Troubles Mount At Hill Health

by Thomas MacMillan | Oct 10, 2012 3:04 pm

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Posted to: Health, The Hill

Amid “very real concerns about our financial future,” the Cornell Scott Hill Health Center is instituting pay cuts and company-wide furloughs and canceling plans to open a clinic in Hamden, according to a confidential internal memo. Those decisions are laid out in a confidential memo distributed recently to staff. The memo paints a dire portrait of the organization, which has about 450 employees and runs 16 community health centers in and around New Haven. The memo states that Hill Health is in a difficult financial position compounded by a shortage of providers and problems with bill collection. Click here to read the memo. Meanwhile, Hill Health has hired local attorney Floyd Dugas to conduct an investigation into “a personnel matter.” Dugas said his probe stems from a lengthy letter of complaint about mismanagement submitted to the board of directors in August by Chief Operating Officer Stewart Joslin. Hill Health laid off 25 workers in February, after 30 layoffs last May. Rob Rioux, Hill Health’s director of community relations and corporate development, said he didn’t know anything about Dugas’ investigation. He described the current financial difficulties as “temporary cash flow issues” and said that he hopes more layoffs can be avoided. The center also currently faces several lawsuits from former employees for wrongful termination, workers compensation retaliation, and intentional infliction of emotional distress. One woman has accused Hill Health of “the unlawful receipt of millions of dollars in federal grants and reimbursements from Medicare and Medicaid.” Rioux said he had no information about these lawsuits but added, “I assure you it’s highly unlikely those things would be proven.” Jamesina Henderson took over as CEO at Hill Health three years ago amid a turbulent period following the death of founder Cornell Scott. Corrective & Specific The confidential memo, distributed to senior staff last week, consists of a bullet-point list of problems and proposed solutions. “These are critical times,” the memo begins. “We have very real concerns about our financial future.” The subsequent bulleted points include problems about “Access to Care”: “We continue to have a shortage of providers. We struggle to ensure people can be seen in a timely manner.” The memo also lists problems related to billing: “We’ve discovered issues with our internal controls and collections processes. We are struggling to collect what is owed to us and to correct rejected claims.” While the organization is looking for “continuity of care,” the memo states that less than half of the center’s over 900 new patients every month return for a visit within two years. The memo then lists a number of “Corrective Actions” followed by a set of “Specific Actions.” The corrective actions include general intentions regarding things like completing documentation “in a timely fashion” and findings ways to “improve customer service.” Among the specific actions: “• Our plan is designed to cut costs and increase revenues within the next 90 days. • First, the senior leadership team is taking a substantial reduction in pay. • Our plans to open the Hamden care site have been cancelled. • We will have a company-wide furlough of five days to be taken before December 20th. We will be asking all departments to reduce operational expenses by 15% • Our vacation payout program where you can exchange vacation days for cash is no longer an available option.” Rioux declined to say how big the pay cuts are. He said they are affecting 12 people in “senior leadership.” “All of us are taking sizable reductions,” he said. “Our promise” is to not even consider bringing the pay back up until Hill Health is on a better financial trajectory, he said. The furlough will affect all staff. Workers can take the unpaid days of leave non-consecutively, he said. As for the Hamden expansion cancellation, Rioux said that plan has been “on the drafting board for a number of years.” Hill Health didn’t get the federal money it was hoping for to pay for it, and the organization is now taking it off the table entirely, he said. Asked if more layoffs are likely, Rioux said, “We certainly hope not. But we won’t know until we get there.” He said he hopes the new plan will help Hill Health avoid laying people off. Threefold “Three things are driving this,” Rioux said of Hill Health’s “temporary cash flow issues.” First: “We still have a shortage of primary care providers, specifically in internal medicine,” he said. “We’re down about three providers.” The absences are part of a nationwide shortage of providers, he said. It’s difficult for Hill Health to attract primary care doctors and nurses. When the conversation turns to salary, “we’re at a disadvantage.” Without those staff members, Hill Health can’t see as many patients and collect the corresponding reimbursements. Second: Grant dollars have dried up. Grants are harder to get and pay for less and less, he said. Funders will pay for a position for a year and then pull the money, he said. Third: Hill Health is still struggling to implement an electronic health records system. That’s been a “major project” since last year, he said. “We haven’t gotten it right every single day,” he said. That has meant delays in claims collection, as mentioned in the memo. Take those factors together and “things are getting tight,” Rioux said. Asked about morale at the organization, Rioux compared it to the Hospital of St. Raphael as it struggled with financial problems before being acquired by Yale-New Haven Hospital. “It’s a tough industry,” Rioux said. “But the fact of the matter is all these issues can be solved and they will be solved. We’ve been here 44 years and we’ll be here another 44. We may not look the same. ... But nothing stays the same.”

