Reflecting industry-wide realities, both New Haven and Waterbury will see their two major hospitals become one
If current plans proceed to fruition as expect, the face of health care in Connecticut — and particularly in New Haven County — will undergo radical changes later this year as four hospitals work out the details of two different ongoing mergers affecting nearly 863,000 citizens, or nearly a quarter of the state’s total population.
Last September, Yale-New Haven Hospital (YNHH) and the Hospital of Saint Raphael (HSR) signed a definitive agreement to merge the two major teaching hospitals, a proposal that has since moved closer to completion this year.
YNHH, a 1,008-bed non-profit tertiary medical center, will acquire HSR's assets, invest approximately $135 million for capital improvements and operate as a single hospital organization with two separate campuses. HSR, a 533-bed not-for-profit hospital and the centerpiece of the Saint Raphael Healthcare System sponsored by the Sisters of Charity of Saint Elizabeth, also includes the 125-bed Sister Anne Virginie Grimes Health Center that provides short-term rehabilitation services and long-term care. HSR expects to post a loss of about $8 million next year.
Currently, Yale-New Haven Healthcare System — comprising YNHH, Yale-New Haven Children’s Hospital, Smilow Cancer Hospital at Yale-New Haven and Yale-New Haven Psychiatric Hospital — also includes Bridgeport Hospital, with 425 beds, and Greenwich Hospital, with 206 beds, already making it the second largest health-care system in Connecticut. Currently available figures show that 15,471 employees would work under the Yale-New Haven Healthcare System umbrella — making it the third largest employer in Connecticut, with a combined capacity of more than 2,100 beds. In New Haven alone, 11,992 employees would work for the resultant new YNHH — making it the city’s second largest employer with more than 1,500 beds.
The move would allow HSR to retain its Catholic traditions regarding reproductive services and other matters previously supported by the hospital. The approval process includes the state attorney general’s office, the state’s Office of Health Care Access and the Federal Trade Commission. The Archdiocese of Hartford and the Vatican will also have to approve the merger. During the approval period, the two hospitals will continue to operate independently.
“The primary goal of the transaction is to drive better efficiencies and look for cost-avoidance,” explains Vin Petrini, vice president of public affairs at YNHH. “We could deliver better quality of care more efficiently. Both organizations can think about how we invest in clinical services. We can consolidate certain services on one campus or the other. That allows us to find efficiencies and investments.”
Petrini adds that YNHH faces capacity constraints to accommodate future growth in the number of patients expected to be served by the hospital.
“Our solution, if this doesn’t move forward, is an in-patient tower which could cost in excess of $400 million,” Petrini says. “We absolutely need to meet our patient demand and to grow our capacity, so absent the transaction with Saint Raphael’s, we’re looking at a very significant investment. We’re in the process of developing our clinical plans for the unified hospital. We’ll be taking a look at all our clinical services to see how they align with the goal of integrating them in a way that best meets our patient demand.”
Christopher O’Connor, president and CEO, of the Saint Raphael Healthcare System, which includes the Hospital of Saint Raphael, says that health care continues to be a growing sector of the economy, remains an integral part of the greater New Haven business community and that the newly merged organization will take advantage of the opportunity to grow and develop resources, generating new opportunities for employment and economic growth for the region.
“We firmly believe this integration is the right approach to managing a challenging environment,” explains O’Connor. “It provides an opportunity to enhance quality, preserve access and provide high-quality care in the most cost-effective manner possible. The integration of these two exceptional hospitals will provide financial stability and allow for clinical growth on the HSR campus, while providing much-needed additional capacity for YNHH.”
O’Connor underscores several benefits of the merger, noting that having one integrated system will incorporate the best practices of both hospitals to improve the quality and coordination of patient care.
“This includes developing one combined electronic medical record for each patient’s care so, whether they are treated in a physician’s office, in the hospital or in an ambulatory setting, their provider will have access to their treatment history, tests already performed and medications prescribed,” O’Connor says. “Efficiencies will be created by standardizing supplies and vendors, and reducing the unnecessary duplication of capital purchases.”
O’Connor echoes Petrini’s assertion that the acquisition immediately addresses Yale-New Haven Hospital’s ongoing capacity issues by providing additional capacity available within the Hospital of Saint Raphael and avoiding the estimated $400 million cost to construct a new patient bed tower on the existing YNHH campus.
