Friday, the state Office of Health Strategy gave final approval Yale-New Haven’s application to move primary care for over 25,000 low income consumers out of neighborhoods and shift them to the Cornell Scott and Fairhaven health centers for payment purposes. Under the final agreement patients would still be cared for by the same YNHH primary care clinical and administrative staff in a facility on Long Wharf owned by YNHH. The shift is planned for next summer. The move has been widely criticized by community members and providers since it was first publicly revealed a year and a half ago. The state asked multiple sets of questions about the plan over the 15 months that the application was under review. Community concerns include transportation barriers to the remote site, substantial new costs for uninsured consumers, lower access to services including prescriptions and family planning, even longer waiting times at current health center sites, reductions in the quality of care, higher ER visit rates for community health center patients, and costs to both the state and to uninsured consumers.
YNHH’s plan to address the community health centers’ sizeable charges for uninsured patients are unclear. Details on this are promised but the application’s approval is finalized. The transportation plan to get patients to the new facility will be evaluated by a YNHH-chosen entity, but the application is finalized. There are multiple education and evaluation provisions about other access to family planning services and a $10,000 payment to a community organization offering family planning services including abortion. YNHH will track complaints about access to prescriptions, financial assistance and transportation.
Concerns about significant new Medicaid costs to the state have not been answered. Community health center primary care reimbursement rates are far higher than the rates paid to community providers. In their application materials, YNHH predicted the shift in payment rates would save the hospital $8.3 million/year. Also after the shift, the two community health centers will receive over $1 million/year in extra payments from the controversial PCMH Plus program. YNHH is not the first Connecticut hospital to consider this financial scheme. YNHH is the sixth hospital in the state to shift payment for primary care clinics to community health centers but keep providing the same services with the same staff. This is the first proposal to move the site of care. The state has not evaluated how much this trend is increasing state spending. It is important to note that any promised improvements in care, including behavioral health, did not require shifting payments to community health centers.
Concerns were also raised about $68,665 executive bonuses paid by YNHH to executives at the health centers when the deal goes through.
Press on the move: