Thomas MacMillan Photo
Gretchen Rose said she fell victim to a “changing health care landscape,” losing her job as a Yale sleep technician while her former boss kept his.
Dr. Paul Taheri, head of Yale Medical Group, had a different take: “We are all victims.”
Those two perspectives emerged Wednesday afternoon at one of the first full-blown public looks at how New Haven’s fast-arriving brave new world of health care.
Rose (pictured) and Taheri — the head of the practice of Yale medical school doctors who comprise many of the physicians working at Yale-New Haven Hospital (YNHH) — offered their views at a Wednesday evening panel discussion entitled “The Changing Healthcare Landscape,” held in an auditorium at the Yale School of Medicine on Cedar Street.
Local 35 and 34 Presidents Bob Proto and Laurie Kennington.
The event — which featured state Attorney General George Jepsen and state budget director Benjamin Barnes — was organized by Yale’s UNITE HERE unions, Locals 34 and 35, along with the Universal Health Care Foundation of Conneciticut, the AFL-CIO, and the Connecticut Health Policy Project. It was billed as a discussion of a new trend: “Large hospitals are taking over smaller ones and rapidly taking over private physician practices. Yale-New Haven Hospital is a notable local example of these trends.”
In 2012, YNHH bought out the Hospital of St. Raphael, becoming the one of the country’s largest hospitals. Recently, 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.
At Wednesday’s panel discussion, four of five panelists raised red flags about the dangers of such consolidation. Jepsen said it can lead to higher fees for patients;Barnes said it can lead to “segregation” of care between private payers and publicly supported patients.
The fifth panelist, Taheri (pictured), called for a consideration of context. The health care system is changing rapidly, he said. “We are all victims of a system that is extra complex.” Hospitals need to respond to changes, to be able to meet costs and continue healing people, he said.
Pies
Rose, the laid-off sleep technician, was not a member of the panel. She shared her experience outside the auditorium, before the official discussion began Wednesday.
Rose, a Yale University employee, said she worked for over 15 years at the Yale sleep study center, run by Yale Medical Group (YMG), until all the staff was laid off in January. She said she was told that YNHH would open a new sleep clinic in North Haven, and that she and the other staff could re-apply for their jobs there.
If she were r‑hired, she’d no longer be a university employee, would lose her benefits package, and take a pay cut of $6 per hour to join a non-unionized workforce, she said.
Rose said she’s wary of the “hospital getting it’s fingers in all of the pies” by buying up practices like hers. “I’d be scared as a university employee and as a patient.”
“I don’t think healthcare should be monopolized,” she said.
YNHH Senior Vice President of Public Affairs Vin Petrini said the hospital acquired a sleep center in North Haven to “fill the gap” created by the closure of the YMG sleep center. He said didn’t know the specifics of the the wages for workers at the new sleep center, but was doubtful of the $6 pay-difference claim: “I can’t imagine there’d be that much of a gap.”
Petrini said YNHH hired the former administrator of the YMG sleep center for its new center. But the closure of the YMG center and the opening of the new one were “separate and distinct transactions,” he said. “We didn’t acquire the Yale Medical Group practice.”
“There is no giant conspiracy on this,” Taheri said during a question-and-answer period with the panel, when asked by one of Rose’s former co-workers asked about the closure of the sleep center. The sleep lab had been losing money for years, and was finally forced to close. It may have “appeared, optically” bad, but the deal was a consequence of a simple financial reality, he said.
Taheri’s answer to the sleep lab question followed from his comments earlier in the panel discussion, when he said that medical practices simply have to make choices given rapid changes in the health care system. It’s a national phenomenon, he said. People all over the country are learning to adapt. “It’s not easy on physician providers either.
Academic hospitals like YNHH have higher costs, for several reasons, he said. The hospital has a “very broad range” of specialists with “enormous capabilities.” Those expensive doctors are “on call all of the time.” Other hospitals know that, and send their patients, including those who can’t pay, to YNHH for treatment. “We bear it.”
You have to consider the whole picture, Taheri said. Lots of services hospitals provide do not make money, he said. The government doesn’t fully reimburse the hospitals for treating Medicaid and Medicare patients, who represent a large chunk of YNHH’s case load. “People have to pursue profit because so much is unprofitable,” he said. “If there was no money in the system, none of us would be sitting here.”
Change
Panelists listed a number of possible dangers as hospitals acquire more medical practices. Secretary Barnes said that such acquisitions can lead to “segregated” care, because hospitals tend to send their Medicaid patients to hospital-based specialists rather than to the physicians in their newly acquired practices.
Attorney General Jepsen (pictured above) listed three ways hospital acquisitions can lead to higher prices for health care: As hospitals expand, they have more bargaining power to raise their rates with insurers. They can start to charge “facility fees” at acquired clinics. And, as “market concentration” increases, every oncologist, cardiologist, and dermatologist in the area might be a hospital employee, giving the hospital the ability to charge more.
Reached by phone after the panel discussion, Petrini, the YNHH vice president, offered a number of counterarguments — reasons why hospital acquisitions might improve health care: First, they can help practices stay open by taking on some of the increased bureaucratic burden of running an independent small business in the era of the Affordable Care Act. That helps ensure that local communities continue to have access to health care. Second, the care can be enhanced, because practices can be connected through common medical records. And third, hospital expansions can create economies of scale that reduce costs.
“Change is sometimes difficult and challenging,” Petrini said. “We’re just managing it proactively to the best of our abilities.”
It has been reported that YNH is already charging "facility fees" at related operations. This has come under severe criticism by the OHA and others. It can be very steep and simply adds tremendous expense to your medical bill.