“[The merger] also addresses Saint Raphael’s financial stability by enabling us to pay our dept obligation, help address our existing Church Plan pension shortfall, and access the capital needed to expand our clinical services and renovate our facilities,” O’Connor adds.
O’Connor noted that medical care will continue to be provided according to Catholic tradition on the Saint Raphael campus.
“We will be able to bring together outstanding medical professionals and resources around centers of excellence and other services to provide patients with the most advanced and sophisticated healthcare resources,” says O’Connor.
As for the merger’s impact on jobs at both hospitals, YNHH has created a website (newstory.org/for-employees) to explain the details of the merger to both hospitals’ employees.
“For the majority of staff at both hospitals, the proposed integration will have little impact on their day-to-day activities, and most HSR employees will become part of the new integrated hospital,” according to the site. “The transition will be structured to offer HSR employees opportunities at YNHH through existing operations, vacancies and growth opportunities, keeping any job loss associated with the transaction to a minimum. It is anticipated that the transition will likely create more jobs in the long run. YNHH intends to expand certain clinical services on the HSR campus and, in addition, health care is a growing sector and an economic engine for greater New Haven and the broader region. A healthy and vibrant integrated hospital is expected to drive continued growth in ancillary industries.”
On the northern edge of New Haven County, the city of Waterbury is undergoing significant changes with its two hospitals. Waterbury Hospital, a non-profit with nearly 1,600 employees and 393 beds, and St. Mary’s Hospital, also a non-profit with over 1,200 employees and 379 beds, are in the midst of negotiations on a merger that also includes LHP Hospital Group Inc., (LHP) a privately held company headquartered in Plano, Tex. that provides hospital capital and expertise to not-for-profit hospitals and hospital systems.
When the merger is complete, LHP will retain an 80-percent ownership stake in the merged new hospital while each current hospital organization will retain ten percent each. LHP is owned by affiliates of the private equity firm CCMP Capital Advisors, LLC, and the CPP Investment Board.
“Waterbury Hospital entered this joint venture to significantly enhance the quality of care we can provide our community for years to come,” says Darlene Stromstad, president and CEO of Waterbury Hospital. “By partnering with LHP Hospital Group and Saint Mary's, we will have the resources to provide sophisticated, high-quality health care in a modern, convenient setting,” added Stromstad. “Alone, we would continue to struggle at best. We believe by working together, we can provide more efficient, effective care and are excited to be part of transforming health care in our region.”
The new hospital that emerges will honor the ethical and religious directives of the Catholic Church relating to reproductive services, instead relying on other non-affiliated facilities to provide them, says Stromstad. Total beds will be initially established at 400, with room for expansion as needed. Currently, Waterbury Hospital has an 87 percent occupancy rate while St. Mary’s is at 74 percent. Stromstad says she expects a reduction in staff levels via attrition and retirements, which have already begun, with a keen eye toward filling only those vacancies that must be filled to maintain quality of services.
Stromstad adds that when LHP said they would build a replacement hospital to house the two, “that was a game-changer.” Two sites within Waterbury are being considered and, if those fail to accommodate the project, one site outside of the city is also available, noted Stromstad, though she declines to identify the sites by name. No decision has been made on what the new hospital’s name will be or who will lead the new hospital.
Chad Wable, president and CEO of Saint Mary’s Health System, echoes Stromstad’s observations.
“This joint venture is a once-in-a-lifetime opportunity to transform the health-care delivery system in greater Waterbury,” says Wable. “It will dramatically improve the health-care experience for the people we serve. Current changes in healthcare policy and reimbursement demand that hospitals across the country find ways to reduce costs. For Saint Mary’s and Waterbury Hospital, there is no question that remaining in two 100-plus-year-old facilities is by far a more costly approach. Building a state-of-the-art, optimally designed and constructed facility will enable us to achieve real cost efficiencies.”
“We would never be able to do this, just the two hospitals, without a third-party capital partner,” says Stromstad. “There is a lot of demand on our system with an aging population. Our industry is going through a major transformation right now. As health care leaders, we have to face these times with courage and vision and be able to move our organizations forward.”
Increasingly downtown hospitals rely on satellite facilities to reach consumers beyond the city center
For someone living outside an urban center, a medical emergency could become even more serious when time used to get to a health-care facility is factored into service delivery.
But with more and more hospitals opening community satellite facilities and/or becoming affiliated with independent health-care providers, individuals potentially have access to services right in their neighborhood.
