Public hearing on controversial YNHH primary care plan this week

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The state Office of Health Strategy (formerly OHCA) will be holding a CON public hearing next Wednesday November 28th at 3pm at the Parish House at Betsy Ross Arts Magnet School, 150 Kimberly Ave., New Haven, CT 06519. Yale-New Haven Hospital, together with New Haven’s two community health centers, Fairhaven and Cornell Scott Hill Health Center, plan to transfer YNHH primary care services from the current three hospital clinics to a new site, owned by YNHH, on Sargent Drive in New Haven. All staff and provider training at the current three sites will transfer to the new site. The clinics currently serve over 25,000 area residents, mainly Medicaid members. They also intend to technically transfer all patients from YNHH to the community health centers; the clinics will lease both the site and the staff from YNHH in an undisclosed agreement. So patients will technically become patients of the two community health centers, but will be cared for by the same clinicians and other staff in a less accessible setting. According to YNHH’s CON application, they expect to save $8.3 million annually raising Medicaid spending for the state. YNHH is not the first CT hospital to technically transfer patients to community health centers but continue their care by hospital staff and trainees. The cost implications to the state budget of these transfers are unknown. Medicaid rates paid to community health centers are much higher, often three times higher, than payment rates to private providers.  This CON proposes a significant increase in the number of patients seen each day by YNHH clinicians. In addition, as all former-YNHH Medicaid members will now be attributed to the two clinics for purposes of the controversial PCMH+ program, the state will incur an additional $1.2 million in annual costs approximately. Advocates are concerned that the three entities will now have an incentive to inappropriately reduce the costs of care for these additional patients. Additional concerns voiced by providers, community organizations and consumer advocates include significantly higher out-of-pocket costs for uninsured patients, transportation concerns and lack of access, increased crowding at current community health center sites, capacity at the new site to accommodate services and training, a cap on losses by the clinics which could reduce care, and large “bonuses” paid to clinic management upon competition of the deal.

 

OHCA’s concerns include:

  • The proposal’s cost implications to the state as a result of increased primary care going
  • to the FQHCs;
  • The FQHCs’ ability to accommodate future capacity increases;
  • Accessibility and quality of care concerns from members of the public regarding the
  • termination/transfer of services to the FQHCs; and
  • The continued availability of YNHH obstetrical and family planning services and the
  • Women, Infant, and Children’s Clinic program to the same patient population following implementation of the proposal.

 

For the full proposal and all associated documents click here for the CON portal. Currently the proposal, #32231 is at the bottom of page 3 (it may shift to page 4 soon). Click on View Documents at the right on that line for all documents. FYI—the original CON application is 570 pages.

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