Health Care

Hospitals, regulators lean hard on surgical center investors

Amy Cooper
Amy Cooper, the executive director of HealthFirst and the lead representative of the proposed Green Mountain Surgical Center, testifies before regulators Thursday. Photo by Erin Mansfield/VTDigger

Investors seeking to build a surgical center in Colchester faced stiff opposition from hospitals Thursday while trying to persuade state regulators to grant them a certificate of need.

Representatives for Northwestern Medical Center in St. Albans and the Vermont Association of Hospitals and Health Systems framed the proposed six-room surgical center as a “for-profit,” “unregulated” project that would hurt community hospitals and drive up health care costs.

Watch online
Follow these links for VTDigger video of the hearing:
Video
Video
Video
Video

The local investors had spent nearly two years in a regulatory battle for this opportunity to make their case to the Green Mountain Care Board. The investors want to spend $1.8 million to open a 12,800-square-foot surgical center in Colchester for surgeons who would prefer not to operate in a hospital setting.

The investors argue such centers save patients and insurance companies money because both Medicare and private insurers pay them less than hospitals for the same procedures. These types of facilities are called ambulatory surgical centers and are both licensed and regulated by the U.S. Centers for Medicare and Medicaid Services.

But allowing the new facility, called the Green Mountain Surgical Center, to open would let these independent doctors penetrate a general surgery market that to date has been exclusively controlled by hospitals. And hospitals say that could be detrimental to the health care system as Vermonters know it.

Jeff Tieman
Jeff Tieman is president and CEO of the Vermont Association of Hospitals and Health Systems. Photo by Erin Mansfield/VTDigger

“The question before this board today is whether the application meets the criteria that need to be met to grant the application,” Jeff Tieman, the CEO of the Vermont Association of Hospitals and Health Systems, testified before the board. “We have concluded that the application … does not serve the public good.”

Tieman, who started his job in the summer of 2016, said he came to Vermont in part because he was impressed with how the state’s hospitals are all nonprofit. He said enabling a for-profit provider such as the surgical center would be a first for Vermont.

“Our system works,” he said. “Recently, the Commonwealth Fund named Vermont the No. 1 health care system in the country. … Their evaluation is based on many different elements of an effective health care system, including access, quality, outcomes and controlling avoidable costs.”

Jill Berry Bowen, the CEO of Northwestern Medical Center, hammered the surgical center, saying it would operate completely outside of state scrutiny if allowed to open. She said the center would “be able to offer new procedures as they wish,” with no oversight over its budgets or limits on its revenue.

The Green Mountain Care Board currently regulates budgets for 14 hospitals and places limits on how much revenue they can take in from patient care. The board issues certificates of need, which are essentially permits, for major capital investments in the health care industry.

Christina Oliver
Christina Oliver, vice president of clinical services at the UVM Medical Center, testifies about existing space at the hospital. On the left is Mike Del Trecco, vice president of finance at the Vermont Association of Hospitals and Health Systems. Photo by Erin Mansfield/VTDigger

Christina Oliver, the vice president of clinical services at the University of Vermont Medical Center in Burlington, said the proposed facility is not needed because the hospital’s operating rooms and procedure rooms are working far below capacity. “We have open time available every day that is staffed but unused,” she said.

“We have no requests for blocked time (in procedure rooms) and no requests to fill them,” Oliver said. “There are no requests from our queue, no complaints from surgeons waiting to get access, and no patients waiting to get access” to operating rooms.

Amy Cooper, the executive director of HealthFirst, was the main witness for the surgical center. She said Vermont ranks dead last in the country in the number of surgical procedures performed at these types of small centers, which are paid less than hospitals and often perform surgeries more quickly.

Cooper estimated that, because the proposed facility would charge less than hospitals for basic surgical procedures, it would save insurance companies, Medicare and Medicaid a total of $5.5 million a year. She also said the facility would be subject to income tax and property taxes because of its for-profit status.

Cooper said the surgical center would accept patients who cannot afford to pay, just as hospitals do. She said its pricing philosophy is to try to have Medicare, Medicaid and insurance companies pay the same price, if the center can negotiate that. Additionally, she said the surgical center wants to have a price transparency tool on its website so patients can shop around.