Fairfield residents who encounter an emergency, for example, don’t have to go to Bridgeport Hospital for immediate care. They can utilize services right in their town, at the Fairfield Urgent Care Center on Stillson Road.
“Our Fairfield [County] urgent care centers clearly have some advantage to [hospital] emergency department,” says Michael Werdmann, MD, chairman of Bridgeport Hospital’s Department of Emergency Medicine. “At lots of hospitals, clearly there are a lot of things we see in the emergency department that don’t require the full services of a hospital.”
Some of those needs include small lacerations, splinting and X-ray — services an urgent care center often is better equipped to handle, Werdmann explains.
There are additional Bridgeport Hospital urgent care/walk-in medical centers in Stratford, Shelton, Monroe and Trumbull.
Anita Shrum, Bridgeport Hospital’s director of emergency services, estimates that between 60 and 70 percent of emergency patients have maladies that “are not emergency and could be treated adequately at an urgent-care facility.” Community-based urgent-care centers, she says, “can hugely impact an emergency department” by lessening its load. She says she’d like to see them utilized much more by area residents.
Making patients more aware of its outsource services is one of the goals of New Haven’s Hospital of Saint Raphael (HSR) as it opens a new cardiology facility at 2080 Whitney Avenue in Hamden. To help raise awareness, staff will offer informational sessions in June focusing on issues such as CPR, stroke awareness, diabetes, automated external defibrillators (AEDs) and smoking cessation.
The new Hamden office focuses on general cardiovascular care and includes services such as stress testing, echocardiography, nuclear cardiology and vascular ultrasound. The services complement those offered at other HSR community medical centers such as the Hamden Blood Draw Center, the Fr. Michael J. McGivney Cancer Center, Occupational Health Plus and Outpatient Rehabilitation Services, Chapel Pediatrics and Saint Raphael’s Eldercare Clinic.
Samuel Hahn, MD, director of Saint Raphael’s Cardiac Catheterization Lab, notes that the new Hamden office gives area residents greater access to needed medical care.
“Adding cardiology and other new services to our existing capabilities at 2080 Whitney Avenue will truly make the Hamden site a multidisciplinary setting, providing residents with easier access to a broader range of services,” Hahn said.
Yale-New Haven Hospital (YNHH) also has a number of satellite care facilities. In addition to the main facility in New Haven, there are outpatient services medical facilities in Guilford and Hamden; blood-draw stations in Hamden, North Haven, West Haven, Madison and Branford; radiology services in Guilford, East Haven, Madison; and an urgent care unit in East Haven, among others
Also, right in New Haven services offered in addition to those at the 20 York Street main hospital include medical, surgical and recovery centers, a radiology facilities and blood-draw stations
YNHH’s Urgent Care facility in East Haven opened in May. Within three months, an average of some two dozen patients were being seen by medical professionals there daily, according to staff. A survey of area residents, who voiced a need for the acute-care center, helped bring it to East Haven.
The facility, located at 317 Foxon Road, addresses non-life-threatening emergency medical needs, such as work-related injuries, small cuts and earaches. The East Haven facility not only helps East Haveners avoid the longer trip to the main hospital in New Haven during for a medical emergency, it also helps decrease patient overflow in the main hospital’s emergency room.
According to a recent article in the Boston Business Journal focusing on the entrepreneurial aspect of community urgent care centers, there’s been a “national trend toward entrepreneurial alternatives to emergency room care for non-life-threatening illnesses.” The article notes that two Massachusetts doctors who opened such a center received substantial funding from lender Century Bank. The business model the entrepreneurial pair presented, states the BBJ article, “inspired confidence in Century Bank, which granted the partners a $500,00 small business loan to launch the venture.”
At Quinnipiac University, a new physical therapy clinic opened recently. It is staffed by students, who offer services free of charge to referred patients.
“Right now we’re only accepting referrals,” says Traci Underhill. She, along with fellow Quinnipiac sixth-year physical therapy student Meredith Wolanin, opened the service, called Volunteers in Service Impacting Our Neighborhoods (VISION) Rehabilitation at Quinnipiac University. It is open weekly, Tuesday evenings, on QU’s North Haven campus.
The unit taps into another potential advantage of satellite facilities: the ability to target a particular population and/or offer a specific service. Currently, care is available exclusively to uninsured patients.
“Our patients have no health insurance, so we know we’re not stepping on the toes of any other provider in the area,” explains Underhill.