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posted by: anonymous on October 10, 2012 3:14pm Given the funding stream, shouldn’t all salaries be public information? Can the Aldermen request this? Also, if the memo is “Confidential” why did you share it?

posted by: westville man on October 10, 2012 3:53pm Now would that be the same Floyd Dugas that produced the flimsy “investigative” report on Hillhouse HS? Very interesting that he would be hired. Some more dots need connecting here. Stay tuned.

posted by: HhE on October 10, 2012 9:16pm Westville man, exactly how was Atty. Floyd Dugas’s investigation on Hillhouse “flimsy?” I thought it was over priced, but not flimsy. Please explain.

posted by: NewHaven145 on October 10, 2012 10:30pm Hill Health has served a tremendous need in our community for many years and now the health care environment has changed. There are many providers that have created access for care in our neighborhoods. By closing some of the departments of Hill that have community Docs, Hill could survive and thrive with departments that are truly needed and not redundant. The leaders of Hill should look hard at their clinic and evaluate why some of the weak struggling departments need to stay open. Let’s focus on what will help the neighborhood.

posted by: SaveOurCity on October 10, 2012 11:52pm this is driven by a ‘shortage of primary care providers’....hmmmm…..isn’t this one of the main problems that we knew ObamaCare would create? By financially punishing doctors, thousands have quit or retired early and less are coming in to take there place. Pray for good election results and a repeal.

posted by: Brutus2011 on October 11, 2012 9:54am Hill Health is truly a wonderful community organization. In fact, I have often thought that if I were to make a stock market killing or win the lottery, I would donate a substantial portion of that windfall to Hill Health. It is interesting though that Atty Dugas is once again involved as an investigator in a city organization—recall the recent Hillhouse debacle. And, the former personnel director of NHPS now holds the same senior executive position at Hill Health. As to this person’s competency at Hill Health, I don’t know, but I do know that this person was the subject of litigation arising from job performance at NHPS. What is the point? I wonder just how inbreed the managers of the mayor’s administration are with important local community organizations. Another example would be the lawyer who served with New Haven Promise who then took a position at the local United Way. But then my best friend refers to me as “conspiracy brother,” so who knows?

posted by: PH on October 11, 2012 10:23am Uh, SaveOurCity, in what way can you imagine a Romney adminstration providing assistance to the poor, the sick and the needy? If you want to keep 1% more of your money and leave millions on the street dying, that is on your conscience. I, for one, hope that the Medicaid expansion is fruitful, that all citizens get the medical services they need and that the community health clinics are funded in a way that they can continue to serve our city. Sending people to the emergency room for health care and letting insurance companies squeeze us all for profits instead of services never has been and never will be the answer.

posted by: NewHavenGirl on October 11, 2012 12:21pm I’m a lifelong resident of New Haven. Love ‘em or hate ‘em, we know the “leaders” of this community. The New Haven community and the Black New Haven community. The people who are involved and invested in this city. Anyone who knew the name of the CEO of The Hill before reading this article wins the golden ticket. Who IS she? What organizations does she belong to? What church does she attend? What boards does she sit on? Can you pick her out of a lne up? Three years and she is still not involved in anything community related? She stepped into Mr. Scott’s shoes and did nothing with the links to community he spent his life developing. Seems like that would have been a job requirement for the CEO of a community health center.

posted by: westville man on October 11, 2012 1:20pm Hhe, while only tangential to the article, i will give you 3 of the many problems i have with his so-called investigation:

1. Two teachers indicate a student at issue attended all his classes. They then provide an attendance sheet confirming so. Dugas footnotes that the attendance record could be fabricated based upon his experience. He names those teachers in the report- they cant defend themselves from his allegation, which has no foundation in evidence.

2. 2 administrators, in addition to Carolina, indicate that the school no longer follows the “160 day rule” which Dugas admits is discretionary. While Carolina confirms this in an email, Dugas takes the word “temporarily” from the email to mean Carolina (and the other admins) lied to him about it, through torturing the word’s meaning.

