Health Care

Independent doctors locked in regulatory battle with hospitals

Amy Cooper
Amy Cooper is executive director of HealthFirst. Photo by Erin Mansfield/VTDigger

COLCHESTER — Independent doctors are fighting an uphill battle as they try to compete with two of the state’s largest hospitals.

Doctors have been seeking state approval for the Green Mountain Surgical Center for more than a year without success. That’s because the independent physician group is deadlocked in a regulatory battle with the Vermont Association of Hospitals and Health Systems and Northwestern Medical Center in St. Albans. The association and the hospital say the center would have “a direct negative impact” on the health care system.

The Colchester facility would offer basic surgeries and other procedures, such as knee surgeries, shoulder surgeries, hysterectomies, certain pelvic exams, colonoscopies and treatments for spinal pain.

Investors in the project say it would reduce wait times and save money for patients in the Burlington area. Numerous businesses and community organizations have written letters supporting the proposed surgical center.

The projected savings are based on lower fees for surgical services. Independent doctors charge insurance companies less than academic medical centers for the same medical services. Independent doctors also do not bill for “facility fees,” unlike academic medical centers and community hospitals.

Northwestern in St. Albans and the Vermont Association of Hospitals and Health Systems, which represents Vermont’s 14 hospitals, including the University of Vermont Medical Center, oppose the surgical center.

The hospital association has written in regulatory documents that the proposed project is an “unregulated ambulatory surgery center without any obligations to the Vermont community” that would have a “direct negative impact” on hospital finances, access to health services, health care costs and health care reform.

“Ambulatory surgery centers are only equipped to provide straightforward procedures to uncomplicated patients, and they usually focus on those services that turn a profit,” said Jill Olson, the vice president of policy for the hospital association.

“They would not offer critical medical services such as emergency care or mental health services,” she said. “Duplicating infrastructure and services that already exist will increase the total cost of the health care system for everyone.”

At the request of the hospital association’s lawyers, the investor group has submitted an analysis of how much business they would take over from neighboring hospitals and an extensive list of billing codes for the procedures that will be performed.

The investors said in regulatory filings they would take 14 percent of patient surgeries from the University of Vermont Medical Center and 3 percent from Northwestern Medical Center. The investors hope to get a permit by December and open in 2018.

Dr. Paul Reiss, an independent family doctor who supports the facility, said the hospitals “are definitely being anticompetitive.” He said the independent surgical center threatens to take away cash flow from hospitals, even though the doctors involved don’t stand to make a lot of money.

“One of the main reasons that there are physicians looking forward to this is that these centers have the ability to turn over their procedure and operating rooms very quickly and very safely, whereas often times in hospitals physicians have to sit and wait and twiddle their thumbs while they wait for the operating room,” Reiss said.

“It’s anybody’s guess what the Green Mountain Care Board will do with this,” he said. “It really is very surprising that the Green Mountain Care Board hasn’t expedited this process because this is an unmistakable and easy solution to one section of our health care budget that we’re paying much too much for.”

Jeffrey Tieman, the new CEO of the hospital association, said in a statement that the association’s concerns are about whether there is a need for the new facility.

“Our examination of capacity data at five hospitals in the area shows that there is more than adequate capacity today, and we expect that information to be part of our presentation to the Green Mountain Care Board as they debate whether this project would be in the public good,” Tieman said.

Doctors seek protection from retaliation

Amy Cooper, the executive director of HealthFirst, is one of the primary investors in the Green Mountain Surgical Center. She and Tom Dowhan, who owns the only other ambulatory surgery center in the state, an eye surgery center in South Burlington, are the only two people named publicly for their role in the surgical center.

The group of doctors investing in the project are referred to as “Physicians A-P” in public regulatory documents. They are largely represented through Cooper and their lawyers, who have fought for the doctors’ confidentiality in regulatory proceedings.

In the request for confidentiality, the group’s lawyer wrote: “The physicians are concerned that if their identities and surgery volumes are made public, they could be targeted for retaliation, lose privileges, or otherwise see their patient base eroded through anti-competitive behaviors.”

In addition to the promised confidentiality, the investors are protected by the name of the company representing the doctors on the application — ACTD LLC — which appears to be a limited liability company named using the initials of Cooper and Dowhan.

Cooper said in an interview that the doctors are not willing to talk to the news media, and she said the confidentiality measures are a “standard procedure in surgical center applications across all states because of the tension between hospitals and physicians who often plan these.”