“Physical therapy often is a benefit that most people with insurance tend to have,” adds Wolanin. “To pay out-of-pocket is crazily expensive.”
The Quinnipiac physical therapy clinic fills a void, Wolanin says.
“Without it, they [patients] would not get what they need.” In the past, she notes, patients at the referral facility who could not afford physical therapy would have only been prescribed pain medication — in essence treating the symptom, not the cause.
VISION receives its referrals from Haven Free Clinic, which is operated by Yale health professions students in conjunction with the Fair Haven Community Health Center.
“There’s a significant need for this clinic,” says Underhill, who notes that while 27 percent of Haven patients have complained about musculoskeletal disorders, Haven does not have a physical-therapy unit.
“For our patients, they obviously receive physical therapy services they otherwise wouldn’t be able to access,” says Underhill.
“I’ve always been drawn to service opportunities,” says Wolanin. She adds that while there are programs for those training in health-care services to travel to underdeveloped areas throughout the world and help address the medical concerns of indigent populations, there also is need here in the United States.
“For example, there’s a program to go to Nicaragua,” says Wolanin. “So many students apply. But it’s frustrating to see that there are people in our own neighborhood who don’t get the care that they need.”
The student-run campus physical therapy center also provides an added advantage for its volunteer practitioners, Underhill says.
“It gives mentorship opportunities. Students work in teams, and the practice under the oversight of our faculty members.”
There are scores of volunteers, adds Wolanin.
“We have over 100 student volunteers” signed up, she says. But, as in the case of many student-operated initiatives such as this, continuity of care might become an issue.
The clinic is seeking ways to address that, as well as further serve the community with enhanced services and by addressing concerns that could impede the delivery of those services, such as lack of transportation.
“We’re constantly looking for grants” and seeking fundraising opportunities, says Wolanin. Not only would funds be used to purchase equipment, they would be channeled into the population served by the clinic, she says.
“We want to put the money back into the patient population — for example, money for cab fare. Often transportation is an issue.”
Plans for eventual expansion of care include incorporating occupational therapy and nursing to its pro bono offerings.
The free physical therapy clinic is not necessarily a new concept, but it’s one the students want to improve on. “We hope that we can serve as a model,” says Underhill.
HARTFORD — Connecticut’s iconic insurance giant has earned a distinction that probably didn’t exist a decade ago. According to the Human Rights Campaign Foundation (HRC), Aetna is one of 2012’s “Best Places To Work” for lesbian, gay, bisexual and transgender (LGBT) employees.
According to HRC, only 190 of the 850 businesses evaluated achieved a perfect score in the group’s 2012 Corporate Equality Index (CEI) rating. Aetna was among them. The CEI rates companies on 40 specific policies and practices related to the LGBT community, 32 of which are new or more demanding this year. As a result of this change in criteria, the number of companies achieving a perfect score was reduced by almost 50 percent.
In the mid-1990s, Aetna implemented changes to many policies affecting domestic partners. In early 2009, Aetna was the first major health-benefits company to add gender reassignment surgery as a benefit for its employees and any contracted companies choosing to add it to their benefits package. In addition, Aetna’s LGBT employee resource group (ERG) has chapters across the U.S., including a virtual chapter that engages employees regardless of their work location.
NORTH HAVEN — Yale-New Haven Hospital (YNHH) will move ahead with its plans to develop an outpatient center in the former AT&T building at 6 Devine Street. YNHH will purchase and remodel the 120,000-square-foot, four-story building for a comprehensive ambulatory care program.
“We are delighted to move this project forward,” said Richard D’Aquila, YNHH’s president and COO. “The concept of a Yale-New Haven ambulatory center has received widespread community support. It will create access to key health services for residents of North Haven, Hamden, Cheshire and other surrounding communities.”
Plans for the new facility include a walk-in/primary care center to provide comprehensive medical services from injury care to management of chronic conditions. The center will be open seven days a week.
The building will also include a Smilow Cancer Hospital Care Center for outpatient medical and hematological care for cancer patients and an Inflammatory Disease Center for patients with multiple sclerosis, rheumatoid arthritis and related disorders. The facility will offer onsite MRI and digital X-ray imaging, as well as laboratory and blood-draw services.
In addition, Yale New Haven Health System will consolidate and move some of its information-technology offices from multiple sites in New Haven to the North Haven facility, which is estimated to open next January 1.
