Does Vermont Need a For-Profit Ambulatory Surgical Center?

This is a tough question, as I always want patients to have access to high quality lower cost care.  In thinking through this response thoughtfully and not emotionally, my answer is no, there is not a need for the proposed for-profit ambulatory surgery center.  Vermont already has appropriate surgical capacity at every hospital in the state.  Duplicating our communities’ existing resources with additional costly infrastructure is not wise, even in light of promises of lower prices for selected procedures.  Instead, Vermont’s regulators, physicians, and hospitals must continue to work together on integrated healthcare reform and create further cost-saving efficiencies within our existing not-for-profit hospitals which already have the surgeons, staff, equipment, and facilities for ambulatory surgery. That being said, as hospital leaders we need to step up our work to create a more efficient surgical system. 

This is a noteworthy and challenging time for Vermont’s hospitals. We are helping to lead a fundamental transformation of how Vermonters are cared for and how providers are paid for that care. When it comes to health care reform, new proposals must always be considered in light of our shared goals: ensuring that every Vermonter is covered and has access to health care they can afford from the hospital and doctor of their choice.  We know that every change has an impact somewhere, on a patient’s care or a family’s finances. Ideas that make sense at first glance often have unintended or hidden consequences. The current well-funded campaign to win approval for a new for-profit ambulatory surgical center is a great example. It is being marketed as a quick fix to our state’s affordability problems, but in truth it is shortsighted, and would move health care reform and care for Vermonters backward.

I am very concerned about what this proposed facility could mean for the cost of care and access to critical services for Vermonters. We have felt the negative impact of the for-profit eye center that duplicates our resources and has its patients traveling for care we provide here.  Let me be clear – the new proposal will not bring more doctors, such as primary care physicians, to underserved communities in Vermont like our own. It’s about a new building to duplicate services where there is no clear need and ultimately higher costs for Vermonters.  It’s a profit-driven approach to propose a lower price for a few select simple services – not a good faith effort to join the complicated work of bringing down health care costs across the board.  

As a hospital CEO, it feels like we are drinking from a firehose in making the changes necessary for healthcare reform.  Vermont’s hospitals are working with our medical staffs and the Green Mountain Care Board to keep costs down – keeping people well and reducing costly avoidable emergency room visits and preventable hospitalizations. NMC is working to further streamline our processes to achieve even greater efficiencies in ambulatory surgery.  This is the right approach for Vermont: using our existing resources more wisely.  The proposed facility is a step in the wrong direction, as it would operate on the outdated fee-for-service model (where more procedures equal more profit) that our state and country are moving away from. 

We already have enough physical space to meet the demand for surgeries.  We need to rework our systems to reduce costs and ensure high quality.  We need to partner with insurers to set targets of performance together to make sure we are on track with reducing costs.  As one team of providers, we must wrap around our community to provide the right care, at the right time, and the right place.  It is important to think of accessing healthcare in this community as a continuum with all providers working together.  Your primary care provider is the anchor.  We must work together to keep you and your family healthy right in your own community with your local team of caregivers.  Our future is about partnership, integration, prevention, and value. 

Vermont’s hospitals are proud to serve everyone who comes through our doors, no matter how complicated their health needs may be; this includes the uninsured and under-insured, regardless of their ability to pay. Hospitals operate 24 hours per day, seven days per week, and 365 days a year. Our communities have peace of mind that when a loved one needs care, the hospital will be there. Ambulatory surgery centers cannot exist without hospitals because they take the simple, most often profitable cases, and if a complication arises, they depend on a hospital to address the acute problem. Duplicating hospital services is not healthcare reform.  Allowing an unregulated for-profit entity to choose a few services from a highly regulated hospital system would threaten our ability to meet our communities’ most vital health needs.  However, we do need to hold hospitals accountable to rework what happens inside our surgical walls to be more efficient and cost effective.  In short, is there an unmet need that an ambulatory surgical center would address for this community?  No.

— Jill Berry Bowen, NMC’s Chief Executive Officer