NEW HAVEN — The U.S. Green Building Council has awarded LEED (Leadership in Energy and Environmental Design) certification to Smilow Cancer Hospital at Yale-New Haven Hospital (YNHH) in recognition of the hospital’s successful sustainable design and construction strategies.
The LEED Green Building Rating System is the nationally accepted benchmark for the design, construction and operation of high-performance green buildings, providing verification that a building was designed and built using strategies aimed at improving performance across all metrics.
“When planning for Smilow Cancer Hospital began in 2002, sustainable strategies, including LEED certification, were not easily attainable in health-care facilities because of their high energy demands and other constraints,” said YNHH President and CEO Marna P. Borgstrom. “We are very pleased with this recognition knowing that Smilow Cancer Hospital is the largest health-care facility in Connecticut to receive LEED certification.”
Completed in 2009, the 516,000-square-foot Smilow’s sustainable features include optimum circulation of natural light in lobbies, corridors and waiting areas to reduce energy consumption; occupancy sensors in non-patient spaces to further reduce energy usage; pumps with variable speed drives and room pressure monitors to reduce power usage for enhanced air supply.
BRIDGEPORT — Starting this month Housatonic Community College is offering two non-credit Patient Care Technician courses. The PCT Program, which adds another layer of skills to those earned in a Certified Nurse’s Aide program, prepares students to perform patient-care activities that include such things as lab tests, electrocardiograms, simple dressing changes, phlebotomy, and physical and occupational therapy. Two funding sources are available: the Connecticut Jobs Bill and the Workforce Investment Act.
The training offers a career-ladder pathway that will enable interested people, including unemployed individuals and underemployed health-care workers, to develop the skills necessary to seek higher-level positions in health-care facilities. There are 20 available seats for each course. To learn more phone the HCC Center for Lifelong Learning at 203-332-5057.
The state's health insurance exchange, a key part of federal health reform, is intended to give individuals and small businesses more options for buying insurance. But for many people in Connecticut, the new marketplace might not bring affordable coverage options when it launches in 2014, according to a consultant to the board developing the exchange.
That's because according to data from Connecticut insurers, the majority of health plans sold to individuals and small businesses provide less generous coverage — most likely, at a lower cost — than plans sold on the exchange will be required to provide.
The analysis suggests that people buying insurance through the exchange could get plans that offer more coverage with lower out-of-pocket costs, but they would likely have to pay more for them.
"It's going to be very difficult for the exchange to compete in the marketplace based on price," Paul Grady, a partner with the consulting firm Mercer, said during a presentation to the exchange board. He added that small businesses and the uninsured tend to be very sensitive to the price of coverage, which will likely be a driving force in their insurance selections.
But Grady added that the exchange could compete in other ways, such as by offering innovative health plans that can reduce costs by improving health, or by targeting employers that don't provide coverage to workers.
Health reform requires plans sold on the exchange to be offered at four different levels of "actuarial value," which refers to how much of the benefits the plan pays. A plan with a higher actuarial value covers more of the costs of health care, with the member responsible for fewer out-of-pocket costs like copayments or deductibles, while a plan with a lower actuarial value would leave more to the member to pay. Generally, those with higher actuarial values have higher premiums, while those that leave the members to pay more out-of-pocket have lower premiums.
Under the health reform law, plans sold on the exchange must come at four levels: bronze, silver, gold and platinum. The minimum, bronze, must have an actuarial value of 60, meaning the plan would cover an average of 60 percent of a member's health care costs and the member would be responsible for the other 40 percent.
But in Connecticut, a large swath of the population that could buy coverage through the exchanges currently have plans that fall below the bronze level of coverage, the Mercer analysis found. Half of employers with fewer than 50 workers provide coverage below the minimum that an exchange plan would provide.
Larger companies are more likely to offer plans with higher actuarial values, known as "richer" plans. Only seven percent of companies with 50 to 99 workers provide "below-bronze" coverage, as do five percent of companies with between 100 and 499 workers.
