Health Care

Surgical center investor contests ‘misleading’ testimony

Amy Cooper
Amy Cooper, the executive director of HealthFirst and the lead representative of the proposed Green Mountain Surgical Center, testifies before regulators last week. File photo by Erin Mansfield/VTDigger
At a second day of testimony on a controversial planned surgical center, the lead investor in the project responded to what she called “numerous misleading or even false” assertions from hospitals opposing the project.

Amy Cooper, the executive director of HealthFirst, took aim at the University of Vermont Medical Center’s statements that it has plenty of capacity in its surgery rooms and that hospitals are fully nonprofit entities.

Cooper’s testimony happened in front of the Green Mountain Care Board on Wednesday. The board scheduled the additional time for testimony that Northwestern Medical Center, investors and members of the public were not able to complete last week.

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

“The doctors who were accused of being profit mongers during the hearing last week are the same ones who have been serving this community for many years and have taken all payments, including substandard Medicaid rates, with no ability to cost-shift in their budget for this,” Cooper said Wednesday.

“It is done purely out of a sense of a community,” she said. “I think independent physicians in Vermont have shown historically that they are primarily community-driven, rather than primarily profit-driven. They dedicate the majority of their lives to serve others, and I think a little more consideration of that fact would be appropriate.”

Cooper said recent UVM Medical Center financial reports describe that the hospital has for-profit endeavors. She also cited meeting materials from the Vermont Association of Hospitals and Health Systems that say disruptions can spur innovation.

“The UVM Medical Center, Vermont’s largest nonprofit corporation, notes on page 12 of its 2016 financial report that UVMMC runs some ‘for-profit’ corporations, without offering definitions as to what they do,” Cooper said, making air quotes when she said “for-profit.”

“One is called UVM Medical Center Executive Services,” she said. “Another, 116 Realty. Another is called UVM Health Ventures. Another is called VMCIC, which is exempted from taxes by the government of Bermuda until 2035.”

“They also state, in their financials, that some of these entities are not accounted for in their statements because they have uncertain tax positions,” Cooper added.

She also disputed testimony from Christina Oliver, the vice president of clinical services at the UVM Medical Center, who said last week that the proposed surgical center is not needed because the hospital’s operating rooms and procedure rooms are working far below capacity.

“We have no requests for blocked time (in procedure rooms) and no requests to fill them,” Oliver said last week. “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.

Cooper said the medical center’s intake endoscopy rooms are so full that it creates a bottleneck such that the procedure rooms cannot be used. “Given the realities of this situation, in effect (the utilization rate Oliver referenced) is in fact full capacity at UVMMC,” she said.

“The truth is that there are not enough intake rooms in the endoscopy center to support keeping all of the procedure rooms full at all times,” Cooper said. “That is why there are available hours and empty rooms in their utilization calculations, but that does not mean that they can realistically be used to that capacity.”

She went on to read from an invitation to the annual meeting in September of the Vermont Association of Hospitals and Health Systems, with the theme “Positive disruptions and the opportunities ahead.” She read a Melinda Gates quote from the invitation praising the potential benefits of disruption in solving health challenges.

Cooper concluded by saying, “Our small (surgical center) project is just the kind of positive disruption that is needed in Vermont health care, and it will be a disruption that our hospitals are ready for, are preparing for, and are capable of reacting to, in the best interests of the patients, the payers, and the community at large.”

The hospital association, which did not testify Wednesday, has argued in the past that there is no need for the surgical center; it would increase the cost of commercial health insurance and the need for public funding to Medicaid and Medicare; and it is “inconsistent with health care reform.”

The Green Mountain Care Board will continue to accept public comment through its website until May 1.

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Erin Mansfield

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  • Dave Bellini

    A new surgical center would be a benefit for thousands of Vermonters who need services and don’t want the hassle and long waits for treatment at UVM. Lower costs mean lower insurance premiums. Monopolies keep prices high. UVM has gobbled up most of the medical practices and hospitals in the area resulting in higher cost. It’s not even a close call folks. I don’t want the government deciding for me, where I am allowed to receive medical treatment. The GMCB is essentially deciding if medical care will become part of state government.