“This project is not against the hospitals,” Cooper said. “This project is for the patients. We in the independent practice community here believe there is space for all providers in the health care landscape.”

“It’s going to be a building of 12,800 square feet,” she said. “That’s much smaller than any new (hospital) building project or renovation that I can remember that’s been approved by the board recently.”

“This is really an incremental step I think in the evolution of the Vermont health care system,” she said. “It’s not going to drastically alter the landscape here in the state of Vermont.”

Board members press for answers

Jessica Holmes, a member of the Green Mountain Care Board, challenged Cooper to implement a company policy to have prices be lower than at hospitals. Holmes also asked whether Cooper would guarantee that the prices be available on the company’s website on the day it opens.

Cooper said she would commit to a lower-price policy. She said she wants to have a price transparency tool in place on the first day but could not guarantee it because prices will still depend on negotiations with commercial insurers.

Holmes then asked Cooper if she would commit to allowing surgeons to use the facility only if they accept Medicaid patients.

Cooper would not. She said 15 out of the 16 surgeons involved accept Medicaid patients, and about 12 percent of patients using the facility would have Medicaid for insurance.

Lunge and Hogan
Robin Lunge and Con Hogan, members of the Green Mountain Care Board, at a hearing on the proposed Green Mountain Surgical Center. Photo by Erin Mansfield/VTDigger

The one surgeon who does not take Medicaid patients was about to close his practice, Cooper said, but decided instead not to accept Medicaid. She said forcing him to accept Medicaid would hurt both the practice and the patients.

Con Hogan, another board member, said he wasn’t convinced that the project would lower costs. “Fairly or unfairly the burden of proving that is on your shoulders, not ours,” Hogan said.

“How do we get to the bottom of that subject?” he asked. “How does the board get to the point where we know or don’t know whether this project is going to reduce overall health care costs or increase them?”

Cooper deferred to Dr. Paul Reiss, a primary care doctor who also works for HealthFirst. Reiss said health care reform pilot programs have not worked yet in Vermont “because we have high quality and low utilization. What we don’t have is opportunity for lower cost.”

He pointed to other states, which sometimes have dozens of these types of surgical centers. According to national data that the investors presented, Vermont ranks last in the number of ambulatory surgical centers in the state, behind Guam and Washington, D.C.

“The proof is in what’s going on in the rest of the country,” Reiss said. “We’re behind. We’re way behind.”

Hogan replied: “I’m hearing the logic, but I can’t find the evidence. That’s what I need.”

The board is taking public comment on the surgical center through its website and will take additional public comment at its board meeting April 19.

If you read us, please support us.

Comment Policy

VTDigger.org requires that all commenters identify themselves by their authentic first and last names. Initials, pseudonyms or screen names are not permissible.

No personal harrassment, abuse, or hate speech is permitted. Comments should be 1000 characters or fewer.

We moderate every comment. Please go to our FAQ for the full policy.

Erin Mansfield

Recent Stories

Thanks for reporting an error with the story, "Hospitals, regulators lean hard on surgical center investors"
  • Dave Bellini

    The GMCB has a concrete opportunity to lower the cost of care. If this surgical center is denied then I question the need for a GMCB. Listen to consumers instead of hospital executives. There’s long waits for treatment, there’s great expense and there’s ZERO transparency from hospitals. I noticed that UVM is practically sitting this one out, letting St. Albans hospital take the lead. What this is really about is UVM WANTS ALL THE MONEY. They are a behemoth monopoly and they don’t want any competition. It’s like Walmart saying no one should open a corner store. A surgical center would benefit everyone. It would lower costs and that’s what UVM is afraid of most. UVM continues to take in huge amounts of money and the executive management wants to continue its lavish salaries. I waited for hours yesterday to speak but public comment was shut down after only a few minutes. The whole setting and management of this meeting was designed to make it nearly impossible for public comment. Send the GMCB a letter was the response.

  • James Rude

    “Fairly or unfairly the burden of proving that is on your shoulders, not ours,” Hogan said.

