(This story was updated June 5, 2017, at 5:30 p.m.)
[T]he Visiting Nurse Association of Chittenden and Grand Isle Counties says it may affiliate with the state’s largest hospital system.
The association announced in a news release Monday that its board of directors has signed a nonbinding letter of intent to explore affiliation with the University of Vermont Health Network.
The association and the network will spend several months looking at the pros and cons of having the VNA, which is Vermont’s oldest and largest home health and hospice agency, join the hospital system.
The two groups have been discussing the affiliation since early 2016.
The UVM Health Network, formerly Fletcher Allen Partners, was created in 2011 to unite the UVM Medical Center in Burlington — which was then Fletcher Allen Health Care — and Central Vermont Medical Center in Berlin.
The network has since added three affiliate hospitals in upstate New York and Porter Medical Center in Middlebury. This would be the first visiting nurse association to join the network.
Dr. John Brumsted, the CEO of the UVM Medical Center and UVM Health Network, said in a news release that the affiliation would “give us the opportunity to better coordinate patient care wherever it is delivered and improve outcomes for the residents of those two counties.”
Brumsted said the care coordination would help meet health care reform goals that have been integral to the state’s planned adoption of an all-payer model. The major reform that health care leaders have promised is a switch from doctors being paid based on the procedures they perform to a flat monthly fee to take care of patients.
The VNA is funded largely through reimbursements from Medicare, Medicaid and commercial insurance. The VNAs also get money from self-pay patients, the cities they serve, foundations and nonprofits.
The VNA of Chittenden and Grand Isle Counties has an annual budget of around $33 million, sees 6,000 patients a year and has 630 employees.
The health network’s flagship hospital, the UVM Medical Center, has an annual budget of $1.3 billion from seeing patients. The hospital and its dialysis centers have more than 1 million patient visits a year and 7,800 employees.
Judy Peterson, president and CEO of the VNA, said the governance changes under the affiliation with the UVM Health Network would be “identical” to the changes that affiliate hospitals have made.
Peterson would answer to both the VNA’s board of directors and Brumsted. The VNA’s board would answer to the network’s board, and the VNA would have to have its budget approved by the network.
Peterson said joining the network started with a discussion with Brumsted in November 2015. “We ended up saying, ‘You know, we should be working more closely together,’ and that was when it really all began,” she said.
For the past 18 months, Peterson said, a small group with some VNA board members and some of the network’s board members have been meeting and “trying to decide if this is something that would be beneficial to the community.”
Peterson said the VNA would like to share electronic medical records software with the hospitals. She said the VNA is able to tap into the UVM Medical Center’s current software, called PRISM, but not contribute notes or records.
The network has been seeking permission from state regulators since January for a $112 million upgrade to a software system called EPIC. The Green Mountain Care Board needs to approve the application, called a certificate of need, in order for the project to go forward.
If approved, the system would finally integrate records between the UVM Medical Center and Central Vermont Medical Center, which has been interested in an integrated records system since the original affiliation in October 2011.
Porter Medical Center also said it was interested in using the network’s records system when it decided to affiliate. Originally, Porter was not part of the proposed electronic medical records system because it was not part of the network at the time it started project planning. However, the hospital system decided in March to include Porter.
“The EPIC (system) is a hospital-based system, but they do have a home health module, and that’s what we would be looking at potentially utilizing,” Peterson said. “If that were the case, then we would all, in real time, be able to look at one another’s records.”
Peterson said the affiliation is still only a possibility, but the board could decide to move forward with it as soon as the fall or the end of 2017.
“Transition to a new medical records system is a time-consuming and costly project, so I’m sure … it would at least be a year or two after that before this would be able to be fully in place,” Peterson said.
She said the quality of care delivered to patients would be more “streamlined” with the new system in place. She used examples of patients having to tell different doctors over and over their date of birth. She also said using multiple systems can make it harder for doctors to accurately track whether patients are taking their medication.
Mike Fisher, the chief health care advocate for Vermont Legal Aid, said the possible affiliation didn’t immediately raise red flags for him.
“They describe the motivation for this change as based on quality, and so that’s at least interesting as we discuss transitions in the health care system,” said Fisher.
“When I hear that this VNA is contemplating this change, my first question is that they engage in a community process that includes a sort of transparent community conversation with their community of both providers and patients,” he said.
Fisher said he is not concerned about the size of the UVM Health Network unless it lowers the quality of care. “UVM is by any Vermont measure huge,” he said. “It’s not huge by other measures, by national standards. … It’s hard for me to see a size concern related to this decision.”
Mike Noble, the spokesperson for the UVM Health Network, said he is not aware of any other organizations that may join the network.
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