“Those surgeons right now operate at the various hospitals in the state that have publicly stated that are opposed to the opening of this center,” she said. “They wouldn’t want their current places where they (rent operating rooms) to know that they’re interested in operating at a surgery center because it might create poor relations.”

That’s what Dr. Christine Murray says happened to her in late 2014, when she and a group of fertility doctors left the UVM Medical Center to open a new clinic in Colchester. The idea was to offer the same in-vitro fertilization service that they offered at the hospital, she said, but at lower prices for their patients, who often pay cash.

Christine Murray
Dr. Christine Murray, a reproductive endocrinologist who co-founded Northeastern Reproductive Medicine in Colchester. Photo by Erin Mansfield/VTDigger

Within 10 days of opening, according to Murray, UVM Medical Center filed suit against the owners of the clinic for allegedly violating their employment contracts and looking at patient records that still belonged to UVM Medical Center. The attorney for the hospital was Eric Miller, who at the time sat on the hospital’s board of directors and is now the U.S. Attorney.

“We were pretty petrified because we had loans, and it’s just scary to be thrown a lawsuit like that,” Murray said. While the lawsuit was ongoing, the UVM Medical Center started referring fertility patients to Dartmouth-Hitchcock Medical Center in New Hampshire, according to WCAX-TV.

She said she and her business partner met with one of the top doctors still at UVM Medical Center to explore collaboration. “But somehow when it got to the level with the administration it just became very antagonistic and unpleasant,” she said. “It could’ve been great. It could’ve been great for the patients, it could’ve been great for the residents and the fellows.”

Murray said UVM Medical Center based its case on a complaint from a patient, who she said turned out not to exist. Murray said she and her business partner spent at least $70,000 on legal fees to defend themselves. Records from the Vermont Superior Court show the dispute ended in a settlement after four months of legal wrangling.

“It was a real nightmare for awhile,” Murray said. “Neither one of us were sleeping or eating well. It was awful. And to this day I don’t understand why they would do that to us. We were really important parts of that community there and we wanted to stay that way. But if you don’t play on their terms, it can be really devastating.”

Mike Noble, the spokesperson for the UVM Health Network, said: “What I can say is we have a legal obligation to protect patient confidentiality, which was at issue in this matter. There is no factual basis for the claim that the suit was retaliatory.”

Murray said she would likely use procedure rooms in the proposed ambulatory surgery center. Right now, she said she often has to book time in the UVM Medical Center’s operating rooms during one of the worst times in the week — on Thursday mornings, when medical residents are not available to be assistants.

“I have no issue with the hospital except I just don’t know why they can’t just be a hospital and focus on the things that a hospital should be doing,” Murray said. “Why do they have to have everything under their wing? I don’t understand that.”

Competition with UVM Medical Center

The UVM Medical Center got involved in the ambulatory surgical center case on July 29. The hospital does not have official party status, but it sent a letter to the Green Mountain Care Board to clear up what it called “inaccuracies” in ACTD LLC’s responses to questions from the hospital association.

In the letter, Diana Scalise, the vice president of strategic and business planning for the UVM Health Network, refuted comments from ACTD LLC that the investors were “still in the process of exploring what forms a collaboration (with UVM Medical Center) might take” and working with the hospital on an “ongoing” basis.

“UVM Medical Center is not engaged in any active discussions with ACTD LLC regarding joint venture opportunities or joint purchasing arrangements, both of which would raise legal concerns that would need to be carefully analyzed” based on the hospital’s nonprofit status, Scalise wrote.

“As a 501(c)(3) tax-exempt organization, any joint ventures we engage in must be in furtherance of UVM Medical Center’s charitable purpose, and any patient care joint ventures we enter into must adopt UVM Medical Center’s charity care policy,” the network wrote. “That may be difficult if the other party to the joint venture is a for-profit provider like ACTD LLC.”

The hospital’s parent health system received regulatory approval on Sept. 1 to own up to 25 percent of a for-profit drug-testing lab in Burlington. In a letter to regulators, a lawyer argued for the hospital system’s involvement because Burlington Labs was vital to the communities it serves in Chittenden Country.

Scalise also wrote that the hospital wants to update its own surgical rooms at the Fanny Allen campus in Colchester, and that the location ACTD LLC chose is a poor choice for a new surgical center. The hospital has not filed an application with the Green Mountain Care Board to update those facilities.