    Well, given that logic, no heath care organization in this state would have been allowed to open their doors. Cost is one thing, but how about less hassle when receiving care. The problem with government controlled healthcare….and let’s not kid ourselves, but that is what we have in VT….is that your choices become fewer as the men and women behind the curtain (GMCB) are pulling the strings trying control what choice you have left.

  • Sheldon Katz

    Wait a minute. This firm wants to open a facility to compete and attract customers/patients. If it does not offer a combination of lower price and better quality and convenience, it will fail. If it does, it will succeed. There is no legitimate reason to disallow it from doing so. We should be laying out the welcome mat and eliminating regs that prevent this or other firms from competing. Let consumers decide, for goodness sake.

  • I am an admirer of and contributor to UVM Medical Center; but I think that the for-profit surgical center hospital should be allowed to open. The quality of care I’ve gotten at UVMMC has been excellent; once the hospital saved my life. But that doesn’t mean that Vermont won’t benefit from competition in order to keep medical costs down..

    We will attract more doctors to the state if they have a choice of being in a wonderful research and teaching hospital or providing care in a smaller, more flexible organization.

    There may be plenty of surgical operating rooms in Vermont, as stated in the article; but I know from experience that does not mean that minor non-emergency operations can be scheduled expeditiously. If a for-profit operation can provide faster care in these cases, that will be a help to many Vermonters.

    We are not cost conscious medical consumers in Vermont because we have neither enough choice of providers nor transparent pricing to compare. The proposed center will offer both choice and transparency.

    Finally, “for-profit” should not be considered an epithet. A for-profit provider will fold if it does not offer something better than its non-profit competitors. There will be, and should be, quality regulations to assure that efficiencies are not achieved by cutting corners which shouldn’t be cut.

    It would take a lot to convince me to choose some other provider over UVMMC or Copley; they have set a high bar for quality. Nevertheless, prices are anything but transparent and waits for non-critical care do exist. Competition should be allowed.

  • Louis Meyers, M.D.

    UVM Medical Center and its affiliates have driven up the cost of health care in Vermont by creating a huge monopoly and decimating the ranks of independent practices. The difference between a non-profit and profit enterprise in health care is often blurred. UVM is a non-profit which pays its CEO over $2 million per year and pays six-figure salaries to a large number of vice-presidents within its system. I support an independent surgery center, just as I would support the resurgence of true independent primary care practices.

  • John McClaughry

    Ever since the Nixon administration promoted the Certificate of Need programs in 1974, CON has become a major government protector of monopolies. This is just the latest Vermont example.
    The article reports “to open would let these independent doctors penetrate a general surgery market that to date has been exclusively controlled by hospitals. And
    hospitals say that could be detrimental to the health care system as Vermonters know it.” Well, duh!

    The hospitals – especially UVMMC – bring out all their political artillery whenever their regional monopoly and facility charges are threatened. Vermont has arguably the broadest CON jurisdiction (30 categories) of the 35 CON states. I have argued for 20 years: repeal the CON law, as half a dozen other states have done. Let UVMMC compete on price and quality, a totally repugnant concept from their point of view..

    • Sheldon Katz

      The CON is a con.

  • Sheldon Katz

    Wait a minute. This firm wants to open a facility to compete and
    attract customers/patients. If it does not offer a combination of lower price
    and better quality and convenience, it will fail. If it does, it will succeed.
    There is no legitimate reason to disallow it from doing so. We should be laying
    out the welcome mat and eliminating regs that prevent this or other firms from
    competing. Let consumers decide, for goodness sake.