    • Jim Manahan

      That decision was made a long time ago when Obama nationalized our healthcare system with Obamacare.

      • JohnGreenberg

        Please explain in detail how Obama “nationalized our healthcare system with Obamacare.” Actually, that proposition is utterly false.

        • Peter Chick

          If the IRS is able to fine an individual for not paying for health care insurance I would call that nationalized health insurance.

          • JohnGreenberg

            You can call a cloud a horse if you want, but that doesn’t mean you can ride it.

            The individual mandate requires that everyone purchase health insurance or pay a tax penalty.
            Most states require that those wanting to drive a car carry liability insurance. Does that mean they’ve nationalized the auto insurance industry?

            The US healthcare system, meanwhile, is entirely private (other than VA, Medicare and other programs which pre-date the ACA).

            The government doesn’t provide insurance OR healthcare. Nationalized systems, such as those found pretty much everywhere else in the developed world. provide one, the other, or both.

        • Neil Johnson

          Lobbyists, moneyed corporations had the ACA waiting for him on his desk. No representative or senator read the 1800 page document before voting on it. And the American public didn’t even have time to read it either.

          More appropriately he sold out along with all our other elected officials to a monopoly controlled business. That’s why drug prices have been allowed to sky rocket. Monopolies.

          • JohnGreenberg

            Your first paragraph is simply hogwash. I spent many hours watching Congressional committees debate the ACA bill over a period of
            many months on C-Span. The bill was hashed out publicly in considerable detail. I’m sure the hearings are still available in the C-Span archive.

            How many representatives and senators read the bill in its entirety I can’t say, any more than anyone can say how many read ANY bill in its entirety. But the passage of the ACA provided as much or more opportunity to do so as any
            bill the goes through Congress.

            As to the US insurance industry, it’s many things, but it’s not a monopoly, although in some
            areas, the number of ACA insurance providers has declined to just one. On a nationwide basis, at the time of passage of the ACA, there were as many large insurance companies as there were appliance manufacturers, car manufacturers, etc. There were then and still are tens of thousands of healthcare providers.

            All that said, Obama clearly did decide not to oppose critical interests of affected industries like the drug and insurance companies. Had he done otherwise, the bill would almost certainly not have passed since, at final passage, there were only just enough votes to pass the bill, with no additional votes to spare.

          • Neil Johnson

            50% of the states have on insurance company that has 80% or more of the market, call it what you want. Then a holding company oversees all the blue cross organizations for every state. You can’t insure across state lines, what other insurance profile works that way? Lobbyist were in control of everything……my hog wash is very accurate. Since the ACA was enacted, we’ve had mergers galore and soaring drug prices, which have nothing to do with supplies, everything to do with market control. We’ve had so many consolidations that have saved so much money, yet our insurance premiums are going up with our deductible going through the roof. Sorry it’s not me that’s messed up on this one.

    • Skyler Bailey

      I would actually say that the entire purpose of the GMCB, as intended by its creators, was specifically TO decide that medical care is a part of state government.

      • JohnGreenberg

        Medical care is NOT a part of state government. REGULATION of medical care is. There’s a pretty vital difference between those 2 propositions.

        • Jim Manahan

          That’s what it used to be prior to Obamacare, now they are both part of our government at the fed and state level.

          • JohnGreenberg

            I’m sorry, but I don’t understand your comment.

          • Jim Manahan

            No need to apologize. Just realize that Medicare and Medicaid are most certainly a part of state and federal government and the last I checked, both of those government funding sources are a key component of our state and federal budgets, as well as all the regulatory and administrative bodies at the state and federal level that encumber our healthcare system. The VA is a good example of just how incompetent our government is in administering a healthcare delivery system.

        • Skyler Bailey

          Only because Shumlin’s single-payer system, which the GMCB was created to help implement, failed.

          • JohnGreenberg

            The point is that it DID fail. As the Israelis say, if grandmother had wheels, she’d be a bus. The point is grandmothers do NOT have wheels.

    • Jim Manahan

      The same could be said, and much more accurately, for numerous functions of state government. Lower costs mean lower taxes. Monopolies keep healthcare and pension costs high. Obama and Shummie already decided that medical care will be part of our federal and state governments, so that ship sailed a long time ago.