“ACTD LLC did not appear to believe that a collaborative approach based on UVM Medical Center’s current capacity and future plans for the replacement of its (operating room) facilities at Fanny Allen to be a potential way to address the needs they purport in their (certificate of need) application,” Scalise wrote.

Noble said of the hospital’s involvement: “We needed to clarify what we found to be inaccuracies in their (permit) filings. The letter speaks for itself regarding the details. Although we aren’t a party to this regulatory proceeding, if inaccurate statements are made about us, we’ll correct the record.”

Cooper contests that ambulatory surgical centers in other states routinely collaborate with nonprofit hospitals, and says her company brought a business expert with them to meet with UVM Medical Center about a possible arrangement between the LLC and the 501(c)(3). “It’s certainly still a possibility in our view,” she said.

She also rejects the idea that she’s in it for the money. “We are going to be a locally owned and locally operated small business that is going to provide a much-needed service to Vermonters,” Cooper said.

The business model, she said, would be “just like our local newspapers, our local dentists, our local grocery stores are all locally owned, for-profit small businesses, that are providing a much-needed service to Vermonters.”

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  • Eric Davis

    It would be useful to know the cost of a common surgical procedure such as a knee replacement or a colonoscopy at UVM HC, community hospitals, and the proposed independent ambulatory surgical care center.

    Vermont supposedly has health care price transparency requirements, but the Web page with that information at the Dept of Financial Regulation site appears not to have been updated since 2012:

    A few other states have such requirements, such as Massachusetts, where insurance company Web sites must make available to consumers an online cost comparison tool.

    If there is a statutory requirement for publicly available medical cost data in VT, hopefully the next Administration will make sure that information is readily accessible by consumers.

    • Doug Hoffer

      My office released a report on this subject in 2014. See “Opportunities for Health Care Price Transparency and Greater Consumer Information”

      The legislature first asked for price transparency in 1992 (Act 160). Not much happened until 2006, when the legislature again asked that this information be made available to consumers. Subsequently, the State worked with insurers to create an all-payer claims database. This information can be used to meet some of the needs of consumers, but the Green Mountain Care Board has declined to do so even as other states move in that direction.

      In response, the legislature asked instate insurers to develop web-based tools for consumers and I think Blue Cross Blue Shield has complied. We intend to look at the site and evaluate it.

    • Please note this information is available and easily accessible. In 2014, all health care price transparency reporting was moved from the Dept. of Financial Regulation to the Dept. of Health. All pricing information is located here:

      The website compares the costs of inpatient admissions, such as a knee replacement, or outpatient procedures, such as a colonoscopy, at UVM HC and all other Vermont hospitals.

      The Dept. of Financial Regulation’s website has been updated by directly linking to this information. Thank you to Mr. Davis for letting us know our website needed to be updated.

      • Thanks for the link.
        1) Please note that some of the spread sheets are outdated. For example the MRI data covers Oct 2014-Sep 2015.
        2) A breakdown is needed so one knows what the cost is based on their insurance, not the list cost. For example Medicare may only allow $1,200 for an MRI with a list price of $4,200, while Blue cross allows $3,200 for the same procedure.
        3) It would be of additional value to have these prices compared to those of independent labs (like Affiliated Labs in Rutland), and those of hospital independent providers. The problem is that the insurance companies and hospitals don’t want to share this information.

        An up to date data base with this information would empower patients to seek out better value for routine labs and procedures. This would be of great benefit to those with more cost-sharing health insurance policies and for the uninsured. Health care cost transparency has a long way to go in VT, but this would be a good start.

  • John Samuelson

    UVM was incentivized, in the run-up to single-payer healthcare, to amalgamate as many healthcare practices in their catchment. This is also true of many of the State’s Regional hospitals. In some cases, 80-90% of the healthcare market is owned and operated by the local hospital.
    The legislature created fiefdoms, and local monopolies which, by all reports, have waged economic havoc on their communities by increasing rates to consumers and indirectly forcing insurance companies to raise their premiums.
    Single-payer failed and the monopolies have been left in place.
    Of course, the hospitals are lobbying behind the scenes to keep the lucrative fee-for service standard, while at the time presenting a public mantra of cooperation with the GMCB. Needing the cooperation of the hospitals, the GMCB is unwilling to regulate and therefore is promoting the monopolies and the structural inefficiencies which result.
    The GMCB and the legislature should allow free-market forces to control prices.

