Sen. Chris Murphy pays a visit to Day Kimball

By Denise Coffey - Staff Writer
Putnam - posted Thu., Feb. 28, 2013
Dr. Raja Fattaleh shows Sen. Chris Murphy a medication cart while Donald St. Onge looks on. Photos by D. Coffey.
Dr. Raja Fattaleh shows Sen. Chris Murphy a medication cart while Donald St. Onge looks on. Photos by D. Coffey.

U.S. Sen. Chris Murphy (D-CT) toured Day Kimball Hospital on Feb. 22. With his recent appointment to the Health, Education, Labor and Pensions Committee, Murphy told DKH leadership that he wanted to learn as much as he could from them about the healthcare needs and concerns in northeastern Connecticut.

DKH Senior Vice President, COO and CNO Donald St. Onge led Murphy on a tour of the hospital's Burdick Family Birthing Center, the oncology unit and the emergency room. Later, during a roundtable discussion, DKH doctors shared their concerns about the impact the Affordable Care Act would have on hospital practices and procedures.

“What's happening is a double whammy,” Murphy said. “At the same time we've made the decision to transition our healthcare delivery system to something I think will be ultimately beneficial, it's painful, and there is no money to do it.”

An emphasis on primary care will be a cornerstone of the ACA, according to Murphy. By 2014, when the ACA rolls out, thousands of additional patients will move from being uninsured to insured. How those additional patients will be absorbed into the healthcare system is of critical concern. “That transition will be a little less stressful in Connecticut than other places because we've had a generous Medicaid system,” Murphy said. “I want to start the conversation now about what we can do at the federal level to continue your ability to broaden primary care so we are ready for 2014.”

DKH currently employs 70 primary care providers. That represents 80 percent of the primary care providers in this area, according to DKH President Robert Smanik. But DKH continues to have trouble recruiting. Part of the reason is geographic and part of it is the larger issue of reimbursements to PCPs. “We should have the courage to stand up to some specialty groups that have done very well throughout this crisis period of health care and say they need to share the wealth,” Murphy said.

A federal emphasis on primary care will help DKH maintain its local flavor, said Murphy - something DKH leadership stressed was crucial to the hospital. “When you put decision making in the hands of PCPs, it is very hard for that sense of control to leave the community. I think we've lost that over the years,” he said.

A paradigm shift with small community hospitals folding into large tertiary centers is one of the main challenges facing DKH, according to Nursing Director Ralph Miro. That shift is being encouraged by the ACA with its emphasis on Affordable Care Organizations. By their very nature, ACOs favor metropolitan areas where the aggregation of doctors is easier to accomplish. Partnerships haven't always been sustainable for DKH. A contract with the University of Massachusetts Medical Center failed to provide sufficient psychiatric care, so DKH severed the contract. “We thought we could do better on our own,” Smanik said. “It took us a while.”

Creating a system of ACOs is still 10 years out, said Murphy. “If you want to stay where you are, we have to work together to make sure you don't get hurt from a reimbursement perspective,” he said.  Staying independent will be challenging. There is a trend in Connecticut where for-profit hospitals are becoming the standard. Murphy is not a foe of big systems of care, though he doesn't like for-profit institutional care. Still, he has seen good models of care emerge. He mentioned Sharon Hospital in northwestern Connecticut.

“I think there is some inevitability with this,” he said. “Payments are going to force these decisions.”  He did promise to work on DKH's designation as a rural hospital, something DKH has been trying to get for years. “It's ridiculous that you aren't recognized as a rural hospital,” Murphy said. “You bear all the burdens of a rural hospital. That's something we can work on.” A rural designation would free up federal money that DKH cannot currently access.

Murphy also promised to help with DKH's IT challenges. Helping small hospitals build IT systems that are accessible to the community is a worthwhile investment, he said. “The only institution that can do that in a rural area is the acute care hospital,” he said. “The federal government can help.”

Murphy blamed the current crisis on an outdated system. “We haven't adjusted the public payment system because we're talking about Medicare and Medicaid pressures. I'm in it to ask tough questions,” he said. “People are living longer. Medicine is becoming more expensive and complicated. You are getting a senator who will try to challenge some of the structural deficiencies in how we fund health care. If we don't do that we're going to constantly be in crisis.”

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