But that's not the exchange's target market. When the exchange starts in 2014, it will be required to cover only people who buy coverage on their own and employers with 50 or fewer workers.
If the exchange isn't likely to be able to compete with the rest of the insurance market based on price, Grady said, it could still have an important role.
He noted that larger employers, who tend to have more control over their insurance plan designs, have been able to contain their health care costs without shifting costs to employees by using innovative plan designs, such as by encouraging the use of preventive care or managing chronic conditions.
Small businesses tend to buy their coverage from insurers, rather than designing their own plans, and Grady said products that mirror what large employers do have not been developed for the small-employer market. The exchange board could play a role in encouraging them, he said.
In addition, Grady said, the exchange has an opportunity to reach small employers who don't offer insurance to their workers now, and who don't understand how the insurance marketplace works.
Board member Mary Fox suggested another niche.
"Since we can't compete on price, we could compete on elements like transparency and consumer education and making sure that we have simple products, simply and well explained to the consumer," she said. "Because I think one of the things that would be attractive would be to kind of reduce the complexity in the overall insurance marketplace."
William Van Deventer, a senior associate at Mercer, said that in general, people who have more health risks and need more medical services are going to be attracted to gold or platinum plans that require fewer out-of-pocket costs for getting care, while people who are healthier would tend toward bronze plans.
Federal health reform requires health plans to cover the full cost of preventive services, with no out-of-pocket costs to members, Grady noted. "But the people aren't going to get those preventive services because they're worried if they get to there and they find out that there's something wrong with them, they're not going to be able to afford the care that's necessary," he said.
Grady also spoke of the difficulty of operating a health insurance exchange. Massachusetts has one, known as the Massachusetts Connector, but it has limited options for small businesses; none of the major insurance carriers in the state offer products for small businesses on the exchange, and only about 4,000 small businesses participate.
By contrast, Grady said, Connecticut already has an effective exchange, run by the Connecticut Business and Industry Association, or CBIA. It has about 75,000 members and covers about a third of the small employer market, with a choice of 25 plans.
This story originally appeared in Ctmirror.com.
SCSU, WCSU to collaborate on new academic program for 2012
HARTFORD — A new academic program that has been under study for some time has finally graduated to the real world.
The doctor of education in nursing degree was approved by the Connecticut Board of Regents for Higher Education earlier this month, making the course of study part of the state-system curriculum. The program will be a collaboration between Southern and Western Connecticut State Universities, with faculty from each used to establish and direct course work.
Administrators at the two universities “saw this need for creating educators to teach,” says Paul Steinmetz, WCSU’s interim associate vice president for institutional advancement.
“There’s a nursing shortage in Connecticut,” adds Bernard Kavaler, the Connecticut State University System’s assistant vice chancellor for public affairs. “We need more educators.”
The inaugural class of up to 25 students will begin course work in the fall of 2012. Students studying on a part-time basis are expected to take four years to complete degree requirements, which include 51 credits and hands-on teaching experience.
“It’s easier to do a full program with two schools working together,” Steinmetz says, adding, “We both have excellent resources and excellent faculty. There are more benefits, and we can offer a more robust program.”
All courses will be conducted online, giving degree candidates — many of whom will be working full- or part-time — greater flexibility, Steinmetz says. “We thought more people would be able to take advantage of it that way.”
While a Ph.D. (doctor of philosophy) degree is geared more towards academics and research, an Ed.D. is oriented more towards examining a subject area and applying knowledge from a practitioner standpoint, Steinmetz explains.
In considering new Connecticut State University System initiatives, says Kavaler, “We look to see if there is demand and interest for the program, if there is a need for the program in the state, and if there is a capacity to deliver on the program.” The Ed.D. in nursing program met those criteria “across the board,” says Kavaler, adding that a number of potential students already have expressed interest in the new program.
NEW HAVEN — Axerion Therapeutics is investigating potential treatments for neurological injuries and diseases such as Alzheimer’s using technology licensed from Yale University.
