Editorial: Watching closely as a new surgical center opens in Colchester

Independent doctors in Vermont have dwindled in number over the years as the University of Vermont Medical Center and other large providers have extended their reach, incorporating physician practices with the aim of developing better coordinated, seamless, efficient care in the state.

And yet independent doctors argue that private practices are less costly than the large hospitals. It's partly because of Medicare reimbursement rates, which are lower for independent practices. It is in this context that a group of physicians proposed to build an independent, for-profit surgical center in Colchester.

But first they had to obtain a certificate of need from the Green Mountain Care Board, and the large hospitals in the region were opposed to the idea. It is the job of the board to prevent costly redundancy from burdening the health care system with extra costs that provide a profit to providers while driving up the price of health care. The hospitals were concerned that the surgical center would siphon off patients, reducing revenues to the hospitals while leaving them with the expense of maintaining more costly facilities.

It was a closely watched case, and no one knew what the Green Mountain Care Board would decide. The decision came earlier this week, approving the project but attaching 29 conditions designed to ensure that it does not lead to profiteering and does not damage the large hospitals. Additionally, the board said the ruling in this case should not be viewed as an open door to a proliferation of for-profit health care facilities in the state.

The power and reach of the University of Vermont Medical Center are immense. It is part of the One- Care Vermont accountable care organization that is working to transform the financing of health care in the state. It has long been the aim of health care reformers to forge the state's fragmented, helter-skelter, disorganized health care system into a large single system that would provide care more efficiently while containing costs.

And yet the creation of a large monolithic system raises concerns of its own. Might small, cost-conscious entrepreneurs be able to provide readier access at a lower cost? That is what the new surgical center hopes to do.

Then again, it's possible that a proliferation of private practices could cherry-pick cases that are suitable for an out-of-hospital setting while leaving the costlier and more complicated cases to the hospital. It's another version of the problem created when insurance companies are allowed to cherrypick healthy customers.

The Green Mountain Care Board was aware of these problems, and its 4-1 ruling reflected it s awareness. Con Hogan, a knowledgeable and experienced member of the board, was the dissenter, warning that the decision would harm the hospitals' trust in the board and create an adversarial relationship in the future. Another board member, Robin Lunge, approved the surgical center but with reservations. Among them, she was concerned that the center would be overbuilt, thus wasteful.

The 29 conditions address in detail the potential problems that might be created by an independent surgical center. Significantly, the board requires that the center take part in an accountable care organization, such as OneCare Vermont, which would tie it into the cost-saving structure of the UVM Medical Center. Also, the center will have to negotiate prices with insurance companies that are below those of the hospitals and must accept patients regardless of their ability to pay. These provisions seem directed at the potential problem of overcharging or cherry-picking.

It appears that the board wants to hold the line against profiteering in health care while allowing that this group of physicians might be able to provide a useful option. No one likes to wait in line for treatment, and maybe an additional surgical center would help alleviate that problem.

The lead investor for the new surgical center was pleased by the board's decision. She saw the group of participating physicians as part of the solution, suggesting that the independent doctors in Vermont want to have a role in keeping costs under control.

The board seems willing to give it a try, but it intends to watch closely to see if the project works.

— The Rutland Herald


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