December 14, 2018

Transit drives response to primary-care plan

Photo | Liese Klein
Photo | Liese Klein
The crowd at a public hearing last month on the New Haven Primary Care Consortium.

Ride-sharing, more bus routes and a limited "hardship fund" are the answer to doubts about a new plan that would relocate Yale New Haven Health (YNHH) primary-care services to Long Wharf, according to documents submitted by the health system this week.

The documents came in response to concerns aired at public hearing held last month by the state Office of Health Strategy's Health System Planning Unit. The hearing and YNHH response are the final steps before the state rules on the system's application for a Certificate of Need on the proposed New Haven Primary Care Consortium. The state has 60 days from the close of the hearing — Dec. 12 — to rule on the application.

Under the consortium plan, YNHH would shutter primary-care sites on York and Chapel streets and Whitney Avenue and relocate its doctors and other health professionals to an existing YNHH facility at 150 Sargent Dr. on Long Wharf. Fair Haven Community Health Care and the Cornell Scott-Hill Health Center would manage the new site, enabling providers to get more state funding per patient under the centers' higher reimbursement rates.

Transportation issues were a primary concern at the public hearing, and most of the YNHH response was devoted to explaining ride-sharing plans and bus routes. A 60-page attachment detailed the consortium's plan to help bring all of YNHH's 25,000 primary-care patients — now served at sites near Yale-New Haven Hospital — to Long Wharf.

YNHH reiterated that a least two-thirds of its current primary-care patients drive to their appointments and will benefit from the 250-plus free parking spots at the Long Wharf location. Patients who rely on buses or walk to get care are scattered across the city, a survey found, so YNHH determined that a new shuttle system that had been proposed would be inefficient and add excessive wait time.

The consortium partners worked out a five-point transportation plan to address concerns. The plan would:

  • Create more free parking at Long Wharf to encourage patients to drive.
  • Add to a contract with Uber to provide accessible ride-sharing, funded by YNHH, for those living within 10 miles of the new center.
  • Expand Veyo non-emergency medical transportation access for those who can't drive and/or require accessible vehicles.
  • Advocate for more bus routes, more bus stops and more frequent bus service.
  • Continue to collect data and adapt transportation to meet needs after the consortium starts operations at the Long Wharf center.

Putting the new consortium under the control of the two community health centers will result in some patients paying higher co-pays for service, so YNHH also addressed financial issues in its response. By law the centers must charge some kind of of co-pay to those not covered by Medicaid, but Fair Haven and Cornell Scott officials pledged to adjust fee-waiver policies to accommodate those with no income or facing eviction, homelessness and domestic violence, among other challenges.

It's not as simple as asking YNHH to pick up the bill for poor patients, according to the response. Federal laws prohibiting paying patients from switching providers limit YNHH's ability to set up a "hardship fund," the document stated. "In order to avoid allegations of patient inducement," and to limit costs for other locations, the new fund will be limited and cover only those served by YNHH primary care in the three years leading up to the switch.

YNHH's response failed to address concerns raised at the public hearing about the consortium's claim to more state funding through its new reimbursement-rate structure.

The increasing share of taxpayer dollars going to hospitals is a major factor threatening the state's fiscal stability, according to outgoing Office of Policy and Management Secretary Ben Barnes. Barnes' remarks were reported by CT News Junkie. Speaking Thursday at the Connecticut Voices for Children's 18th annual State Budget Forum, Barnes said that major hospitals "have used their virtuous status to somehow strengthen their demand for resources that the state cannot afford."

Hospitals are a "group that gets what they want virtually all the time," Barnes said, adding that a 2016 lawsuit filed on tax policy by the hospital industry now in the courts could cost the state an additional $4 billion.

Contact Liese Klein at lklein@newhavenbiz.com

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