  • Melinda Moulton

    Good afternoon, my name is Melinda Moulton and I am the CEO of Main Street Landing. I support the Green Mountain Surgery Center. I have been involved in watching this vision develop over the past few years. I am so excited to have the Green Mountain Surgery Center in the Burlington Area because I will use it.
    This is not a referendum on the UVM Medical Center – this is a practical and wise and much needed addition to the fabulous health care Vermonters already receive in their communities.
    When I had my cataract surgery I chose the UVM Medical Center for that care. I received amazing care – but the experience was overbearing – it took long periods of time to get an appointment and when I arrived to my appointments I had to wait sometimes hours to be seen. I switched over to the Vermont Vision Center for my eye care. The availability for appointments and time spent was noticeable different. I have a friend who tore his Achilles heel – it took him weeks to be seen at the Hospital. I have another friend who had to wait months for the removal of his cancerous prostate with appointments being changed or put off.
    Look – We need More Accessibility to quality health care – not less. Our Health Care should not be centered within one organization.
    The surgeons who want to own and operate the Green Mountain Surgery Center will deliver an affordable, professional and high level of service to our community that supports and complements the services at the UVM Medical Center. This Surgical center will not have the extraordinary overhead of the Hospital – it does not have to pay a development staff and administrators or high overhead for facility operations and expansion. The Green Mountain Surgery Center operations are directed and overseen by their professional surgeons. My guess would be that we will receive extraordinary service – at an affordable price – quickly and efficiently. How can this be anything but a Good Thing for the people of Vermont? Monopolies are not good for people – more choices for the people of Vermont in where they go for their health care is a Good Thing – I hope the Green Mountain Board supports the Green Mountain Surgery Center and the surgeons who so passionately – and compassionately – wish to operate in order to serve our Vermont citizenry.
    Thank you,
    Melinda Moulton, CEO Main Street Landing
    Resident of Huntington, Vermont

  • Justin Worthley

    With a self-insured health benefit platform for our employees, Burton Snowboards is a STRONG proponent of this center. Same procedures at 59% of the cost, and much more accessible to docs and patients. We think the hospital system is important too and plays a critical role in Vermont’s health care delivery system, but the argument that they don’t want competition is quick frankly offensive. They will adapt to the competition and that will make the system work better. It’s sort of shocking that Vermont has been willing to try massive change efforts to our health care system that are unproven, yet it takes 2+ years to approve a proven model that delivers high quality health services at lower costs. Take a look at how common these centers are in other states: http://www.ascassociation.org/advancingsurgicalcare/whatisanasc/numberofascsperstate
    Come on folks, let’s get this done and move on.

    • Neil Johnson

      This is a perfect example of how Vermont can lead the way, When a company like Burton can save massive money by self insuring, captive insurance, of which Vermont is famous for, why aren’t we doing this on a state level?

      Vermont could transform insurance for the United States with captive insurance. The lobbyists control our government, which is why this monopoly has been created. Non-profit does not mean what people think. The NFL was non-profit for decades……billion dollar industry. Non-profit doesn’t mean good deal, ever have a hot dog at these football games? Same thing with medicine.

      Think…2 YEARS and they still don’t have permission to do business in the state of Vermont. We are business friendly? This is a prime example of how backward, incestuous our political dealings are.

      We could have the same health care your family is currently paying $1200 per month, at $500 per month if we allowed price transparency, competition and captive insurance. There’s a reason why the lobbyists don’t want to reduce healthcare expenses, they’ll get a drastic pay cut.

      Ethics reform desperately needed in Vermont

  • Gerry Silverstein

    I support a Certificate of Need for the proposed independent surgical center.

    In the April 4, 2017 issue of JAMA, an article entitled “Making Healthcare Work—Competition Policy for Health Care” the authors make the following statement: “many studies have examined trends toward increasing consolidation of physician practices and hospitals in the US health care system and the negative effects of decreased competition on the quality of patient care and health care costs.”

    The authors go on to state: “Despite general consensus among economists and health policy experts that competition enhances patient choice, improves quality, and reduces cost, few actionable policy recommendations have been offered beyond greater antitrust enforcement by the Federal Trade Commission.

    My own experience will help provide clarity to the need for independent medical facilities. In 2015, I had a problem with my hand. Since my PCP is with the UVMMC, I sought an appointment through their orthopedic department. The earliest appointment required a 6-week wait. Not wanting to wait 6 weeks I made an appointment with an independent orthopedic group, which I was able to see within 2 weeks.

    I saw an orthopedic hand surgeon (MD). His practice billed my Blue Cross Blue Shield insurance $126, and BCBS paid $63.51.

    Wanting a second opinion, I kept my appointment with the UVM Medical Center. My appointment was with a physician assistant who billed BCBS $292, of which BCBS paid $228.83.

