As hospital systems grow in CT, rural patients lose services

Across the country, hospital mergers are changing the ways in which people access health care. Most hospitals are no longer independent but instead part of larger health systems that own multiple facilities. In Connecticut, two systems — Yale New Haven and Hartford HealthCare — are on the brink of owning more than half the 27 hospitals in the state.

In 2000, Connecticut had 23 independent hospitals. Today, the state has six.

Hospital consolidation contributes to service cuts

When hospitals merge, they decrease costs by cutting duplicative services. The Office of Health Strategy currently has three pending proposals to cut services. A spokesperson acknowledged the agency “is concerned with the number of the proposals currently filed to terminate services.”

Nuvance Health, which owns seven hospitals across western Connecticut and the Hudson Valley, has filed to eliminate the birthing unit at Sharon and terminate inpatient psychiatric services at Norwalk. Hartford HealthCare is awaiting final approval from the state to cut labor and delivery at Windham Hospital, about 40 minutes from Hartford.

But, those only account for the cuts formally on file with the state. In other cases, hospitals have made changes without seeking state permission.

Nuvance plans to replace the intensive care unit at Sharon with what's known as a progressive care unit, which can't handle the same complexity of care. According to physicians in the area, the hospital has already started transferring some patients in need of the most critical care — like Trotta's mother — to other hospitals, even though the change hasn't received state approval.

Others have effectively terminated services for years without approval by dubbing them “suspensions,” stating that they have no intention to permanently close the units. Suspensions, unlike terminations, previously didn't require state approval.

In March 2020, Gov. Ned Lamont issued an executive order allowing hospitals to temporarily shut down services to increase capacity for COVID patients. The order expired in May 2021, at which point any suspended services should have resumed. But at least two hospitals have not done so.

Under the waiver, Trinity Health of New England, which owns three hospitals in Connecticut, suspended birthing services at Johnson Memorial in Stafford two years ago. Services have remained shuttered ever since, but Trinity claims it will reopen the unit once it can find appropriate staffing.

OHS has opened an investigation into the suspension.

Prospect Medical Holdings, a Los Angeles-based company that owns 16 hospitals across the country including three in Connecticut, also took advantage of the COVID waiver. The company notified the state that it would shut down surgical services, among others, at Rockville General Hospital. As of February 2022, surgical services had not yet resumed, and OHS issued a $118,000 fine for the violation, which the company has appealed.

In emailed comments, a spokesperson for the hospital said that “certain services” have resumed and that the temporary suspensions at the hospital were “done in accordance with requirements set out by the Office of Health Strategy.”

The legislature just passed a measure that seeks to prohibit long-term suspensions by specifically defining a “termination of services” as any stoppage of service lasting more than 180 days.

Big changes in rural markets

Rural hospitals face a particularly complicated situation. Sparked by financial challenges, the pace of rural closures began accelerating in 2010 and peaked in 2020. Getting acquired by a large health system could provide a way for some to avoid permanent closure.

From the perspective of the health care executives, eliminating a financially struggling unit provides immediate cost savings. A service cut makes even more sense if another facility within the system provides those same services.

While regionalizing health care services in this way improves the bottom line for hospitals, it leaves patients farther away from the medical care they need, sometimes unexpectedly.

Today, only one of Connecticut's four rural hospitals remains independent — and it's not likely to stay that way.

Sharon, Windham and Johnson Memorial have been acquired by large health systems. And last year, Connecticut's last rural independent hospital — Day Kimball in Putnam — announced plans to become part of Covenant Health, a nonprofit Catholic system based in Knoxville, Tenn.

Service cuts have followed these acquisitions. The cuts would have a particularly devastating impact on the state's rural labor and delivery landscape.

If the suspension remains permanent and the proposed closures receive state approval, only one of Connecticut's four rural hospitals would offer birthing services. Windham and Litchfield counties would be left with one labor and delivery unit each, and Tolland County would have none.