    • Bob Zeliff

      The “Free Market” mantra has proven not to work in Health Care.

      We have had that in the US forever and it has give us a system where we pay twice as much for health care as most advance Countries, have approximate 30% of our population with out health coverage or less than adequate coverage, have company that charge $600 for EPI pens when the internal drug cost about $5.00, have Drug companies making record profits and hiding it off shore.

      While I don’t fully understand the details of this for profit center, I would hope they would be bound to accept and treat all patients who walk thru their doors. I am curious how they would answer that question. I hope they do not intend to cherry pick only the wealthy or people who have excellent insurance coverage.

      • Dan Caver

        Sorry Bob,

        The “Free Market experience” in the health care arena ended over 50 years ago when LBJ knowingly or unknowingly opened the door for government to become the dominant player.

        In Vermont, the legislators eliminated community rating systems, under the false guise of people will make healthy choices becasue they watn to live healthy lives. (Ha!) All of which decoupled personal consequences related to adopting poor personal life style choices.

        If people made a conscious commitment to living a healthy lifestyle, demand for medical services would drop significantly. But due to government intervention, we have a self-induced illness system–insatiable demand for processed foods and sitting on one’s “brains” to watch TV, which leads to unlimited demand for our illness system. Address the cause, not the system…

        • Stuart Friedman

          50% of our health care costs are incurred during the last 6 months of our life, nothing that a healthy lifestyle will do to prevent that.

          Living a healthy lifestyle is important but not at the heart of our outrageous health care costs. While in the US we pay whatever the drug companies ask, elsewhere there is fierce negotiation and much lower associated costs. Why should we be subsidizing the care of other nations.

    • Walter Carpenter

      “The GMCB and the legislature should allow free-market forces to control prices.”

      If we do that none of us except the hospital CEO’s could afford anything since this “free-market only favors those who can pay the most for it. The problem here is that we have hospitals acting like it is a free market and they are doing what free markets do, which is to create a monopoly to get the highest prices and the most profit.

      • Dan Cunningham

        Walter, *some* markets tend toward natural monoplies. Operating systems do, for example. Health care is not one of them. The monopoly is not natural, it’s imposed by players using leverage, in this case political and system leverage.

        Genuinely free markets consist of many buyers and sellers, and feature price transparency. A good link is here:

        Equating UVM’s behavior to a free market is disingeneous – this is not at all how free markets behave.

    • Amber Goss

      Adding to the problem is lack of competition amongst insurance companies in VT. BC/BS is the largest insurer next to Medicare and Medicaid, private doctors can’t even shop around for companies who will pay them even close to what the hospital providers make.

  • Frank Beardsley

    I thought the information in medical records belonged to the patient, while the physical record itself belonged to the hospital. The only place I’ve ever had difficulty obtaining my record is UVM Medical Center – the least customer friendly hospital I’ve ever encountered. The only two options given to obtain my own record: (1) sending a form by mail to fill out and return, and then they’d mail it to me. (2) sending by fax. Strange, given the fact my tiny, local clinic can retrieve it electronically and print it out locally.

  • Dave Bellini

    UVM wants to continue its monopoly and the high salaried boot-lickers in Montpelier aren’t about to stand up to them. This is a clear opportunity to save Vermonters money and help mitigate healthcare spending. Where’s all the politicians now? All talk, no action.

    • Joanie Maclay

      Every word you write is very truthful. I will add, I have a family member living in another state who is a retired Surgical Nurse & Supervisor who says how lucky she is to have these centers in her area. IF the Center cannot handle a situation they do not hesitate to refer.
      Yes we do need these Centers here in VT. Medical Care, surgeries included is breaking the backs of our VT. Area RESIDENTS! Some actually forego much needed surgeries that would improve their quality of life! Why? Lack of enough funds!
      Go for it Dr. Reiss. Keep on keeping your patients well being in the forefront! Thank you.

  • ruth sproull

    I’d like to know if the new surgicenters (like hospitals) would have to admit emergencies, regardless of the patient’s ability to pay, which I believe is a federal law. The procedures done at surgicenters are often the bread and butter of hospitals which help to pay for indigent care and those on medicare and medicaid. If the surgicenters are held to the same rules then the “competition” that some were talking about is fair. If they’re not, then they will just be taking the “cream” from the top, leaving the hospitals to scrounge for funds to pay for the most difficult and expensive cases.

