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Harp Blasts “Facility Fees,” Sleep Center Deal

by Thomas MacMillan | Jun 19, 2014 8:58 am

(9) Comments | Commenting has been closed | E-mail the Author

Posted to: City Hall, Health

Thomas MacMIllan Photo 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.”

Dangers

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.

Gaylord Responds

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.”

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posted by: Wooster Squared on June 19, 2014  10:21am

Mayor Harp ought to spend more time getting New Haven’s disastrous finances in order and less time worrying about how YNHH decides to conduct its business.

Harp giving YNHH advice on business decisions is like Chris Christie doling out diet and exercise tips.

Let’s get our own house in order before we go nosing around the hospital’s business.

posted by: LookOut on June 19, 2014  1:17pm

@Wooster Squared:  VERY well said.  It would seem that Harp has plenty to work on (budget mess, shootings, crime, high taxes) at home without getting into this issue.  It’s rather embarassing

posted by: Noteworthy on June 19, 2014  2:12pm

While the Harp House budget is a disaster - the core issue in this story is about YNHH’s unending ferocious acquisition appetite. It is creating a monopoly of care at the expense of the public. This has nothing to do with economies of scale and less expensive or better healthcare. It has everything to do with being able to increase fees and find creative ways to charge consumers even more outside of the constraints of their insurance policy with contracted limits on co-pays, deductibles etc.

The facility fees Yale charges can go into the thousands of dollars and/or at very least, double your office co-pay. The shuck and jive response of the Yale New Haven Hospital ought to be sending shock waves across the political spectrum. It’s an epidemic.

The legislature and Johnny Come Lately approach of our state leaders is as shameful as Yale’s insistence on fleecing the sick and those needing care.

posted by: FacChec on June 19, 2014  2:19pm

@Wooster Squared on June 19, 2014 10:21am

“Let’s get our own house in order before we go nosing around the hospital’s business”.
.


@LookOut on June 19, 2014 1:17pm

“@Wooster Squared:  VERY well said, It’s rather embarrassing”


I highly disagree with both of your comments,

First, this was a public meeting and the Mayor was acting within her mayoralty duty to represent the city’s interest.

Harp asks that her HR department look into how the city would be impacted by the increase in fees..

” 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”.

Second, the Mayor was in her right as a private citizen to comment on matters affecting the city.

” 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.”

A similar story was posted on the NHI late last month in which Harp registered her opposition to the fee increase.

http://www.newhavenindependent.org/index.php/archives/entry/suprise_fees_revealed_but_not_eliminated/

While I sometimes question positions being taking by Mayor Harp, this is not one of those times.

I find that your comments above:

“Nosing around hospital business and

“It’s rather embarrassing”

Both far off the mark and clearly show you did not read and digest the body of the story as intended.

For your further understanding of the issue, here is the version from the NHR:

http://www.nhregister.com/apps/pbcs.dll/article?avis=NH&date=20140619&category=NEWS&lopenr=140619429&Ref=AR&profile=1030040&template=printart

Peace, out>>>>>>>>>>>>>>>>>>

posted by: Atticus Shrugged on June 19, 2014  3:43pm

Mayor Harp, contrary to popular belief, has done her homework on the budget.  She understands, very clearly, the impact the closing may have on a self-insured city.  That is part of the reason she is taking a position in this fight.  She is trying to stop taxes from rising, something people are generally in favor of.  She is also sticking up for the poor and working poor of New Haven.  Those who constitute a significant portion of New Haven’s residents.  Those same constituents who helped get her elected to office - those are the people she is fighting for.  I don’t expect all who comment on here to understand that, but I am glad to see her be a voice for the voiceless.

As for the “advice,” none was given.  She merely stated that for every action, there is an equal and opposite reaction.  For every dollar saved by the hospital, there is a dollar lost by someone else.  In this case, several of those dollars may come from the City.  In the end, this may be an exercise in futility but I am very happy to see her get into the ring.  Hopefully, as the transfer and closure will go through, she at the least gets a reasonable cap on “hospital fees” and an agreement to provide for transportation that may only be revoked upon notice and hearing.  Those would be major wins.

posted by: 32knot on June 19, 2014  4:28pm

The Mayor is correct to comment on the cost to the budget of facility fees. But i get the impression she was there to back up the play of Loca 34 which really doesn’t want to lose the jobs at the sleep center. If the unions were really concerned about health care costs they would have spent a little more time oppposing the Affordable Care Act. the real payback to the unions will be when their health insurances are dropped at next negortiations because the employeers will discover it is cheaper to pay the fine then provide the coverage. and when most in a city are in that situation, the city and yale unions will follow because by themselves the unions can not reelect the politicians, they need the non-union, non insured to vote with them.

posted by: Shaggybob on June 20, 2014  10:35am

I am not a fan of this Administration, BUT I have to side with Mayor Harp on this one.
YNHH needs to hear opposition of their outrageous “facility” charges in addition to co-pays that are only burdening the sick, elderly and working poor. YNHH does need the additional income from individuals who are struggling so top execs can have fat bonuses.
The reality of moving the sleep center and the impact it has on the people who REQUIRE the services at this center are very real (transportation).
As much as there are many other real issues city wide and yes we need to get our house in order, BUT this issue should be addressed whenever the opportunity presents itself. YNHH needs to stop gouging the public with their ongoing monopoly!

posted by: IloveMYcity203 on June 20, 2014  3:44pm

I am also not a fan of this administration. Well, I wasn’t in the beginning, but her administration still deserves a chance. It has only been 6 months.

Also, there is a sleep center located at the Temple Medical Center. For those of you who are not aware of this, take that into consideration. She had every right to voice her opinion for the residents of New Haven who do not have the luxury to travel out to North Haven by car.

Enjoy the day :)

posted by: Jones Gore on June 21, 2014  1:52am

For once I am with Mayor Harp. As far as I am concerned, it was a mistake for the state to allow YNHH to buy St. Raphael Hospital. I know two people who have been misdiagnosed. I just learned today that one of them was told he had cancer, went through chemo therapy just be told it was a mistake.

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