Blue Cross backs independent surgical center

Blue Cross Blue Shield of Vermont 1080

Blue Cross Blue Shield of Vermont headquarters in Berlin. File photo by Andrew Stein/VTDigger

Vermont’s largest insurance company has endorsed a proposed surgical center in Colchester that hospitals in the state are opposing.

Blue Cross Blue Shield of Vermont submitted a letter of recommendation to state regulators for the project, called the Green Mountain Surgical Center, on Thursday.

“Our members benefit from having a robust network that offers a choice of settings in which they can receive care,” wrote Andrew Garland, the vice president of client relations and external affairs for Blue Cross.

“For this reason, we credential and contract with any qualified provider that can offer high-quality care to our members at competitive prices, as collectively we work toward reducing overall health care expenditures in Vermont,” Garland wrote.

He said in an interview Friday: “Blue Cross Blue Shield is a customer-focused organization, and our customers, both our members and employer groups, have asked us to support projects like this, that offer them more access and more choice.”

Blue Cross insures about 90 percent of people who use Vermont Health Connect and more than 72 percent of the entire [commercial insurance market]. Blue Cross also administers the self-insured plan for state workers and workers at the University of Vermont Medical Center.
State Category | Insurance Market Competitiveness | The Henry J. Kaiser Family Foundation

MVP Health Care, which insures a minority of customers who use Vermont Health Connect, endorsed the project [in January]. Cigna, which administers plans for self-insured companies like Burton Snowboards, [endorsed the project] on March 6.

MVP backs independent surgical center in Colchester

Regulators set hearing on for-profit surgical center proposal

Amy Cooper, the main spokesperson for the project and the executive director of HealthFirst, said the insurer’s opinion “matters a lot” because of its influence in Vermont’s commercial health insurance market.

“We are very encouraged to see Blue Cross Blue Shield join with the other commercial insurers in the state to support a lower-cost, high-quality option for their members,” she said.

The proposed surgical center has been [tied up in a regulatory process] in front of the Green Mountain Care Board for nearly two years. Investors are proposing to offer basic surgeries, such as knee repairs and hysterectomies, and other procedures such as colonoscopies and treatment for spinal pain.

Independent doctors locked in regulatory battle with hospitals

Cooper said the project will save customers money because Medicare reimburses these types of surgical centers about 50 percent to 60 percent of what they reimburse hospitals for the same surgeries.

She said these types of surgical centers have figured out how to “streamline the operations and supplies” so they can stay in business while being paid less than the hospitals.

The Vermont Association of Hospitals and Health Systems, which represents all of Vermont’s hospitals, and Northwestern Medical Center in St. Albans have been intervening in the regulatory case.

They have said the project would reduce their profits, which the hospitals in turn use to provide services like running emergency rooms.

Erin Mansfield

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  • david schwartz

    “Reduce their profits?” What about concern for Vermonter’s costs of health care? Should we continue to subsidize the grossly inflated salaries of the layers of administrators at these griping hospitals and continue to overcharge the insurers, or should we loosen the reigns of the monopolies and offer an alternative? I believe that UVM also wanted to put in a same day surgery center so they have Northwest’s CEO and the hospital association doing the obfuscation. And ask them how much they will lose as a percentage of revenue. Again, what is more important; administrators or patients? I know of NO care providers making half the salary of these administrators. For being “not for profits”, they sure do make lots of money. Please get your legislators to understand this. It ain’t brain surgery after all.

  • bobzeliff

    It is not surprising that Vermont’s insures support GMSC because it is in there self interest. GMSC cost will be cheaper than a Vermont hospital costs because the stream line their operations to a limited set of procedures and only treat patients who have good insurance (Blue Cross, MVP, etc).
    These cherry picking policies do give them a competitive advantage over our hospitals who have to treat all, those on medicaid, no insurance, poor, which drives hospital costs higher.

    The insurance companies will enjoy the benefits of this cost shifting. However, this will shift paying customers away from hospitals reducing their revenue while leaving hospital to the the costly but necessary and humanitarian work of treating ALL patients. Obviously this will increase their costs, compelling the hospitals to increase their rates on us all for all other procedures.

    It is some what hypocritical that we demand hospitals to treat all people, those on medicaid, those who can not pay but DO NOT require the same of these independent for profit centers .

    This is a crazy spiral of cost shifting, with the hospitals footing the bill. All of us will be using the hospital soon or later. So in the end we will be footing the higher bill.

    The Doctors and Investors in GMSC see the opportunity to tap into this spiral and harvest a good chunk money for them selves.

    • Dave Bellini

      They have stated that they would accept Medicaid. What cherry picking?

      • bobzeliff

        Dave, i looked for a statement to that effect and could not find it. Could you please point me to it so I can read it.

        On that point, did they say they would accept Medicaid payment as full payment…or was it qualified that the Medicaid patient would also have to qualify for their charity health care for the balance due beyond Medicaid payment OR be refused. Details like this are important.

    • Jake Maddocks

      The “non profit” UVM Medical Center did 1.6 billion in total revenue last year, almost 30 million above what they were supposed to pull in.
      They are doing just fine. They are doing so well they were able to monopolize the state’s hospital system even further.

      If anything, the GMSC should help lower the price of procedures, thus helping the people who pay for insurance/procedures, making covering the poor easier for the state and the people who work.

  • James Rude

    When I worked in healthcare in the 80’s and 90’s in California, privately owned surgical centers began to spring up in many towns and cities. They became so popular that even some of the larger more progressive health care systems created their own subsidiary for-profit surgery center companies. They provided great service and at less cost than hospital based practices. Because we live in a state with few health insurance options and monopolistic hospital services, private surgery centers maybe one of the few ways to provide services at a lower cost.

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