    • paul reiss

      Those are good questions, Ruth. The center will take all patients, including Medicaid and Medicare. They will offer assistance to the underinsured, but the center will not receive the same unnecessarily inflated rates that the hospitals charge. They do elective surgeries, not emergencies.
      Did Vermonters decide that hospitals should support their other services by forcing patients needing minor procedures to use more costly, less efficient hospitals?
      By opposing this lower cost option for all patients, the larger hospitals in the state are certainly not acting like we have a crisis in health care costs. They could embrace this and other efforts to contain costs if they are serious about collaborating on cost containment.

      • Steve Moreau

        Mr. Reiss, Neglected to answer whether the new center would accept uninsured patients and his answer that they will offer assistance to the underinsured is a pretty vague answer. How these two situations/scenarios are handled would certainly make an important factor on the “fairness” of the competition.

        • Paul reiss

          Sorry to have
          generalized because of word counts!
          The center is committed to providing their services to everyone including the uninsured, and will provide charity care (though get no grants or tax breaks for doing so). They stated this in their application…

          The main reason I support this option is because of the high cost of health care and insurance – causing so many folks to be underinsured.

  • John McClaughry

    Every business wants to get big and exert monopoly power to preclude competitors. Fletcher Allen (now UVM) has long been an active player in using Certificate of Need hearings to keep out competitors. This is intensely political. For the benefits of an independent surgery, see, describing the very successful Surgery Center of Oklahoma.

  • Richard M Roderick

    There are so many monopolies in Vermont, Health care is just one, There are only a few big gasoline distributors in the state, Champlain Oil, MapleFelds to name two. Just look at gas prices in Chittenden county and the Conn. River Valley. They buy up gas stations, close some and slap on an anti completion clause requiring anyone who wants to buy or lease has to buy gas from them. In the Upper Connecticut River Valley the LP Gas and Oil business is becoming consolidated which can’t be good for consumers. I’ll stop here. The regulators need to start paying attention.

  • Jeanne Norris

    Boy, UVM has all it can handle and then some Judging by the fact thats its taken months and months for my husband to get resolutionfor a back issue he has had over a year now!! They should be happy for this other Practice take some of the overflow! not sueing them!! I guess greedy takes front and center over the lowly Patient!! Not surprised I guess!!

  • On the first hand we have a group of highly trained and sorely needed physicians who want to practice medicine in Vermont.

    On the second hand, we have the Vermont Association of Hospitals and Health Systems or the entrenched establishment significantly responsible for the high costs of health care telling us that these much needed doctors will have “a direct negative impact” on the health care system.

    On the third hand, we have the GMCB led by a Chairman with no prior health care background that will decide whether or not these physicians will work…….decide when he gets around to it.

    On the fourth hand, we have Gov. Shumlin and a legislature that have put this system into place along with the disastrous health care exchange and now a big push for “all-payer” that no one really understands.

    Where we are with health care administration and delivery is so unbelievable that the only thought that comes to mind is…….Holy Cow, how did this ever happen?

    • Tom Pelham

      This was then:

      But reality bites:

      Before our political leaders get in any deeper by allowing the Green Mountain Care Board to continue to build the “too big to fail” UVM Medical Center ACO, they’d best be advised to take a step back and seek a second opinion on the wisdom of their ways. Diversity has its strengths and monopolies tend to topple and fall. Dartmouth Hitchcock just backed out of joining UVM in Onecare.

      • Eric Davis

        I have submitted the following series of questions for the candidates at Digger’s gubernatorial debate in Rutland next week:

        How much information about the proposed “all-payer” health care reform system has the Shumlin Administration shared with you? Do you believe the administration has provided the public and the legislature enough information to evaluate its proposals in this area? If the administration negotiates an agreement with the federal government on an “all payer” system by the time it leaves office, would you go forward with the plan once you become governor, or would you seek to make changes in the plan?

        • Joyce Hottenstein

          You don’t know what you don’t know. How are these candidates supposed to know even if they have asked, if they got all the information. Did we get all Hillary’s emails???

      • Gail Graham

        I sure wish I could opt out of Onecare, as a patient. Guess I need to find a primary physician connected with my Alma Mater, ie Dartmouth Hitchcock.

        • Joanie Maclay

          I believe you will,find Dartmouth/UVM are
          Associated now… Hoping I read/heard this correctly. If not I am sure there will be a flood of opposition to my above statement.