Axerion’s prion protein (PrP) project is developing a biological and a small-molecule approach to block the binding of amyloid beta oligomers to PrP in the brain to prevent brain dysfunction. The results could prove to slow or halt the progression of cognitive decline in Alzheimer’s patients.
The company’s Nogo platform, meanwhile, is developing treatments to re-grow axons, which play vital roles in neurological function. This potentially could restore function in patients with spinal cord injuries and other nervous-system disorders.
Annual costs of spinal cord injuries, stroke and Alzheimer’s disease in the U.S. is estimated at $228 billion.
Axerion was founded in 2009 by New Haven-based Scheer & Co. and Yale University, along with Yale faculty members Stephen Strittmatter and Sylvia McBrinn.
The biotech company’s efforts recently attracted a $400,000 investment from Connecticut Innovations Inc., which previously also awarded the company a $600,000 grant.
Peter Blume, MD
Affiliated Foot & Ankle Surgeons
Pioneering podiatric surgery — and saving diabetics’ limbs
“You’re going to lose your leg. Or, you can see Peter Blume.”
It may sound dramatic, but for diabetics faced with the bleak prospect of losing a limb, Peter Blume, MD might be their only hope.
The podiatric surgeon finds himself at the forefront of diabetic limb preservation and reconstruction, and has worked and traveled tirelessly to keep patients here and abroad standing on their own two feet.
Blume practices at Affiliated Foot and Ankle Surgeons on Blake Street, a practice started 54 years ago by his podiatrist father, James Blume, who still practices there at age 79.
His schedule is exhausting even to think about. He sees upwards of 50 patients at Blake Street three days a week, operates two days a week at Yale-New Haven Hospital, does the rounds there over the weekend, and teaches surgical residents. This is in addition to a massive amount of research and a long list of publications (current count is 119) that he and his team put out.
While evidence of his awards, certifications and recognitions are made visible upon entering his office, he speaks altruistically of his work, while a deep concern for his patients’ well being is evident in his speech.
“I do it all — bunions and basic foot surgeries, and arthritic surgery — but my excitement is in diabetic limb preservation,” Blume says. “You’re rewarded when a patient comes back and they’re walking in a shoe, and they have returned to a somewhat more stable life.”
After finishing his residency at Georgetown Medical Center in 1994 he decided to pursue a plastic surgery fellowship — not for the face, but for reconstructing extremities in those with diabetes or gangrene. It was an “unheard of” move at the time. Even 15 years ago, he said, treatment was relatively rudimentary and the amputation rate was high.
“I learned how to do skin grafting and flaps, and all sorts of reconstruction, and then applied those principles to limb preservation,” he says. “When I started, this whole process was quite limited. There were very few institutions that had limb teams.”
With staggering diabetes statistics — just over eight percent of the U.S. population now has the disease and more than 60 percent of non-traumatic lower limb amputations occur in those with it — the need is greater than ever. Up to 40 percent of Blume’s patients are diabetic. And while amputation is necessary for some, he views it as a last resort, since those that lose one limb are 50 percent more likely to lose the other within five years.
He relays the story of a train conductor patient, now on a hopeful path to recovery.
“He’s maybe 51 years old, and was told he was going to lose his foot. He’s got a wife and family; we’ve got to do something,” he says. “Our goal is to get him back to work. Otherwise, he can’t support his family, he’ll have to go on disability and Medicare and sit at home. He’ll be devastated.”
His use of an external fixating device called the Ilizaroff apparatus, which sets a patient’s foot in place with the aid of metal wires that pass through the bone (think of the spokes on a bicycle wheel), earned him the Ilizaroff Award of Excellence at the International External Fixation Symposium last year.
Blume traveled to Siberia, and later Greece and Italy to hone his skills with the device.
“I’m one of maybe two in the state that uses them at the volume I do,” he says. “I’m known in the community and the Northeast at large as the guy that does Ex-Fix and limb preservation. That’s my forte.”