3. When Carolina says there was a glitch or problem with the Tenex computer system, Dugas says that it’s clear that there was none. He then goes on for 3 pages trying to determine the PROBLEM with the system through various interviews with users and prgrammers, confirming several times that there was, indeed, a problem with it. He had it out for Carolina, that much is sure. I urge anyone who is truly interested in the issue to read the Power Point presentation rebutting the report- available through NHI in the article dated September 11, dealing with the issues.

posted by: NewHavenGirl on October 11, 2012 2:09pm Excuse me folks. Is Dugas the CEO? Is this really all about him? Does anyone care about the patients and staff of The Hill? Why is there a picture of Dugas here? Maybe even the Independent couldn’t find a picture of the CEO.

posted by: Sydney on October 11, 2012 2:37pm Rioux said there is a provider shortage. As a patient at the Hill, I don’t buy that. It seems like every time I get used to a doctor or nurse, they leave for another job. So it seems like they don’t have trouble hiring providers. They have trouble keeping providers. What is the leadership doing to stop them from leaving? Are they asking why so many are leaving? This sounds like a leadership problem to me. NewHavenGirl might be on the right track. Where is the CEO? And where is the Executive Board? Who is looking out for the patients and the employees?

posted by: anon123 on October 11, 2012 11:10pm About salaries, as a 501C Non Profit all salaries of directors, officers/chiefs, and key employees are public information on IRS filing form 990. For some reason CS-HHC has omitted this information in their last filing with exception to the CEO salary. CS-HHC might not be compliant with the IRS.

posted by: SaveOurCity on October 12, 2012 8:57am PH - The point is that more government is seldom the answer to our problems. It usually brings more. As an example, check out the problems with the money giveaways for Hurricane Irene. It appears that poor systems resulted in 50% to 75% of claims paid to be fraudulent. So, lost lost millions in extra $$ paid and will now spend millions on investigation and litigation. Is this the right direction? Contrary to the Obama talking points, the Romney -Ryan plan will get government out of the way so that people and organizations can be successful on their own. It would be nice to see people believe in the American Dream again. In my opinion, we are better off when people gain for themselves and their family via hard work rather than by either failure or being in the pocket of the party currently in power. As far as your comment about me keeping 1% of my money and this resulting in millions of people dying in the streets, you’ve lost me. Even if it were just a million, $500 (which is 1% of the $50,000 I will earn this year) will provide less than a penny to each of your one million starving people. Maybe you should check your math.

posted by: anotheropinion on October 12, 2012 9:04am A non-profit organization that consistently had a strong balance sheet has struggled for 3 years under leadership that has led to a mass exodus of its most seasoned and respected medical staff. But leadership alone can’t be blamed- a do-nothing board chaired by a politician who has controlled the governance reins for more than 20 years needs to be held accountable as well. What a shame for the patients and caring staff who find little recourse but to go elsewhere.

posted by: PH on October 12, 2012 2:15pm @SaveOurCity I’m not going to use a one-time emergency benefit situation (D-SNAP) when talking about Medicaid or Medicare. The fact remains that vastly more money is paid towards benefits and less towards overhead under both of these dreaded “government programs” than any private insurer (even excluding the private insurer need for profits). So while the abstract soundbite of an argument that “government is seldom the answer to our problems” may be your go-to, I prefer to look at the actual numbers that show Medicaid and Medicare to be far and away the most efficient and cost-effective health insurance programs in our country. As to your math. 1% of 9.8 trillion (total US income) is 98 billion. If we reduce taxes by even 1%, we forgo $98 billion. This would pay for a large percentage of our neediest Americans’ health care. So, while you may personally keep only $500 more, in the aggregate a 1% tax cut would dramatically limit our ability to ensure that millions would not be without healthcare, dying in the street. I stand by my math. And would note that R&R are far more likely to cheer for a far larger tax cut than 1%, particularly for their top bracket buddies. Finally, while my government benefits are primarily limited to tax deductions, I am not so short-sighted nor selfish to be unaware that many of our fellow citizens don’t have the access to education, resources and community that I have had and continue to have. For those people, having food on the table, a roof over their heads and a doctor for when they are ill should be a baseline from which they can then start to dream about moving up in the world. For a country with so much, this is something we should be able to provide to our neediest. I’m sticking with Obama, because we are all in this together, even if you can’t see that.

posted by: Brutus2011 on October 12, 2012 4:38pm Actually, “PH” 1% less of 98 trillion is 980 billion. Sorry, the teacher in me can’t let that go.

