Hospital mergers taking place over the last 20 years have made it difficult for some of Connecticut’s rural residents to get the care they need at their local facilities. COVID made it worse.
WSHU’s J.D. Allen spoke with CT Mirror’s Katy Golvala to discuss her article, “As hospital systems grow in Connecticut, rural patients lose services,” as part of the collaborative podcast Long Story Short.
WSHU: Most hospitals are no longer independent, but instead part of a larger healthcare system. What does the healthcare landscape look like in Connecticut?
KG: In 2000, most of the state's hospitals were independent. Today, that is not the case. Most of the hospitals in our state are now owned by a larger health care system. The two biggest ones are Yale New Haven and Hartford Healthcare, which I'm sure folks will be familiar with. And we're reaching a point where Yale is in the process of acquiring three more hospitals from another company. And once that deal goes through if it receives state approval, Hartford Healthcare and Yale New Haven will own more than half of the hospitals in the state.
WSHU: How do hospital mergers and acquisitions impact the health care services offered to patients?
KG: That is a good question. And there are many answers to it. But the one that I decided to focus on in the story was the way that when hospital systems get bigger, there do tend to be service cuts at the individual hospitals, which, you know, makes sense from the health systems point of view, if you own five hospitals around the state, some of them are pretty close together, maybe half hour, 40 minutes driving distance apart. From your perspective, your system does not necessarily need to have a labor and delivery unit at each one of those hospitals. It doesn't necessarily need to offer surgical services in each one of those hospitals. And so you might make cuts to some of those units to improve efficiency, save some money. And so that does have a big impact for the citizens who live around that hospital who had gotten used to going there for their birthing services, for their intensive care needs.
WSHU: So when we talk about ICUs, intensive care units, that's really important in the story of Bea Trotta, who you talk about your story.
KG: Yeah, so, Bea Trotta has lived around Sharon for her entire life. That's decades. And so she has gotten very used to what Sharon Hospital has meant to the community and what services she can come to expect from Sharon Hospital. And one night in February this year, her mother started experiencing difficulty breathing and exhaustion and she was taken to the ER at Sharon Hospital. And when Bea arrived to meet her there, the staff told her that her mother's needs were too complex to be handled at that facility, and that they could make her comfortable there, but if she wanted the treatment she needed, she would have to be transferred to a different hospital. That was extremely terrifying for her because she had come to expect that, you know, you go to Sharon's ER, and most of what you need done is going to get done at that hospital.
WSHU: Who feels the lack of these services because of hospital consolidation the most?
KG: When you look at rural populations that are most likely to have service cuts, it is disproportionately poor communities and communities with disproportionate populations of Black, Native American and to a lesser degree Latinx communities. Those rural communities are less likely to have services in the first place, and more likely to see cuts in services.
WSHU: So how do these hospital systems navigate state regulation and policy that is required to keep these services running? Or in some cases stay open altogether?
KG: Yeah, so we actually have quite a robust approval system here in Connecticut called the certificate of need process. So if a hospital wants to terminate a service, close the labor and delivery unit, for example, they have to apply for state approval through the Office of Health Strategy. In theory, the way this should work is that they have to apply for approval and they have to wait for that approval before they close the units.
That is not how it ends up happening in practice many times. So if we think about the hospitals in the story, for example, Windham Hospital owned by Hartford Healthcare, which has applied to close its labor and delivery unit, it applied in September 2020. But it stopped doing births in June of 2020. And they still haven't received state approval for the official closure of the unit.
WSHU: So there are other hospital systems that have terminated some services for years without approval through suspensions. Is this a case where a hospital has temporarily suspended something, a service for an amount of time?
KG: That is a little bit different in this situation because Hartford Healthcare is in the process of seeking state approval retroactively, which, theoretically is not the way the process is supposed to work. But they are seeking permission. There are other cases in which hospitals say, hospitals will terminate services for, you know, two years at a time but say, we don't have the intention to close these units permanently. So we're not going to apply for a certificate of need, because we're going to reopen them. This particularly became an issue during COVID. Because in March 2020, the governor signed an executive order that said, hey, hospitals, if you want to shut down certain units in order to make room to treat COVID patients, you can do that without going through this huge state approval process, because we know you need to get things done quickly. Then in May of 2021, the governor said this waiver is now over. So if you suspended services, get those services started back up again, please.
WSHU: So what can either the executive branch or the legislative branch in Connecticut do to make sure that suspended services get back on track?
KG: This is a hard problem to solve because there's so many moving pieces. But I think one important piece that the legislature addressed just this past session was these long term suspensions that weren't seeking state permission because they were saying, you know, these aren't closures. So now the state passed a measure that says, if you are not performing services for 180 days or more, that qualifies as a termination and you have to save state approval for it. So theoretically, these long term suspensions should no longer be able to happen.