This is evident by the number of referrals he gets from hospitals all over the region, even New York and New Jersey. While it might seem a no-brainer for these tools to be used more broadly, Blume says being centered at Yale provides the finances, manpower and skill set that other hospitals may not have.
“You have to remain at a big academic center — it takes a lot of hands,” he says. “I may have a colleague with me, then three residents. Someone has to hold the frame, then drill. It takes a lot, plus needing a team of residents and big staff to manage the diabetic problems, the cardiac issues and the vascular surgery issues .
“That’s why I like where we are,” Blume concludes. “I want to be in New Haven, because I get to see patients from everywhere.”
But the technological advances don’t necessarily make treating patients easier. Some of the biggest obstacles he’s faced with lie in an overall lack of education and attentiveness in some patients and the larger population.
Lifestyle and healthy eating habits are key, but with most his patients not even having sensation in their feet, detecting a problem becomes that much more difficult. Something as simple as checking your shoes to make sure you don’t spend the next few days with debris bruising your feet can make all the difference.
He often will have to talk with patients ahead of time to make sure they have an adequate support system at home.
“There are a lot of social issues that play a role here. We always say, ‘Don’t do the surgery unless you can do the post-op, because we don’t want a disaster,” he says. “The easy route is, we can cut your leg off. But we can save it. It’s going to take time and you have to work with me. I can’t achieve this on my own.”
He acknowledges all this is compounded by social and economic issues.
“Some people are just trying to work and stay afloat; the last thing they care about is how much they eat, and checking their sugar,” he says. “That’s why this isn’t just a disease, it’s a social issue.”
While government regulations and expanding insurance coverage make seeking treatment easier, Blume says he still treats some patients without insurance — including at a once-a-month orthopedic indigent clinic at Yale for no cost.
“It’s part of what we do,” he says. “Let’s just get you better.”
Blume has lent his expertise all over the world, and even visited Cuba last year to look at a breakthrough epidermal compound being developed there. Next spring he’ll lecture in China, where he says the meat-and-carbohydrate-centered Western diet is becoming more common.
Blume is determined to help his patients through the disease intact, and is all the more grateful to have the resources New Haven has to offer at his fingertips.
“We’re not just saying, ‘Hey, we do diabetic foot surgery and we’re really great, so you should come here.’ We put our heart and soul into it through research, education, teaching, and a comprehensive approach.”
Jeannette W. Connelly
Parish Nursing and Community Outreach Center
Cardiac Rehabilitation Center
A former heart patient helps heart patients — with lots of heart
When Jeannette Connelly enters a room full of heart patients at Griffin Hospital’s Cardiac Rehabilitation Fitness Center, her infectious smile and cheery attitude calms them down and makes them feel right at home and part of the group. She volunteers on Thursdays at the rehab center, where she has served for 11 years, and at the hospital’s Parish Nursing and Community Outreach Center for the past five years.
Connelly suffered a heart attack 18 years ago while working as an industrial engineering administrator at Sikorsky Aircraft, from which she retired in 1997.
“I began my cardiac rehab treatment here at Griffin Hospital and just fell in love with the place,” she recalls. “I joined the fitness center here and after a few years, I started as a volunteer.”
Her eight-hour-plus day begins at about 7:15 a.m. with morning exercises for patients at the cardiac rehab center. “Because I’m a former heart patient, I know what they’re going through,” explains Connelly. “So I talk with them, put their minds at ease, get to know them better and reassure them. We have a lot of fun.” She points out that there aren’t any televisions in the center so she relies on conversation and communication with the patients.
“Communication is the key,” says Connelly. “We all have a story to tell, and they tell me theirs. We may not get too deeply into it, but they want me to know what their experience with a heart attack was like because they know I went through the same experience they did.”
Connelly says the patients, who on any given day number between five and 15 out of a total of 50, talk about their children, what they did before retirement and what they want for the future. “I’ve had many friendships come out of my work here,” she notes. “It’s a great experience.”
