NMC Commentary

Will NMC Appeal the Ambulatory Surgery Center Approval?

No.  NMC will not appeal the Green Mountain Care Board’s (GMCB’s) recent heavily-conditioned approval of the certificate of need (CON) for the for-profit stand-alone ambulatory surgery center (ASC) proposed for construction in Colchester.  We are disappointed in the decision, as we do not believe the applicant demonstrated in the legal proceedings that their project met the established standard of “need” for Vermont. We see this as an impactful step backwards to fee-for-service medicine while the rest of Vermont’s healthcare system moves forward towards an integrated system based on population health. However, these are critical times for healthcare reform in Vermont and our efforts need to be focused on partnerships, integration, care coordination, and primary prevention and an appeal would be a distraction from that focus with what would likely be a lengthy and costly process.

Within the CON process, the Vermont Association of Hospitals and Health Systems (VAHHS) and NMC provided testimony and documentation that demonstrated that Vermont does not need to invest in additional surgical infrastructure, as the proposed new construction duplicates existing capacity within the Surgical Services departments at both NMC and University of Vermont Medical Center (UVMMC).  Building more operating rooms simply allows for the skimming of patients away from the hospitals rather than meeting a need for additional capacity. This moves the system away from integration and adds avoidable infrastructure costs to the system. A voice of dissent within the GMCB’s split decision acknowledged that “the Surgery Center would contribute to the fragmentation of Vermont’s health care system and increase costs systemwide.”  Unfortunately, this was not the prevailing sentiment amongst the GMCB membership.

The CON was granted with 29 conditions attached to it.  We appreciate the intent of the GMCB in attaching these conditions and recognize that many of them try to address portions of the concerns raised by the interested parties who contested the application.  These include “requiring that each physician certify that he or she will accept patients without regard to payer type, insurance status, or their ability to pay for services. The physician shall further certify that he or she shall not consider the source of payment or a patient’s ability to pay when determining whether to perform a patient’s procedure/surgery at the ASC.”  The GMCB is also requiring that the ASC would need to achieve Joint Commission accreditation and participate in an Accountable Care Organization. They stopped short of imposing a revenue cap on the earnings of the for-profit center, even though they continue to impose that cap on NMC and the rest of Vermont’s not-for-profit hospitals.  Furthermore, the new center will compete against Vermont’s hospitals without being hampered by the 6% provider tax which hospitals must pay to the State.  The conditions are an attempt to make the best of a challenging situation, but they fall short of creating a level playing field for proper competition and do not create a truly integrated system as called for by Act 48.

Despite this decision, our focus needs to continue to be on our mission of providing exceptional care for our community.  Once the names of the physicians involved in the proposed center are made public, we can better estimate how much care may be redirected out of our community and adapt to lessen that impact.  We must continue our focus on streamlining our processes and removing avoidable costs without reducing access.  Continuing to evolve how we do what we do will preserve our ability to continue to meet community need in a changing environment.

As we move forward, we cannot let this decision be divisive in our efforts.  The dissenting voice in the GMCB’s decision worried that the Board “will lose the collaborative relationships we have had with most hospitals around the State for six years. They simply will not trust us. As a result, the hospital budget process will become increasingly hostile, especially as hospitals find themselves under mounting financial pressure.”  Despite the looming potential negative impacts to NMC made possible by this decision, the future of healthcare in northwestern Vermont – and all of Vermont – is too important to allow it to derail our collective future. NMC will maintain our open, collaborative, improvement-focused approach to working with the GMCB.  We will press forward in our efforts to be a leader in health system reform, in cost containment, and in the investment in primary prevention to improve population health and bend the cost curve long term.

Throughout the process, we appreciated the voices of support for local healthcare within our community and the efforts of numerous community leaders who traveled to Montpelier to provide formal public comment.  Thank you for your continued support of NMC and the work of our community partners.

— Jill Berry Bowen, NMC’s Chief Executive Officer