    The UVMMC charge was more than double that of an independent group for me to see a PA vs. an MD surgeon, and the reimbursement rate paid by BCBS to the UVM Medical Center was more than triple the rate paid to the independent orthopedic facility.

    The orthopedic group mentioned above has recently been bought by the UVMMC.

    Without competition (and numerous other interventions to control healthcare costs), the unsustainable trajectory of out-of-control spending on healthcare will continue until the evil word “rationing” becomes commonplace.

  • Anne Donahue

    There is a fundamental reason that this center would not save costs to the system, and it relates to the convoluted way we currently reimburse health care, in particular in this case, health care in hospitals. It speaks to the need for payment reform as a whole. Hospital services are not reimbursed based on costs of the service in question. There are services that are reimbursed at higher than cost, and others that are reimbursed at lower than cost. They balance out in the end. Surgery is a revenue gain. That is why a for-profit provider would like to enter the field and make profits, even at a lower cost per procedure. If hospitals lose that revenue, everything else they do will have to go up in comparison, in order to balance the books — thus no savings to the health system as a whole. That needs fixing. But until it is, we are not comparing apples to apples on costs, and for-profit centers should not be allowed to step in and take advantage of these fundamental payment disparities.

    • Taylor Harmeling

      While that is a very neat summary of how reimbursement for health care works, and it is the easily digestible story that hospitals in Vermont have been spoon-feeding to legislators for years, it’s unfortunately too neat to be true. In the real world, hospitals with negotiating leverage in local markets charge as much as they can for all kinds of services including physician services, surgeries, imaging, labs and all the rest. They charge so much that their books MORE than balance out at the end of the day. That’s why there is so much extra money floating around the health system, which then gets spent by the monopoly hospitals on excessive executive pay, hiring armies of administrators, and massive new construction projects.

      The other thing that is conspicuously missing from your very neat story about how we currently reimburse for health care is… you guessed it… the patients! What about choices for the patients? What about having recourse if you are dissatisfied with service at the massive local hospital? By retelling the hospitals’ neat little story you are advocating for protecting the status quo of system that has systematically eliminated peoples’ choices (witness the closing of independent practices throughout the state) and forced people to continue to pay for health care increases well in excess of the rate of inflation year after year. It’s time we stopped with stories and started demanding to see the facts.

      • walter carpenter

        “It’s time we stopped with stories and started demanding to see the facts.”

        While I wholeheartedly agree with a lot of what you have said here about the hospitals, I want to see the facts on this surgical center. I want to know who is making the money there? How much are the CEO’s getting paid? What about the investors, if there are any, and so on? I do not think that this will save costs at all. Instead, it will add to them. This surgical center is no feel good story and I want to see these facts and more. If this and others like it do succeed, I also want to see them heavily regulated by the board.

    • walter carpenter

      “Surgery is a revenue gain. That is why a for-profit provider would like to enter the field and make profits, even at a lower cost per procedure.”

      Thank you, Anne, for pointing this out. I do not see how adding another company, facility, or whatever that is going after more and more profits is going to lower our health care costs or make things easier. I see huge problems with them. What kind of service will they provide, for example, to those on Medicaid versus Cadillac plans. What about the uninsured? Will insurers reimburse them differently than a surgeon at UVMMC? While I agree with a lot that has been said in this thread about the hospitals and UVMMC in particular, Anne has a good point. This is not going to lower costs at all. The only thing that will do that is Medicare-for-all. Every nation with universal care has proved this.

      • david schwartz

        Face it, you are not going to get medicare for all anytime soon with Trump et al. If you had attended the hearing or read the GMSC application, you would be reassured that there will be no “cherry picking”. If you prefer to pay twice as much for you care with a UVM employed physician at UVM, you are free to do so. But don’t deny others access to more cost effective care.

