Politicians in Washington could take a lesson from state elected officials from greater New Haven and the leaders at Yale-New Haven Hospital.
For almost 90 minutes last month, over breakfast in the East Pavilion special events room, state representatives and senators and hospital leaders discussed social safety net issues, decreases in Medicare funding, Medicaid eligibility, Saint Raphael integration progress and community needs.
Marna P. Borgstrom, CEO, YNHH and Yale New Haven Health System, welcomed the representatives to a breakfast that has become a productive annual tradition.
"We are all facing challenges. Health care is not affordable as it is currently provided and paid for. Self-insured employees — like Yale-New Haven and the city of New Haven — are struggling with the rate of increase in their healthcare rates," Borgstrom explained. "Those rates are rising more rapidly than employee use of healthcare services might suggest because Medicare and Medicaid under-reimburse hospitals and physicians. "The answers to the healthcare cost challenge lie in creating a better integrated system of care, lowering certain healthcare costs and more fairly apportioning reimbursement," she said.
Borgstrom talked about a number of the initiatives YNHH has taken to bring down costs and operate more efficiently in a challenging environment.
To continue providing high-quality, safe care, she noted that YNHH is working to:
- put patients in the most appropriate setting the first time
- reduce length of patient stay
- decrease readmissions
- enhance access to outpatient services
- decrease duplicative costs
- consolidate services and
- implement a system-wide electronic medical record.
"We must become more efficient if we want to continue to have a bottom line that allows us to make thoughtful investments, as we did with the construction of Smilow and the acquisition of the Hospital of Saint Raphael," she said. She then introduced Richard D'Aquila, president and COO, who spends part of every week on the Saint Raphael Campus.
"We are less than three months into integration and it is a wild and positive ride," he said. "On September 12, 3,497 HSR employees joined Yale-New Haven, creating one of the country's largest hospitals.
"For patients, the transaction has been rather seamless due to the effort of employees who make it invisible," he said. "It has given us critically needed beds and patients are now admitted directly to the Saint Raphael Campus from Shoreline Medical Center.
"We work with regional EMT services which decide where patients should go based on their acuity and where their doctors are," he explained.
D'Aquila noted that a renovated unit on SRC was opened in November and that this spring another unit will open — for a total of 58 new beds. He noted that each campus has an emergency department and expects each to continue.
"We would be overwhelmed by demands of people in crisis if the SRC emergency room were to close; we have no plans to close it," D'Aquila said. "We are conducting a study right now on patients who use the ED for primary care. We are waiting for recommendations on how we can better integrate primary care as demands increase so we can change this pattern of behavior."
The officials took the opportunity to ask Borgstrom, D'Aquila and other senior managers about a range of issues, including the need for psychiatric patient care, despite state cuts to funding; the role that health care in New Haven plays in economic development; the cost of care for undocumented patients; the shortfall in Medicaid payments; and the underfunded but important role of teaching hospitals.
Borgstrom noted that YNHHS is working collaboratively with clinicians to reduce non-valueadded services and standardize care throughout the YNHHS that will help contain costs. She also noted that the implementation of the Epic electronic medical record is an investment that is expected to pay off in terms of both costsavings and improvements to patient care.
Borgstrom and D'Aquila thanked their guests for their efforts to understand health care from the hospital's point of view and their support for the hospital. "These breakfasts are always productive because they help all of us better understand the issues and challenges we have and how we can work together to ease them," D'Aquila said.