Connelly plans and hosts several luncheons yearly for the center’s patients and works extra hours on hospital events when extra help is needed. “The husbands bring their wives and wives bring their husbands,” says Connelly. “We get about 40 people at each luncheon. So far, we’ve done 26 this year. It’s really been a good way to get to know people.”
“I know when Jeannette has arrived in the rehab center because soon afterward, I hear laughter coming from the room,” says Eunice Lisk, manager of cardiac rehab. “She puts people at ease. A lot of the people who come to the center have come for many years. At the same time, new patients enter the program gradually and that’s where Jeannette is really great. She welcomes them, makes them feel comfortable, answers their questions and shows them around. She explains the equipment and introduces the new patients to those who’ve been there a while. She’s a smiling, friendly face for them to see.”
Lisk says Connelly’s outgoing personality is a precious asset to the center. “New patients there are a little overwhelmed and have never been to a cardiac fitness center before. They’re oftentimes scared but Jeannette is always friendly, sweet and approachable. I think these traits are very key to making people feel comfortable. If she senses there is a problem with a patient, she’ll clue me in on it. She’s a great communicator.”
At the outreach center, “I do anything that the nurses don’t have time to do,” says Connelly. “It may be filing or copying one day, putting stamps on envelopes on another day — whatever is needed, I’m here to help.” And whatever doesn’t get done during the day, Connelly takes home to work on. “I spread it out on my kitchen table, finish what needs to be done and bring it back the next day.”
“She is the consummate volunteer,” says Daun Barrett, director of community outreach, for whom Connelly works at the Parish Nursing and Community Outreach Center. “She is phenomenal. She accompanies us on the [community outreach] van, handles registration for us and interacts with adults, children, everybody in such a kind and welcoming way.” The 32-foot van, which needs at least two people on board to operate, conducts health care-oriented visits at about 30 sites a month throughout the hospital’s service area.
Barrett notes that no job is too big or too small for Connelly. “You couldn’t pay her enough to do what she does for free,” she says. “We gave her a key to the outreach center because she needs to bring the work she does at home back there. That was her idea.”
Connelly has received the One Heart Touching Another volunteer award from the Women in Heart Disease committee, of which she is a member along with Barrett and Lisk. She also volunteers at the Orange Agricultural Fair and the Red Cross Bloodmobile.
In her spare (!) time, she reads mysteries, watches foreign films and travels. “And I go to lunch with friends whenever I can,” she adds, laughing. Connelly has two sons, two daughters and admits to being a doting grandmother to her only grandchild.
“We’re a community here at Griffin,” says Connelly. “If I were younger and looking for a job, I’d work at what I’m doing here as a volunteer. I have found it to be very rewarding. When I retired, I felt a lack of accomplishment. Then I came here and said, ‘This is what I’m supposed to be doing.’ I love what I do because it’s a good ‘people’ job.”
Cornell Scott-Hill Health Center
Cornell Scott-Hill Health Center provides life-giving care to an underserved population
The need for quality health care in New Haven’s underserved neighborhoods was dire in 1968, when the Hill Health Center opened as a much-needed community resource.
More than four decades later it’s just as vital to the city, if not more so, say administrators. The facility — renamed the Cornell Scott-Hill Health Center two years ago in honor of its longtime director — provides services for low-income populations that otherwise might not receive medical care.
“I don’t know how some folks would manage without the health center,” says Andrea Jackson-Brooks, president of the center’s board of directors. “It’s an unbelievable resource. Our main emphasis has always been access to quality health care. We don’t turn anyone away.”
Established as one of the first community health centers in the country, CSHHC provides comprehensive, quality health care at a sliding-fee cost.
“We are not a free clinic but we are required to have programs for the less able [to pay],” says Rob Rioux, director of community relations and corporate development. If the center did not exist there’d be “substantial” difficulties for various uninsured and underinsured populations, he adds.
From flu clinics to dental care to HIV-related services to help for the homeless, CSHHC aims to detect and fill community needs, says Rioux.