  • christine murray

    I agree with Ms. Donahue’s points but not her conclusion. A payment scheme that requires some to pay significantly more for a procedure to cover the costs and inefficiencies of a large university based hospital system to the point of creating a huge monopoly needs fixing-but not by squashing the very thing that could help the fixing occur! UVMMC enjoys a number of reimbursement assistance policies to address the needs of the un- or underinsured: they are a non profit institution with all the tax benefits that affords, they receive specific CMS funding to train residents, they charge considerable facility fees, their insurance reimbursements are up to 300% more for the very same services that non affiliated practices provide, they are allowed to maintain reserves in the millions of dollars-the list goes on. They are an amazing institution that provides great care but removing all the incentive for them to run a tighter ship doesn’t benefit anyone. The ever expanding administrative costs, the continued acquisition of enormous real estate holdings, the waste and duplication in the system-all of these will continue to increase our health care costs if left unchecked. As a founder and owner of my own clinical practice (started after having spent 16 years at UVM) I can assure you that our eyes are continuously on the bottom line. We are keenly aware of competition and adjust our practices accordingly. We understand that not providing the best service for the lowest cost will quickly lead to our failure. I am sure that the Green Mountain Surgery Center will follow those same guiding principles. There are a finite number of outpatient surgical procedures that need to be performed in this state: if some of them can be done for less cost, how can anyone believe that this is not a good thing for the state of Vermont? One final word: as a provider, there are many patients I see who would be better served by an ASC approach: young adolescent women and women with disabilities requiring minor surgical procedures are likely to have an easier time in a smaller, quieter setting than in a large and intimidating operating room. I am hopeful that the GMCB and legislators can see fit to move away from a model which relies on an ‘us or them’ mentality and towards a more collaborative approach recognizing the benefits of choice and competition for our patients and our economy.

  • If you have taken the trouble to comment here, please also post your comment – pro or con – on the website of the Green Mountain Care Board. VTDigger is a great forum but postings on the GMC site are something the Board must take into account. http://gmcboard.vermont.gov/board/comment

    • Tiki Archambeau

      Thanks for sharing this link!

  • Jenny Keller Brown

    I am a physician practicing in VT. My question for the Green Mountain board: In the ever-changing healthcare landscape, are we trying to force our current model to answer our needs in a sub-par manner, or are we open to change to meet the needs of our community and economy? Can we work to improve patient satisfaction, while lowering costs? Hospitals are an integral part of our health care system and always will be; however, this doesn’t mean we should dig in our heels and resist change in our system.
    1) The question is not capacity, but rather need. Patients need and want a more focused, less complex, more accessible environment when they are receiving outpatient care. We all want efficiency: the time for me to perform one common, simple outpatient procedure is 1.5 hours or more at UVMMC whereas this same procedure took me 30 minutes in a surgery center (Colorado). Add in unpredictable turnover times (not “24 minutes” as testified yesterday), and more office hours are blocked and my patients wait longer to get an appointment.
    2) Why do we have a shortage of physicians in Vermont? New graduates expect to work in a modern health care system. Across the country, the bar has been set for efficient, focused, personalized care—outpatient surgical centers are part of this expectation. I completed my training in VT 5 years ago, and when looking for practices, I prioritized innovation and personalized, accessible care— important in my field of infertility. I initially took a position in CO; as my family grew, I was lucky to find a practice in VT, which had recently been established independently and allowed for those opportunities. In order to recruit young physicians to our state, we need to embrace change.
    3) Competition works! When our practice first opened its doors 2.5 years ago, we offered a price for in-vitro fertilization (IVF), that was 30% lower ($7000) than the hospital currently offered (close to $10,000) and hence accessibility to care was greatly improved: our number of IVF treatment cycles rose to 185 cycles in the 1st year- a 45% increase from the 120 cycles done by our same doctors who left UVM the year before. Interestingly, when this happened, UVMMC was able to lower their costs to compete, after years of charging higher prices. Competition is much needed in VT.
    The economist recently wrote an article about how hospitals have been reinvented many times. (http://www.economist.com/news/international/21720278-technology-could-revolutionise-way-they-work-how-hospitals-could-be-rebuilt-better)
    This is not the first nor will it be the last change we embrace as Vermonters. Thank you.
    Jennifer Brown MD,MBA

  • John LaCroix

    Health care costs are continuing to rise WITHOUT competition. Now a group of investors willing to put up their own capitol are willing to wade into the pool. Hospital executives accuse the effort of ‘driving up costs’. If the GMCB doesn’t allow this to go forward, they are simply giving the hospitals card-blanche to increase costs. Is the GMCB in the business of creating a monopoly on health care services within the state of Vermont?

