Multiple vaccine dates? It’s possible
A quirk of Connecticut’s decentralized vaccination appointment system means that one patient could make many appointments with different providers, a scenario that has state officials hopeful that people will cancel appointments once they've been vaccinated.
“Unfortunately, that is the case that individuals can potentially make appointments on more than one scheduling platform,” said Maura Fitzgerald, a state Department of Public Health spokeswoman.
On Monday, about 600,000 people in Connecticut will become eligible to be vaccinated against COVID-19, including everyone over the age of 55, plus all teachers, educators and
people who work inside schools.
Any one or all of those 600,000 people could, theoretically, make an appointment using YaleNew Haven Health’s platform, and the site managed by Hartford Healthcare, Nuvance, CVS and Walgreens.
“There’s no centralized scheduling process,” said Ohm Deshpande, vice president for population health and a physician leader for Yale New Haven Health’s vaccination program. “The state has had something called VAMS, which obviously has not fully met the need.”
Cornelius Ferreira, system chairman of primary care at Danbury-based Nuvance Health, leading the Nuvance Health Vaccines Task Force, said it’s an attempt to make sure patients actually get an appointment.
“Individuals do sometimes schedule multiple appointments at different sites out of fear they will not get a vaccine,” he said. “We encourage folks to schedule one appointment only and to return to their first dose site for their second dose.”
But the ability to schedule multiple appointments isn’t necessarily a bad thing, Fitzgerald said. It means that people will be better able to make appointments. It means there is no centralized system that can crash, that there won’t be a bottleneck on the user side.
As long as people cancel their appointments when they decide to keep one.
“We would hope people who are shopping around for convenient times and locations would keep their fellow residents — who are also trying to secure appointments during a time when our supply of vaccine is dwarfed by the demand — in mind and would kindly cancel appointments that they don’t intend to keep so that other people can fill those slots,” she said.
Deshpande said Yale has maintained a philosophy to “waste no vaccine,” so when people do miss an appointment — perhaps because they’ve made another appointment elsewhere and failed to cancel — staff members hit the phones.
Other patients, whose appointments might not be for days or weeks, are often “thrilled” to come in for the shot that day, Deshpande said.
“We’ve been wasting pretty much nothing,” he said.
Though one patient making multiple appointments is an issue, it’s not a crippling one.
“It’s not something that is of such epidemic proportions that it impacts the process,” Deshpande said.
On the other hand, states that have fully centralized vaccine appointment systems have had some significant issues.
When Massachusetts allowed residents older than 65 to make appointments, the state’s vaccine finder website crashed. David Eaves, a lecturer of public policy at Harvard Kennedy School, said while that wasn’t predictable, it’s also not rare.
“This outcome is more common than one would think,” Eaves told the Harvard Gazette. “What is particularly challenging is that government is still wrestling to acquire the new skills and processes the organization needs to launch a service.”
Similar systemwide crashes and “latency issues” caused by demand were seen in Georgia, Indiana and Tennessee, among other places.
When the city of San Antonio, Texas, opened up
appointments in January, 9,000 people signed up within six minutes. The centralized system did not crash, though officials were not prepared for that level of demand.
“The registration system worked as designed, but there is far greater demand than available supply at this time,” San Antonio Assistant City Manager Colleen Bridger said in a statement.
Though the state’s system
is not centralized, Connecticut health care providers are working toward a solution in the coming weeks that will bypass any potential overload.
Many of the providers offering COVID-19 vaccinations use a medical records management system called Epic, which Deshpande said “allows for interoperability through separate health systems.”
So when a patient makes
two appointments with separate health systems — with Yale and CVS, for example — the providers will be able to see that and decide which appointment stays on the books.
The goal, Deshpande said, is to minimize the possibility of a no-show, though the system is not yet ready to handle that application.
“I think we’re still in the process of integrating that data,” he said.
WINDSOR LOCKS — Bradley International Airport’s operator is advocating for state legislation that would allow it to change its non-union employees’ retirement plans in an effort to save millions of dollars as it grapples with the financial disruption unleashed by the coronavirus pandemic.
The Connecticut Airport Authority wants to give approximately 30 non-union employees the option to withdraw from the state retirement system and join defined-contribution plans and put future non-union hires in those accounts. Those changes could initially save up to $1.25 million per year and eventually up to $3 million annually, according to CAA officials.
“Despite hiring freezes, significant budget cuts and withholding salary increases that were due to personnel, we still have a number of financial issues,” Kevin Dillon, the CAA’s executive director, said while testifying Feb. 19 in an online meeting of the state legislature’s Transportation Committee. “As we look toward recovery from the pandemic, costs will be everything to any airport across the airport . ... The airlines are very focused on our costs.”
