Windham Hospital is facing significant job cuts and service reductions – needed changes, officials from its parent company say, to help the financially struggling hospital survive in a rapidly changing health care market.
But the magnitude of the potential cuts has drawn concerns about access to care for residents of an area with significant poverty and poor health outcomes, where transportation options are limited and hospitals are farther apart than elsewhere in Connecticut.
“This is really going to put a lot of patients in jeopardy,” said Arvind Shaw, CEO of Generations Family Health Center, a Willimantic-based community health center. “Most of this community depends on public transportation and walking, and for them to be able to say, ‘Oh you need to go somewhere else to get your services,’ it’s a huge hardship.”
The potential cuts have also raised concerns among those worried about the growth of large hospital systems like Hartford HealthCare, the parent company of Windham and four other hospitals. While some hospital officials contend that joining larger organizations is key to ensuring small community hospitals survive, some critics see the potential Windham cuts as a sign of the pitfalls of consolidation – including decisions that aren’t made locally and the potential for erosion of services.
“The situation at Windham Hospital reflects the fears that we’ve been worried about as a legislature in the past couple of years, when you see this consolidation in health care and hospitals being run by very few health care organizations,” said Sen. Mae Flexer, D-Killingly.
Flexer said she’s particularly concerned because Hartford HealthCare is now in talks with Putnam’s Day Kimball Hospital and worries that if it joins the network, there could eventually be only one major hospital in Eastern Connecticut.
Hospital officials offer a different take. Being part of a larger system has helped Windham Hospital survive amid years of financial losses, spokesman Shawn Mawhiney said. The hospital is one of two in the state that has posted negative margins for each fiscal year since 2009. According to Hartford HealthCare, the hospital is projected to lose $8 million this fiscal year, the equivalent of $11,000 per day.
The potential changes – including cuts to the critical care unit and reducing the number of inpatient beds from 87 to 32 – are intended to ensure the hospital adapts to a health care market in which hospitals are projected to have fewer inpatients, Mawhiney said.
“First and foremost, what we’re trying to do is keep Windham Hospital’s doors open,” he said. “The reason we’re doing this is to avoid closure. We want Windham Hospital to be there for the community for many years to come, and in order to do that, Windham needs to be transformed into a different kind of health care organization.”
What would that look like?
Hartford HealthCare officials have described the Windham of the future as offering “cornerstone” services – like emergency medicine, cardiology, oncology and short-stay inpatient care – while functioning as a “gateway” to the health care system. In some cases, patients would get more complex services at other facilities.
What would be lost?
Hartford HealthCare hasn’t released definitive plans or sought state permission for any changes that would require regulatory approval. But a June 23 notice to staff listed significant changes, including:
- reducing beds from 87 to 32;
- no longer offering complex inpatient surgery or critical care unit-level care;
- eliminating the sleep lab and clinic and radiology school;
- moving the general surgery and wound care clinic to another part of the health system;
- downsizing and regionalizing community benefit and support services, including nutrition and diabetes services;
- cutting 119 positions, part of 418 being eliminated throughout Hartford HealthCare.
The cuts are part of a broader set of changes to the system that officials attributed to state and federal funding cuts, declining inpatient volume and increased competition.
The prospect of changes to the critical care unit has drawn particular criticism. Some say not having that service as a backup could make doctors hesitant to perform even routine procedures at the hospital.
Mawhiney said Wednesday that the hospital is not planning to eliminate critical care entirely. The 12-bed unit averages two to three patients per day who need critical care services, with other patients who require other levels of care, he said.
“We are working on a plan that would enable us to provide critical care, but we just need to be able to provide critical care in a different way,” he said.
Mawhiney called the plans “a work in progress,” and said it would be irresponsible not to consider changes in the face of financial struggles and a changing health care landscape.
“There is the reality that community hospitals can’t be everything to everyone,” he said.
Windham isn’t alone, but is it different?
Windham isn’t the first Connecticut community to face hospital changes.
But those in Windham say Eastern Connecticut is different than other parts of the state. It has fewer hospitals and limited public transportation.
“I think everyone gets that health care is changing dramatically right now, but if people want to talk about the consolidation of hospitals, this shouldn’t be happening in Eastern Connecticut, where people have less access to transportation, where they have less money,” Flexer said.
“There are heavy-duty transportation issues facing people in the Northeast Corner of the state,” said Lynne Ide, a Windham resident who chairs the Generations health center board and serves as director of program and policy at the Universal Health Care Foundation of Connecticut. “If one thinks that you can easily get into Hartford if you’re a family member of somebody who’s been transferred there, people should take another look at when the buses run.”
Ide said she’s not suggesting that hospitals must remain exactly as they are.
“But somebody should have an idea of what actually is needed, and it shouldn’t just be motivated by profit,” Ide said. “I understand that they’re having to run something based on some sort of bottom line, but in essence, a hospital is more than a bottom-line thing. It is a public trust, a public good that is there to meet the needs of the communities that it serves.”
Shaw, the community health center CEO, pointed to the health status of the area. Windham County ranks worst in the state in premature age-adjusted mortality, a commonly used measure that reflects the rate of residents who die before age 75. The county also has the fewest primary care physicians per resident – one for every 1,867 people, compared to an average of one per 1,190 statewide.
“This is not improving health care,” Shaw said of the potential cuts. “This is not improving outcomes. This is not improving the health status of these patients.”
Through the lens of consolidation
When Windham Hospital joined Hartford HealthCare in 2009, people in the community were told it would help the hospital survive, and that Hartford HealthCare’s deep pockets would help shore up the hospital, Shaw said.
And Matt O’Connor, a spokesman for AFT Connecticut, which represents workers at Windham Hospital and is involved in bargaining over the changes, said there were promises that community access to care would be maintained – which he said won’t be the case if the cuts occur.
O’Connor acknowledged that the hospital might still face tough choices if it were independent. But he said it’s hard not to view the system’s actions through the lens of consolidation.
“My sense is that there would be more of a community conversation, more of a dialogue, more of a process of incorporating local leadership input and local stakeholder input,” if the hospital were locally controlled, he said.
Mawhiney said being part of a larger system has helped Windham Hospital access capital, open family health centers, make investments in the birthing center and recruit physicians.
“If it weren’t for the affiliation with Hartford HealthCare, it would be hard to say where Windham Hospital would be today,” he said.
Executive pay
Critics of the cuts have taken aim at the pay of Hartford HealthCare officials.
Federal tax filings show that Hartford HealthCare CEO Elliot Joseph received $2.1 million in compensation in 2013, the last year for which information is available. David Whitehead, president of Hartford HealthCare’s East Region, received nearly $1.1 million.
During a press conference last month, Rep. Gregg Haddad, D-Mansfield, suggested an alternative to the service and job cuts.
“If you want to save $11,000 a day, then you can cut the executive compensation of just three executives,” he said.
Haddad said Wednesday that the comment was “a little bit tongue-in-cheek,” but added that “it’s not altogether out of touch with what I think average folks think about what should be happening here.” He questioned why pay should be so high for executives leading a system with a hospital that runs a deficit.
Mawhiney said executive compensation reflects the market, and is subject to board oversight.
“Although it sounds like a lot of money, in the overall scheme of things, even if they worked for free, there would still be very large deficits to make up,” he said.