[T]he University of Vermont Medical Center says it will start construction soon on a major expansion that will allow almost all patients in the hospital to stay in private rooms with private bathrooms.
The hospital received final approval from regulators at the Green Mountain Care Board on May 11 to move forward with the project. The board gave the project preliminary approval July 1, and the hospital could not start work until five conditions were met.
“We have worked hard to meet the conditions set by the GMCB on this complex project, and I am glad that we have been given the green light to proceed,” Dr. John Brumsted, the president of UVM Medical Center, said in a statement announcing the start of construction.
In the preliminary permit, called a certificate of need, the board approved a four-story project with 128 private rooms and a total cost of $187.3 million to be built on the land that is currently the emergency department parking lot.
The original construction cost of the project was $174.9 million, but that has fallen to $172.8 million. The total cost remains at $187.3 million, which includes interest that must be paid during the construction period that runs through the summer of 2019.
The certificate of need authorized the hospital to buy about 1 acre of additional land from the University of Vermont to knock down several college dormitories and build a parking lot next to the new building. The project will expand the physical size of the hospital but not the number of beds available to patients, because the new beds will replace semi-private rooms.
In the May 11 decision, the Green Mountain Care Board determined that UVM Medical Center met all five conditions of the preliminary approval. The board said the hospital provided a sufficient construction cost estimate and that it fell within guidelines for how much money it budgets for patient care in fiscal years 2016 and 2017.
The board also instructed UVM Medical Center in its conditional permit to budget for its patient care revenue to grow no more than 3.5 percent a year in 2016 and 2017. That growth rate is the same one the board has been seeking to keep statewide health care costs within.
The conditional permit did not include any instructions for UVM Medical Center related to fiscal year 2015, which ended in September, when the hospital took in $27.6 million in excess revenue from patient care. The board allowed the hospital’s umbrella network to give about half that money to nonprofit organizations.
The May 11 decision also said the hospital has sufficient cash on hand — more than six months’ worth — to cover its expenses; that it has sufficient donations to cover part of the project so the construction won’t come from patient care money; and that the hospital will be able to pay off 30 percent of its bond on the project within 20 years.
The project will maintain the same number of staffed beds at the hospital, 447, but expand the facility to provide all patients with private rooms. According to the original permit application, each room will be 340 square feet, with 200 square feet of open space for the patient, a recliner for the patient, a pullout couch for family to sleep over, and a full private bathroom with shower.
The original permit application says the hospital needs to have private rooms to comply with recommendations from the Facilities Guidelines Institute, used by the hospital’s accreditation body called the Joint Commission. One of those guidelines says that total room area should be at least 240 square feet, according to the application. By comparison, the average size of a hotel room in the United States is about 325 square feet, according to The Boston Globe.
The permit application also says private rooms are necessary because shared rooms “present challenges for maintaining privacy and confidentiality and in preventing hospital-acquired infections.” At the time of the application, the infection rate at UVM Medical Center was about 0.5 percent, compared with federal guidelines of 1 percent.
David Keelty, the project manager for UVM Medical Center, said the hospital’s current facilities are as old as 70 years, “built in an era when health care equipment was different” and when hospitals were transitioning from large wards with dozens of patients to smaller rooms that held only two.
“They don’t meet contemporary standards,” Keelty said. “They’re not the type of environment that’s conducive to the best practice of medicine in a hospital setting. It’s not feasible to renovate those. We can never bring those up to code.”
Keelty said that in semi-private rooms, where there are beds for two patients, the hospital often puts only one patient in the room to prevent the spread of infection. That’s why the hospital’s infection rate has been so low despite all the semi-private rooms, he said.
“It’s not extravagant at all,” said Mike Noble, the spokesperson for UVM Medical Center and its umbrella organization, the UVM Health Network. “If you are terribly ill, lying in a bed in a hospital, do you want another family 4 feet away from you with another person who is terribly ill?”
Noble pointed to a story in The New York Times saying the University Medical Center of Princeton upgraded its rooms to be “more like what you find in a Marriott hotel,” resulting in patients asking for 30 percent less pain medication and raising patient satisfaction ratings to the 99th percentile, as opposed to the low 60s.
UVM Medical Center’s application said it “followed a process very similar to Princeton’s,” one that emphasized “input gathered from patients, families and staff with the goal of improving the patient experience and the quality of patient care. The process resulted in a similar design outcome to Princeton’s.”
UVM Medical Center is the flagship hospital of the UVM Health Network, which announced May 10 that a fifth hospital would join the system. Six weeks ago, the UVM Health Network acquired the last independent orthopedic surgery practice in Chittenden County, and Central Vermont Medical Center acquired an orthopedic surgery practice in Berlin.
Additionally, in the past two weeks, the UVM Medical Center has submitted two additional permit applications to the Green Mountain Care Board, asking to replace diagnostic equipment and a robotic surgical system. The combined spending of both projects is $5.1 million, according to board documents.
