferring Yale’s New Haven sleep center to North Haven by taking over Gaylord’s operation there, the union contends.
The two hospitals disagree with that characterization. Vin Petrini, YNHH senior vice-president of public affairs, has said that the New Haven closure and the North Haven deal are two distinct transactions. Gaylord Specialty Healthcare CEO George Kyriacou described it the same way at Wednesday’s hearing.
Kyriacou sat a table at the front of the meeting room, along with John Blair, Gaylord’s attorney in the proceedings. Also at the table was Henry Murray, attorney for Local 34, who was joined by three union members.
The sleep center transaction presents a number of dangers, said John Canham-Clyne (pictured), a Local 34 researcher. “The consolidation presents challenges for at-risk populations,” he said. “Former and potential patients from New Haven’s low-income communities of color may struggle with the proposed geographic changes.”
In addition to transportation difficulties, Canham-Clyne warned of higher fees and fewer trained employees, since union workers would have to choose between keeping the benefits they have in the union, or leaving the organization in order to continue working in the field of sleep medicine.
Canham-Clyne said OHCA should deny Gaylord’s request for approval and require YNHH to file a similar request for approval.
Kyriacou (pictured), the Gaylord CEO, said the hospital is choosing to close its sleep center because business has been declining in the last several years. He said Gaylord is working with YNHH to ensure a “seamless transition” with no changes to patient care.
Asked about transportation, Kyriacou said YNHH has agreed to provide the same level as currently exists: A hospital taxi service, free transport for Medicaid patients, and public bus service.
“There won’t be any changes,” Kyriacou said. He promised to submit a written agreement with YNHH to that effect.
Kyriacou said he does not know if any of the doctors who worked at New Haven’s sleep center will be hired to work in the North Haven center.
“The issues raised are valid,” said Blair, the Gaylord attorney. But the transportation needs of New Haven patients going to a center in North Haven are “outside of the jurisdiction” of the OHCA, he said. The matter before OHCA is simply the closure of the North Haven center.
The recently passed Senate Bill 35, which gives OHCA the power to review hospital purchasers of physician practices, has not yet gone into effect.
Asked about the argument that OHCA should consider YNHH’s acquisition as part of Gaylord’s closure of its sleep center, Kyriacou said, “I think that is totally incorrect.”
“There is going to be no change in access in North Haven,” he said.
The underlying issue, Kyriacou said, is simply that the union is upset with Yale’s decision to close the New Haven sleep center.
“The union has an issue with Yale University, and somehow we’re being dragged into this.”