NMC Commentary

Can the Public Comment on the Proposed For-Profit Surgery Center?

Yes.  The Green Mountain Care Board, which regulates hospital budgets and oversees the Certificate of Need law (CON) for major healthcare projects, held a hearing last week regarding the unregulated for-profit ambulatory surgery center proposed for Colchester.  A number of leaders, business people, and providers from our area drove to Montpelier to express their opposition to this proposed duplication of services that ignores the open capacity already existing and the serious negative impact it would have on our local system of care.  The hearing was continued and public comment will be accepted through April 23 via an online form at: http://gmcboard.vermont.gov/board/comment/public-comment I hope you will join the voices speaking against the proposed center and in favor of local, integrated, high quality care from your community hospital.

I have made the point previously that Vermont’s hospitals are open to competition.  We face it every day.  The challenge in this instance is that the ‘playing field’ for competition is not close to level.  As the for-profit ambulatory surgery center works to skim off simple profitable cases, it will not have to pay Vermont’s 6% provider tax on hospitals (that’s $6 million in tax NMC pays); it will not be subject to State licensure or accountable to the State for quality reporting like hospitals; it will not be constrained by a cap on revenues like hospitals; and it carries no social mission to invest its revenues to improve the wellbeing of all in our community. The for-profit would have it much easier – and if we really want to go back to the competition approach instead of integration, it should at least be fair competition.  NMC can compete on a level playing field: our rate of infection is a fraction of the national benchmark; our patient satisfaction is above the 94th percentile; and our efficiencies continue to improve so that NMC’s ‘cost per adjusted admission’ was lower in 2016 than it was in 2014.  I am very proud of the care our team provides and we need to ensure that this level of local quality care continues  for our patients.

This is so important because this stand-alone facility would have a significant negative financial impact on Vermont’s smaller hospitals by skimming off the revenue for simple profitable procedures.  St. Albans Mayor Liz Gamache and Franklin County Industrial Development Executive Director Tim Smith spoke of the importance of a strong hospital to our community’s health, our local economy, and our ability to attract and retain strong employers.  The proposed ambulatory surgery center would draw General Surgery, Gynecology, Pain Management, and Orthopaedic procedures out of Franklin County. How concerning is that for our community?  The loss of just colonoscopies – one procedure of many – would mean a loss of $1 million annually for NMC.  The way the healthcare system is structured, it is still the profitable areas whose revenue funds care in the areas where reimbursement does not cover cost: addiction services, maternity care, wellness and prevention, etc.  We need these types of services to meet the needs of our community.  Dr. Katie Montagne, a physician born and raised in our community, spoke at the hearing and followed up, at the GMCB’s request, with additional written comments.  In her written comments, she spoke to the applicants’ assertion that Pediatrics in our community had been threatened “due to Medicaid payments.” She pointed out that what the applicant did not say was that Pediatrics in our community was stabilized and is now strong again because NMC had the financial resources to “jump into action” and keep the practice viable through employment of the physicians in the face of low reimbursements for Pediatric care. Skimming off surgical revenue threatens that kind of maintenance of access to necessary services.

Dr. Montagne also reiterated the fundamental facts of the hearing – the lack of need for additional operating and procedure rooms. Both NMC and the University of Vermont Medical Center have demonstrated to regulators that they each have significant available capacity without the expense of new construction.  A study by national experts Kaufman Hall was shared with regulators that showed that the region has very strong capacity that will carry Vermont well into the future.  Local business leaders (and volunteer hospital Board members) Jake Holzscheiter and John Casavant and Dr. Lowrey Sullivan stressed the importance of taking a systems-view of this proposal. Paying to duplicate existing available operating rooms is a significant added expense to the system that is typically ignored in the promises of lower prices for some patients.

I am proud of NMC’s efforts to work with Vermont’s other not-for-profit hospitals and regulators and insurers to move to an integrated system where providers are paid to keep patients well – not paid fee-for-service every time they see someone. As hospitals we need to also make sure we are focused on reducing cost that translates to lower premiums to you.  We are committed to and demonstrating just that.  Your voice matters.

— Jill Berry Bowen, NMC’s Chief Executive Officer