NMC Commentary

What is the status of the For-Profit Surgery Center?

The Green Mountain Care Board (GMCB) which holds regulatory power over Vermont’s not-for-profit hospitals and other aspects of the health care system continues to review the Certificate of Need (CON) application for the proposed for-profit Ambulatory Surgery Center. After numerous sets of questions to the applicant on the proposal, the GMCB held public hearings on the matter in April where NMC and multiple leaders of our community testified about the duplication of service that the proposed new facility represented and the financial impact that facility would have on NMC by skimming off well-insured patients. At the time of the hearing, the five-member GMCB had two open seats. They paused the proceedings to allow those open seats to be filled. The new members are now coming up to speed on the issue and the process of making a ruling on this critically important topic is progressing.

The two new members of the GMCB are Kevin Mullin (appointed as Chair) and Maureen Usifer. He is from Rutland, holds a degree in finance, runs a company that operates movie theaters, and served in the Vermont Legislature for nineteen years. Ms. Usifer is from Colchester, holds an MBA with a background in accounting and finance, and is the former Chief Financial Officer for Seventh Generation. These two new appointees now have a challenging task of absorbing all of the written material and the hearing records relating to the proposed surgery center.

The specific concerns with the application which I shared in the Spring continue to hold true as the process moves forward.  The ASC is not appropriate, necessary or helpful in Vermont for the following reasons — concisely summarized by the Vermont Association of Hospitals and Health Systems:

  • “Need. Vermont does not need more space in which to provide outpatient surgery. There is currently enough existing operating and procedure room capacity in Northwestern Vermont to serve the needs of patients with room to grow for at least the next 20 years. Building a for-profit ASC will not provide access to more doctors for care and procedures; it simply offers another physical location to surgeons who already have privileges at the nearby hospitals. A real and important conversation needs to take place about access to physicians at all levels – from primary care to the most specialized – but the ASC in no way addresses these challenges.”
  • “Cost and Duplication. The Green Mountain Surgical Center (GMSC) will increase costs for the Vermont health care system by unnecessarily duplicating existing capacity. GMSC claims that the ASC would lower costs for patients. While that may be true for the subset of patients whose procedures can be done at the ASC, building new ORs does not lower costs for Vermonters who need more complicated, higher-risk surgeries that must still be performed at a hospital. To ensure that care is always there when Vermonters need it, our hospitals still need to be available 24/7, 365 days a year. The ASC will not alleviate any of these costs but will add more infrastructure costs to our state’s health care system.”
  • “Inconsistent with health care reform. One of Vermont’s central strategies to reduce overall health care costs is to move providers to a system that aligns payment with desired health care outcomes and avoids costly hospital stays. This for-profit center would operate on the outdated fee-for-service model where more procedures equals more revenue.”
  • “Outside the regulatory structure. This facility would be unregulated under Vermont law. Unlike Vermont’s hospitals, the ASC would not be subject to the annual six percent tax that funds the state’s Medicaid programs, the GMCB’s budget process and financial oversight (including the imposed revenue cap), health care quality reporting or licensing requirements. Nor would the ASC be required to report serious medical errors to the health department. Our state laws are designed to protect the public’s health and reduce health care spending. The ASC would exist outside of these protections.”

Vermont has established itself as a leader in healthcare reform to ensure that we provide everyone with access to high-quality care and that we bend the cost curve to make it sustainable through an integrated focus on population health. Stepping backwards into fee-for-service with a for-profit ambulatory surgery center undermines hospitals’ abilities to be leaders in this effort (as simply skimming off colonoscopies alone would pull approximately $1million from NMC). This is why Vermont has a Certificate of Need law – to prevent unnecessary and harmful duplication of service.  I look forward to moving past this issue and continuing with Vermont’s progress toward a healthier future for all.


— Jill Berry Bowen, NMC’s Chief Executive Officer