  • Robert Ronald Holland

    To address the capacity problem you need more information. For example, how often does UVM Medical Center have to suspend transfer of patients to their intensive care units because they are full? How often is their emergency department housing patients that need the services of full admission to an inpatient bed? Perhaps it is time to consider repurposing resources. Take a wider view – don’t just count the number of operating rooms and procedure rooms. That is an impaired perspective – a “monocular, color-blind, pointer reading mentality” as named by EF Schumacher.

    • Nachman Avruch

      What do those questions have to do with an outpatient surgical center? The center proposes to perform those procedures which require the least degree of infrastructure for patient care (i.e. equipment, room, nursing and other clinical staff, etc.) and the highest profit margin.

      • Robert Ronald Holland

        Some things can be moved off campus – some can’t. Recently many patient were denied timely admission to intensive care – repurpose the campus infractructure to meet that need.

        • Nachman Avruch

          The point is they aren’t doing this to benefit the community, they are cherry picking the easiest and most lucrative work to maximize their own profit at the expense of institutions that actually perform a safety net function for the entire state.

  • Larry Rudiger

    First, Melinda Gates….seriously?
    Second, the value of ‘disruption’ is a myth, but apparently Mrs. Gates hasn’t heard that, yet. Pity.
    Third, what are the odds that nurses at this new facility will be represented by a union?

  • Neil Johnson

    How to spin, how to recognize propaganda…

    How is it that a for profit company can provide the same service at a substantial savings over a non-profit?

    This is going to short circuit many across that state, it can’t possibly be true they will scream! Non-profit good, for profit evil!

    Yet the NFL was non-profit. Surely they made no money! Yes just because you stamp non-profit doesn’t mean it’s a good deal or even a complete waste of money. $7 for a hot dog in Gillet Stadium, yet the hot dog lady only charges $2.50 and makes a great living. How can that be?

    Non-profits are being so abused across our state, inflated wages, waste, fraud. We do need ethics reform.

  • Robert Wood

    It is incumbent upon anyone wishing to discuss health care reform and finances to review the works of Richard Himmelstein, Steffie Woolhandler, Michael Iammarino, Norton Hadler (and many others). Their observations have been validated over the last 25+ years

    Simply put, the only sector in health care which mirrors the geometrically progressive escalation in health care costs is the increase in administrative costs. This is a well recognized effect of any monopoly.

    Those costs include administrator salaries as well as the clerical costs incurred by entering and tracking all of the often meaningless, bean counting metrics [cf Hadler and hemoglobin A1c] the GMCB holds so dear.

    Whatever “faults” conjured up by the image of “for profit” health care, such instituions tend to avoid bloated bureaucracies, have lower costs while maintaining availability, and overall have an admirable track record of trimming the fat. Aren’t these major issues in health care reform?

    • Paul Slobodian

      Yes, the non profit administrators have mastered the language of philanthropy as they consolidate power over doctors and patients and drive up prices. Ambulatory surgery centers usually charge 1/2 of what the hospital systems charge.
      Yes, Nortin Hadler’s books are fantastic. His book Citizen Patient provides great insights to the health care system players. Here is my Amazon review that gives an overview:

  • Jamie Carter

    FAHC has been a money hungry entity for quite some time now. If anyone bothered, MR. Hoffer, to look into charges v. actual realistic cost, one would find an utterly obscene descrepancy. Just outright highway robbery, and yet they are a non-profit. How can that be?? Well just look at some of their plans and proposals recently. $150M expansion going on right now, an expansion that does not add a single bed to the hospital. Gotta use up that money… or look at their proposed land purchase two years ago, paying 10X market rate, may have to take a peek back at that one and see if 116 Realty was involved with that.

    The fact is UVMMC wastes money, they have to or they risk losing their non-profit status. They could lower rates, but why? They’ve already convinced the public that $12 for a single tylenol is just the way it has to be, why ruin the ruse?

    • Peter Chick

      Non-profit does not mean low paying.

    • Jim Manahan

      What evidence do you have to support such an utterly obscene statement?
      You may want to research what it means to be a non-profit, and learn a little bit about GAAP and cost accounting for starters, otherwise you might come off as completely ignorant.