After 35 years as an oral surgeon, Dr. Arthur Wilk closed his practice in Clinton following “daunting challenges” caused by the COVID-19 pandemic. In Darien, Dr. Cecile Windels sold her pediatric practice to a hospital health system after enduring significant income losses. They are among thousands of physicians and other health care professionals across the country who have made coronavirus-prompted career changes such as closing practices, joining larger health systems and retiring early. The reasons for the moves vary from declines in income due to fewer inpatient visits to increased operational costs for personal protective equipment (PPE) and fears of contracting the coronavirus known as SARS-CoV-2. Health care advocates say the changes will exacerbate physician shortages, further erode the existence of private practices, decrease patient choice of doctors and obstruct continuity of patient care. A January report in Health Affairs, a peer-reviewed journal of health policy research, said: “Consolidation tends to lead to higher prices without strong evidence of quality improvements.”
“The national trends are definitely happening in Connecticut,” said Dr. Gregory Shangold, president of the Connecticut State Medical Society.
HUSKY members in a person-centered medical home (PCMH) practice are more likely to get recommended preventative health services and less likely to visit the emergency room, according to Department of Social Services (DSS) data. A PCMH is a medical practice that provides comprehensive and coordinated care. That can mean helping a child get an appointment with a behavioral health clinician; making sure a patient’s apartment is free of asthma triggers; and many other services hard to get in time-crunched primary care offices. Medical homes must also provide a high level of accessibility through measures like extended hours, electronic or telephone access or rapid appointment scheduling. The state instituted HUSKY PCMHs in 2012 with an eye toward improving care for patients with chronic conditions, according to Kate McEvoy, director of the Division of Health Services at DSS.
Connecticut consumers were billed for more than $1 billion in facility fees for outpatient services in 2015 and 2016, documents filed with the state Office of Health Care Access (OHCA) show. Twenty-two of Connecticut’s 30 hospitals charged these fees, bringing in $600.7 million in 2015 and another $488.8 million in 2016, according to an analysis by Conn. Health I-Team. The state’s two largest hospital systems, Yale New Haven Health and Hartford HealthCare, accounted for almost half of the total facility fee revenue in 2016. Yale and its four hospitals billed $144.3 million; Hartford and its five hospitals, $80.9 million.
Hospital administrators in Connecticut who have been involved in the unprecedented streak of mergers and consolidations often tout the financial benefits and efficiencies of such moves. But as the number of independent hospitals in the state dwindles – with more than half of the 29 acute-care hospitals now operating in networks with other hospitals or out-of-state partners – experts and advocates worry that the consolidations will reduce competition in the market and give hospitals more leverage to raise prices. Adding to their concerns is a proposal by a private company to convert four non-profit hospitals to for-profit entities. Several studies, as well as data from the federal Medicare program, suggest that mergers and for-profit conversions may lead to higher prices. But the state has yet to study the impact of mergers on patient pricing, and has no requirement that hospitals try to hold patient charges steady after a merger or conversion. The state also has no comprehensive blueprint guiding hospital configuration or limiting the number of takeovers or networks it will allow.
Connecticut seniors on Medicare are more likely to take sedatives for insomnia and medications for depression than their counterparts across the country, according to a new report by Dartmouth researchers. An analysis of state data in a national report by the Dartmouth Atlas Project also shows that Connecticut’s Medicare program relies heavily on brand-name drugs, versus generics, especially in wealthy towns in Fairfield County – a factor that could be contributing to the state’s ranking in the top 10 nationally in prescription drug spending per patient. Connecticut seniors spent an average of $2,795 on medications in 2010 – 45 percent higher than the lowest-spending state, Minnesota, and the highest rate in New England. The new report provides an in-depth look at how prescription drugs are used by Medicare beneficiaries, age 65 and older, in the program’s Part D drug benefit, which had 37 million enrollees in 2012. It shows wide variations in the use of both effective and risky drugs among the 306 regional health care markets across the U.S.
While the underlying health status of populations is a factor in prescription drug use, “it really does not explain the variations in drug use intensity that we observed,” said Dr. Nancy Morden, a lead author of the study.
Connecticut was among 29 states nationwide to earn an “F” from health advocates for lacking consumer-friendly laws that help residents compare actual prices for health care procedures and services. “There is no public resource in Connecticut that makes (comparison) pricing information available to consumers. That means there’s no consumer protection against egregious pricing behaviors by providers,” said Francois de Brantes, executive director of the Health Care Incentive Improvement Institute in Newtown, which partnered with Catalyst for Payment Reform to publish the “Report Card on State Price Transparency Laws.”
The Report Card’s scores reflected a state’s overall legislative effort toward health care price transparency, with states that post price information on a public website receiving more points than those that release a report or provide data to consumers only upon request. The organizations that developed the report card are nonprofits that support payment reforms to increase the quality and value of health care. Ellen Andrews, executive director of the Connecticut Health Policy Project, said, “The score is totally warranted.
It’s time like these when I miss Jennifer Jaff the most. Jennifer was the executive director of the Farmington-based Advocacy for Patients with Chronic Illness, Inc., and a member of an advisory committee that is helping build the state’s health insurance exchange, the online marketplace for people buying insurance as mandated by the Affordable Care Act. When Jennifer died in September – she’d been living with a variety of ailments, including Crohn’s disease — she left a huge hole in the state’s safety net. Her board is holding a memorial service for her on Dec. 9 at Hartford’s Old State House, and if just a small portion of the people she helped show up, the building won’t be big enough. We need her now, during the state’s organization of its exchange.