  • Tiki Archambeau

    There’s a great article speaking to how hospitals have evolved from consolidating for efficiency to consolidating for the bottom line.

    The article, ‘How U.S. Health Care Became Big Business’, shows how Vermont is not alone. In fact, encouraging such behavior only serves to drive up costs.

    The public seems supportive of this surgical center. Let’s hope the Green Mountain Care Board shares our values.

    • Neil Johnson

      Monopolies always consolidate for the bottom line, they are serving themselves not the public. You’ll note all these great efficiency standards have only raised our health care expenses drastically. Profits, money are the sole reason for monopolies, matters not if they are non-profit or for profit. It’s about power and money, always.

  • John Rolfe

    Healthcare in Vermont is a disaster. Claiming that it currently “works for everybody” is untrue. Full Stop. I run a small business.I have paid hundreds of thousands of dollars in state income taxes over the last decade. My annual health insurance premiums, meanwhile have risen about 150% over the last seven years. I can, and will, pick up and move my business out of state within the next few years if something is not done to address the rising premiums and lack of competition in the foreseeable future. Between insurance premiums and my deductible, my aggregate out-of-pocket for my family is roughly $20,000 annually before heath insurance begins to pick up any meaningful portion of my costs. When I broke my wrist several years ago, I was out of pocket nearly $6,000. This is, in large part, due to lack of competition and lack of pricing transparency as a result of vested hospital interests protecting their bottom line and fighting against initiatives like the proposed surgical center in Colchester. When I got my itemized bill, The University of VT medical center had charged me nearly $1,000 for use of a “recovery room” following my surgery for my broken wrist. The “recovery room” was a bed surrounded by a curtain on a floor with about 10 other similar “rooms”. I was in the “room” for less than 30 minutes while my anesthesia wore off. Seriously, $1000! Crazy. I used to be able to piggyback on the VT Chamber of Commerce small business policy for my health insurance, but the state forced me off onto the individual exchange when the ACA came in several years back. This alone raised my premiums materially. I do believe that there is a moral obligation for us to provide a base level of healthcare for everybody, but the way to do this is not my maintaining oligopolies and discouraging competition. There is nothing wrong with “for-profit”. It merely means we are putting in place economic incentives for efficient delivery of care. Let’s talk about senior administrator salaries at the University of VT medical center…pull that thread and you will understand why these entrenched oligopolists are fighting so hard against any sort of reasonable competition.

  • Tina Helzer

    I support a certificate of need for the proposed surgical center. The problem is that I have a very small voice. I am not a physician, politician or investor. I am a stay at home mother of two that recently moved to Vermont from NYC because we wanted a better quality of life for our family. When I received my first bill from UVM for a very routine procedure, I started to realize that health care was going to be the exception to the higher quality of life that the great state of Vermont offers.

    Last Thursday I hired a babysitter to watch my kiddos and drove to Montpelier to attend the Green Mountain Care Board hearing for the proposed surgery center. Standing for 3 hours as all the seats were occupied by hospital executives and lawyers at the GMCB hearing I became even more disillusioned. It became clear to me that my voice, the consumer, the patient, the VT resident was not represented at that hearing nor did it seem to be missed. The voices of the hospital executives and their lawyers droned on and on as news to me they are now the experts on what is best for the community. Shouldn’t that question be answered by the community not the powerful minority of hospital execs? Where did the patient’s voice go? They believe that not only does our community not need a surgery center (I guess I’m the only patient that has balked at my bill) but a surgery center would be detrimental to our community because it is for profit. For profit to me means it won’t be subsidized by our government, will generate tax revenue and will be successful only by generating value (i.e. providing higher quality at a lower price than the competition) for the consumer. To survive, for profit businesses have to put the consumer/patient first. Now wouldn’t that be refreshing.

    I want choice and freedom when it comes to my family’s health care. This is something I had in NYC. I believe that a surgery center is the first step in providing Vermonters with that freedom.