Financial pressure
Windsor Locks-based Bradley’s passenger traffic in 2020 plunged 64 percent from 2019, to a total of about 2.4 million travelers, reflecting the global drop-off in air travel during the pandemic.
Due to a corresponding decrease in airline landing-fee revenues, fewer passengers parking and frequenting concessionaires and some tenants seeking lease relief, Bradley’s finances have become “increasingly tenuous,” Dillon said. In the fourth quarter of the 2020 fiscal year, Bradley’s revenues finished $10 million under their projected amount.
At the same time, the financial pressures have led to the airport deferring nearly $23 million worth of capital projects, according to Dillon.
“After the pandemic subsides, airports will be competing against each other to attract airlines and regain the services that have been lost over the past year, and that competition will take place in the context of a shrinking pool of airline assets,” Dillon said in written testimony submitted to the Transportation Committee. “Given the financial pain that has been experienced across the industry, the ability to attract airlines will increasingly hinge on presenting the best possible business case to our partners in the airline industry.”
While the CAA’s operations are totally funded by its revenues, it functions as a quasi-public agency. Its approximately 150 active employees — most of whom are based at Bradley — participate in the state retirement system, which covers state employees and public-school teachers. The state system largely comprises pension plans.
CAA officials said that their organization is shouldering a heavy burden in its employee-benefit contributions to help the state make up for years of retirement under-funding. In total, Connecticut faces more than $40 billion in unfunded retirement liabilities.
For “non-hazardous duty” employees, the CAA’s benefit rate totals 95 percent of those employees’ base salaries. Retirement-related costs account for about twothirds of those benefit obligations, according to the CAA.
“It is important to note that our employees do not even experience the benefit of these high rates. The rates are driven by legacy costs that accumulated over decades of the state not properly funding its pension system,” Dillon said in his written testimony. “Although the legislature has made major strides in recent years with … the movement towards a hybrid definedbenefit/defined-contribution model for newer employees, the gravity of the system’s legacy costs will continue to ensure very high benefit rates into the future until the system’s unfunded liability is more under control.”
Implementing a defined-contribution framework would result in the CAA significantly reducing its allocations to the state retirement system that are made through the benefit payments to nonunion workers. That change would produce initial annual savings of up to $1.25 million and eventually up to $3 million annually, according to the CAA.
For the non-union employees, the CAA is proposing a defined-contribution system comprising plans that would essentially function like 401(k) plans. The CAA would contribute 8 percent of non-union workers’ salaries to those accounts.
Current non-union employees would choose whether to stay in the state system or set up a 401(k) plan. All new employees at a certain point would join a 401(k) plan.
For the most part, management positions comprise the non-union workforce. As executive director, Dillon is not unionized and already participates in a 401 plan through his own contract.
Airlines for America, the U.S. airline industry’s principal trade and service organization, has endorsed the CAA’s plan.
“Higher airport costs discourage airlines, especially low-cost carriers who largely transport leisure travelers, from growing their service at a particular airport,” Sean Williams, Airlines for America’s vice president of state and local government affairs, said in a Feb. 18 letter to the committee. “Reducing costs, particularly in this extremely challenging economic environment, will be paramount to the future growth of Bradley International Airport.”
Legislators’ lukewarm response
Transportation Committee members were noncommittal during the Feb. 19 meeting about whether they would support legislation allowing the CAA’s proposed changes. They did not vote during that meeting on House Bill No. 6426, the bill that the CAA has suggested amending to incorporate its proposal.
“A unilateral change that we might make to benefit the Airport Authority would necessarily have impacts more broadly to state pension funds and collective-bargaining agreements,” said state Rep. Roland Lemar, D-New Haven, the Transportation Committee’s chairman. “We didn’t think it was appropriate for the Transportation Committee to take this one issue up in isolation. That’s why we refrained from taking it up on its own because there are much broader impacts to it than just the Airport Authority.”
Some committee members noted that even if its plan were implemented, the CAA would have to keep contributing to the state retirement system.
“I want Mr. Dillon to understand he will still have the responsibility of all the people that were hired by the Airport Authority that are being paid pensions,” said state Sen. Cathy Osten, D-Norwich. “That will still sit on his books.”
The CAA is not seeking to change the retirement plans of its other approximately 120 employees, who belong to statewide unions. Any modifications to their retirement benefits would require their unions’ approval.