The concept of creating federally qualified community health centers to serve disadvantage neighborhoods evolved from the War on Poverty/Great Society policies of the Lyndon B. Johnson Administration. CSHHC was the first such health-care facility established in Connecticut, the result of a partnership with the Yale School of Medicine.
Today, in addition to New Haven, a total of 16 CSHHC facilities serve populations in West Haven, Ansonia, Derby, Seymour, Shelton, Oxford and Naugatuck. CSHHC is headquartered at 400 Columbus Avenue in New Haven.
Patients who need to be hospitalized are referred to Yale-New Haven Hospital or the Hospital of Saint Raphael in New Haven, or Griffin Hospital in Derby.
“We’ve had longstanding partnerships with those hospitals,” says Rioux, adding that the collaborations shatter a common myth equating community health centers with inferior care. For example, he says, “You see the same cardiologist [at CSHHC] that practices at Yale, so you see very, very high-quality [care] here.”
Services include internal medicine, OB/GYN, pediatrics, dentistry, nutrition, social work, psychology and psychiatry, to name some of the medical and health-related care options. CSHHC also has several school-based health centers and offers programs that include HIV/AIDS education and outreach, pregnant teen care, a child and family guidance clinic, a drug and alcohol detoxification program and a homeless shelter and outreach.
“Our goal is to help you become independent,” Rioux says.
That remains in line with the goal of the late Cornell Scott, the first CEO of CSHHC. Scott served in the position for 40 years before his death in 2008. Jamesina Henderson is now the center’s CEO.
“[Scott] was totally centered on the concept of a community health center,” says Jackson-Brooks. “He was responsible for situating it in the middle of the community. He was on the ground running with this. At the time, there were virtually no affordable, quality health services to a large segment of the community in New Haven.”
Scott began to helm CSHHC the same year he earned a master’s degree in public health from the Yale School of Medicine — a testament to his commitment, according to Jackson-Brooks.
“That’s how dedicated he was,” she says. Scott “had his finger on the pulse of everything going on with health care.”
In 1997 CSHHC won the Johnson & Johnson Community Health Care Crystal Award, presented each year for organizational excellence in meeting community health-care needs of the underserved. Some 33,000 patients (210,000 encounters) are served annually by the facility, which has a staff of 500 caregivers.
CSHHC is funded through a combination of federal, state and local grants, with additional revenue from service payments through Medicaid, third-party insurers and sliding fees charged to the uninsured.
However, the recession is taking its toll. This May 30 non-clinical employees were laid off to help address economy-induced threats to funding sources. Coupled with this development is the fact that health-care costs continue to be outside the means of a substantial number of New Haven-area residents.
“We are in a terrible state as far as health care is concerned,” says Jackson-Brooks. An expensive medical treatment “can wipe you out — if you’re fortunate enough to be able to pay for it. I think the situation is getting worse instead of better.”
In light of the precarious economic horizon, CSHHC probably will be looking to direct more of its efforts to fundraising, notes Rioux.
“We need to develop an annual appeal and let people know what’s happening here,” says Rioux. He notes that the number of people seeking health-care services at CSHHC has risen over the years, especially among the working poor and those who have dropped out of what used to be considered something of a middle-class safety net.
“We’ve seen an increase in utilization by people who traditionally might not have used our services. We’ve become an option for them,” Rioux says.
Despite the economic climate, CSHHC continues to press forward in its mission to serve the community, says Rioux. He notes that plans are in place to open a new Hamden facility in early 2012 that will center on primary care and family counseling. And structural and aesthetic improvements at existing facilities are ongoing, he says.
“One of the biggest changes we’ve undergone over the last few years us a rededication to the environment of care,” he says, citing, for example recent lighting, walkway and waiting room enhancements.
“We’re really demonstrating we want this to be a welcoming, warm environment for people,” Rioux says. “Even if it’s just the simple things — better signage or a new coat of paint — that matters as well.”