      • Joyce Hottenstein

        Isn’t that because they could not negotiate a good enough rate for the medicaid population?? The state of Vermont wants to pay them less than UVMonopoly.

  • Theresa R. Lefebvre

    If there is “…more than adequate capacity…” at UVM-MC, why do patients have to wait 3-6 months for knee replacement surgery? If UVM-MC is a “charitable institution,” why are patients who have insurance with high deductibles and co-pays hounded by the UVM-MC collection department? Indigent patients with no insurance are not charged and are referred to state agencies where they can get coverage. Persons with inadequate insurance, or people who are not indigent but can not afford insurance through an insurer who has cut a deal with UVM-MC, are charged top dollar for health care, and then sent to a collection agency if they can’t afford to pay the balance of their bill. Yes, UVM-HC will treat people regardless of their ability to pay; but God help you are among the working poor who can’t afford to pay.

    • rosemarie jackowski

      Here’s a horrific hospital billing story. A few years ago I received hospital care as the result of an auto accident. I had good insurance at the time. The hospital failed to bill the insurance company. Years later, they came after me and threatened to take my home. When they finally agreed to meet with me, I was told that they could not bill the insurance company because too much time had passed. When I asked how a delay like that could happen, I was told that it was because they expected to make money because the accident was caused by a State owned truck. In the end, I won that battle against an unfair billing policy.

  • Bob Elliot

    Monopolies for commonly needed items or services in health care help raise the cost of care Monopolies for commonly needed items or services in health care help raise the cost of care for us patients. We have had too many monopolies in the pharmaceutical industry with many examples of price gouging. Now our health care service providers are being rounded up in a big monopoly to do the same. We have Obamacare and Governor Shumlin to thank for fostering the development of health care monopolies. And I thought government was suppose to protect us from monopolies.

  • Kathy Callaghan

    Yes, where are all the politicians on this? Candidates running for office right now should be all over this. They should be informed, and they should have a position based on knowledge of the issue. Arguably, health care reform and how it is done or not done, is more important than even education, because it affects each and every Vermonter.

    • rosemarie jackowski

      I have been ‘all over this’ issue for years, and I am a candidate.

  • Has anyone thought of it this way?
    The federal government/Obamacare wants to get rid of all small and medium size healthcare providers. The current administration has overseen the largest consolidation of major healthcare companies in history…..Look around, especially in Boston.
    Why, you may ask?
    Once the Feds have eliminated all the outliers and independence, the same Feds can then force the few large remaining providers to bend to their wishes.

  • Art Bell

    As the one time courageous Peter Shumlin said, as he rode the horse of ‘better healthcare for all Vermonters’ to pyrrhic victory: “..We Can do this, if, we can just control the spending at Fletcher Allen”

  • Justin Worthley

    When it comes to health care in Vermont, it’s perplexing to me that we are willing to test unproven big ideas (Single Payer, VT Health Connect…) but then hesitate with small proven models like ambulatory clinics that are providing high quality, more affordable procedures (vs. hospitals) throughout the country. A lot of Vermont companies have made tremendous strides taking a continuous improvement approach. It’s time we apply this same thinking to health care… go after solving small problems instead of trying to find the grand solution.
    Problem: Outpatient procedures in Vermont are challenging to schedule due to limited OR availability, and expensive vs. other states.
    Solution: Build an ambulatory care facility to divert small procedures from the hospitals so they can focus on more complex procedures, using a proven model.
    And this would finally create some market pressure for pricing transparency because there would be choice (that does not exist today due to the near-monopoly).

  • It is always interesting to me to note that the protected party, taxi medallion holder, licensed hairdresser, hospital, etc. always talks about how they are on the side of the consumer to try and protect their monopoly. When the monopoly gets broken, as it inevitably does, prices drop, usually significantly. There is nothing different in this case. It is just a question of when will the protector, the Green Mountain Care Board, break the monopoly and get some real competition into the medical care mix. It will make everyone healthier if they do it now instead of forcing us all to continue to pay higher prices for no reason. It is really basic economics.

  • Jill Olsen’s statement hits the nail on the head: the hospitals and their lobby oppose the ambulatory center because it will siphon off “those services that turn a profit.” Which means that those of us purchasing these services from the established “non-profit” hospitals are paying too much and essentially subsidizing the cost of procedures that do not “turn a profit.” In theory the insurance industry exists to spread the risk. Hospitals, particularly non-profit ones, should charge what services cost… no more, no less.