posted by: True that on October 13, 2012 8:39am Dugas is contracted so that he gets the client the desired result, irrespective of the truth. Why anyone would use him to do an impartial investigation is beyond me.

posted by: I wonder on October 15, 2012 6:36pm As an employee of CSHHC I want to thank The Independent for this story. It has been almost a week and we have not heard a word from our managers or leadership. This story was covered on local news and so many of us got calls from friends and family and questions from patients that we can’t answer. All we know is what we have read here, other than the fact that many of us will have to take unpaid leaves just in time for the holidays. We are not naive enough to believe the ‘no layoff’ story. We have been here before with the furloughs and layoffs.

NewHavenGirl, on layoff days, the CEO is as absent at CSHHC as she is in the community.

posted by: msconcerned Wow… These are critical times,” - not really these times are not critical any more critical to the population served than they were a month ago or 5 years ago. The population is still the same. The subsequent bulleted points include problems about “Access to Care”: “We continue to have a shortage of providers. We struggle to have a list of enrolled providers in NEW HAVEN,CT Medical Capital of the East Coast (okay I’m a little biased) The memo also lists problems related to billing: “We’ve discovered issues with our internal controls and collections processes. We are struggling to collect what is owed to us and to correct rejected claims.” 44 years and you have billing and collections issues that severe?? Medical Billing and Collections processes have and continue to be/are streamlined. While the organization is looking for “continuity of care,” the memo states that less than half of the center’s over 900 new patients every month return for a visit within two years. (A little inexpensive grass roots effort and a walk around the block (metaphorically and physically) to understand the same old dynamics are still at play would alleviate that or at least put a dent in the issue. The memo then lists a number of “Corrective Actions” followed by a set of “Specific Actions.” I suppose the list you provided is for the(general public)...

posted by: NewHavenGirl on October 17, 2012 9:36am If it is true that the CEO has not addressed this article and the report on the local news with her staff of 450, then that is very sad. Is it beneath her to speak to the “little people”? Can the Board make her at least pretend to care? What does the Board have to say in all this? Does anyone there owe answers to the community?

posted by: anotheropinion on October 17, 2012 10:27am NewHavenGirl raises important questions, but sadly, the Board has apparently sat by silently for the past 3 years of deterioration. The community at large deserves much more.

posted by: East Coast Lady on October 17, 2012 10:37am What’s up,with the number of lawsuits? How many of those are related to the CEO and her leadership style? The director of Community Relations is not factual when reporting information because clearly he has misspoken several times. Also, what is his role? Shouldn’t he be taking the advice of msconcerned and walking the neighborhood to bring people into this facility, especially with the financial problems they have identified???

posted by: I wonder on October 18, 2012 10:17am So anotheropinion, what is the solution? If the employees don’t feel like the Board cares about us or this center, and if the CEO clearly has no interest in us or in this community, what do we do? And that is an honest question because we really feel like we are swinging in the wind here. Yesterday, probably because of the comments here, we finally received an email from the CEO a full week after the NHI article. No one trusts what she says. We come to work every day, not sure if this is the day we will lose our jobs. People are resigning every other day. If you want to know stress, try coming to work every day totally unsure of your future, at an organization you believe in that is being run by someone who doesn’t see the value you know exists. It is heartbreaking. So seriously, if anyone has suggestions, please please please, send them.

posted by: anotheropinion on October 18, 2012 11:36am I wonder raises a good question.

Since staff feel vulnerable and fear retaliation, maybe anonymous letters to senior leadership and the members of the board would help- it at least brings the board into this first-hand. Mention what you think are the problems and propose solutions if possible. Also, let them know that next steps might include letters to funders or accreditation agencies. Keep the independent in the loop- it creates more public pressure.

posted by: NewHavenGirl on October 18, 2012 11:52am My Goodness! I feel horrible for I Wonder and for all those employees. Can you all appeal directly to the Board? Do you even know who the Board members are? I guess the thought of that is scary though, considering that you already fear for your job. This is tough. My heart goes out.

East Coast Lady, I feel the same about the Community Relations dude. There was a lot of double talk in that interview: “I have no information on the lawsuits BUT it is highly unlikely that those things would be proven”. Really? Also, since the CEO is MIA in the community, what is HE doing? Where is HIS presence in the community?

But back to the Hill employees, anyone have any suggestions? Other than going to the Board what can they do? Maybe a letter to the Board?