Editor’s note: This commentary is by Tom Huebner, who is CEO and president of Rutland Regional Medical Center.
[V]ermont’s health care system is one of the most regulated in the country. This framework has helped to contain cost and expand health care in a thoughtful and responsible way. The Green Mountain Care Board is responsible for determining if new health care facilities are truly needed to enhance the health care system for all Vermonters.
The addition of an ambulatory surgical center in Vermont like the one being proposed in Chittenden County is precedent setting. If one is approved in Chittenden County I worry that Rutland would be next. For mid-sized and critical access hospitals in Vermont, which operate tight financial ships, there is little margin to manage the impacts of new and unregulated competition.
On behalf of the hospital I lead in Rutland, I am concerned about the effects an ambulatory surgical center would have on our hospital and community should one eventually be approved in our area. Ambulatory surgical centers do not take all comers like Rutland Regional does. At Rutland Regional we accept all patients, no matter their ability to pay. This means that often we provide free and uncompensated care to our community. This is what hospitals do — this is what taking care of a community’s needs looks like. Ambulatory surgical centers do not have to be up and running 24 hours per day, 365 days per year to meet all the needs of the community like a hospital. They can focus on only the easier, more profitable services. That makes it very difficult for a community hospital to survive.
The fact is, Vermont has limited the amount of capacity in the system through tough but fair regulation as a way of containing costs and ensuring access.
Unlike Vermont’s hospitals, the ambulatory surgical center would not be subject to the annual tax that funds our state’s Medicaid program. The ambulatory surgical center would not answer to the GMCB’s budget process or financial oversight, nor would it be subject to state licensing requirements or reporting requirements.
The fact is, Vermont has limited the amount of capacity in the system through tough but fair regulation as a way of containing costs and ensuring access. More buildings, especially unnecessary ones, equal more cost. In a small, highly regulated rural state, an investor-owned surgical center would absolutely affect the strength of some hospitals and the services we’re able to provide. In Rutland, we have expanded our capacity to meet demand and done so within the confines of the certificate of need process. We had to prove that there was a genuine unmet need in our community. Any ambulatory surgical center should do the same.
Twenty-seven years ago, when I joined Rutland Regional, the vast majority of services were inpatient. Now 60 percent of the care we deliver is on an outpatient basis. In 1990, a patient receiving a total hip replacement would be in hospital 12 days. They are usually now here for 24 hours. Technology improvements have driven many of these changes. But the needs of our community have changed as well. We now provide a wide array of behavioral health programs like the West Ridge Center for Opiate Addiction. Not all of these services are financially self-supporting, but our community needs them to be provided. To make investments like this for our community we also must be allowed to balance them with services like ambulatory surgery.
Here in Rutland, our hospital is investing in health care reform, addressing the opioid crisis, grappling with symptoms of poverty, and partnering with community providers and other hospitals to expand telemedicine and specialized services for our neighbors living with mental illness and chronic diseases.
There is a tremendous amount of work ahead, but together with our provider partners, state leaders and so many others we continue to make progress. I hope that we fully understand the implications of allowing for-profit surgical centers on all stakeholders before we set a precedent that could have a significant impact on our forward progress.