NORTH HAVEN — Anthem Blue Cross & Blue Shield in Connecticut last month announced an innovative, patient‐centered primary-care program that will fundamentally change its relationship with primary-care physicians by increasing its financial support of their practices and to help manage their patients’ health, the company said.
Anthem said it would collaborate with primary-care physicians on enhanced information sharing, care-management coordination and provide an opportunity to share in the savings generated by increasing health care value. Thereby improving quality while reducing cost.
“We know that the physician-patient relationship is the most important one in promoting health and wellness. As such, primary care is critical,” said Anthem President David R. Fusco.
Anthem’s patient‐centered primary care program builds and expands upon the best practices from successful medical home pilots. Last year Anthem launched a patient-centered medical home pilot. The goal of the program is to improve access to primary care, enhance care coordination, primarily through a care management model and track outcomes such as emergency room visits, inpatient admissions and hospital readmissions.
Anthem is launching a similar program with select family practitioners this year.
NEW HAVEN — The Father Michael J. McGivney Center for Cancer Care at the Hospital of Saint Raphael is launching several new wellness efforts, including medical Pilates for cancer patients, in-bed yoga, holistic nutrition and live music for patients and their loved ones in the center’s lobby.
“Our new programs allow us to treat the whole person both during and after cancer care with the latest in wellness therapies,” said Joseph Cardinale, MD, medical director of the McGivney Center. “These programs augment our medical expertise and state-of-the-art technology like CyberKnife radiosurgery to allow for a complete range of treatment and support options.”
Medical Pilates, offered at the center’s New Haven campus, combines elements of physical therapy and traditional Pilates exercises to reduce stress and improve muscle strength, posture and flexibility. Certified physical therapist and Pilates instructor Wendy Price will lead the class, designed for cancer survivors and patients in all stages of treatment. The class is free; participants must pre-register by calling 203-789-3488.
Other new HSR wellness programs in New Haven include holistic nutrition demonstrations by a dietician featuring cancer-fighting foods held monthly in the McGivney Center lobby. In addition, January saw the launch of in-bed and in-chair yoga and meditation as part of the Urban Zen Integrative Therapy Program, founded by fashion designer Donna Karan. In coming months, the McGivney Center’s Integrative Wellness program will be expanding to include acupuncture for cancer patients.
MIDDLETOWN — Community Health Center Inc. (CHC) has launched a state-of-the-art, evidence-based program known as CHC Project ECHO Hepatitis C/HIV. CHC is one of the first community health centers in the nation to replicate the ECHO model. Project ECHO (Extension for Community Healthcare Outcomes) is a model developed by the University of New Mexico initially to extend hepatitis C care and management to the rural clinics.
The program uses video-conferencing, electronic health records, disease management and case-based learning to expand access to specialty care for underserved patients. The purpose is to provide specialist support and education to help primary-care teams manage cases that would otherwise be referred out to specialists.
“We are very excited to be offering this innovation at CHC which will allow us to offer specialized treatment to patients across the state, many of whom do not have access to such treatment otherwise. In many communities there are few specialists willing to accept patient without insurance or with state funded Medicaid insurance.” explained Marwan Haddad, MD, medical director of HIV, HCV and buprenorphine services.
Currently, CHC offers HIV and hepatitis C management and treatment as part of primary care at New Britain, Meriden and Middletown. Through CHC Project ECHO HIV/Hepatitis C care will now be offered at additional sites across Connecticut including Bristol, Norwalk, Waterbury, Enfield, Clinton and New London via weekly video-conferencing sessions.
For more information, visit chc1.com.
NEW HAVEN — A bevy of moms, babies and VIPs celebrated the first birthday of the Dr. Romeo A. and Lena B. Vidone Birth Center at the Hospital of Saint Raphael on Friday, February 10. Department of Public Health Commissioner Jewel Mullen, MD, attended the event, which also marked the Vidone Center’s designation as Baby-Friendly for promotion of breast feeding.
“I congratulate Saint Raphael’s on the Baby-Friendly designation,” Mullen said. “This is really part of an international effort to promote breastfeeding for its many benefits for mothers and their infants.” With the addition of HSR, Connecticut can boast of 14 percent of infants being born in Baby-Friendly hospitals, compared to only five percent nationwide, Mullen said.
The World Health Organization and UNICEF started the Baby-Friendly initiative to recognize hospitals that educate and enable parents to make informed choices about how they feed and care for their babies.