Brumsted, who is married to the CEO of Vermont’s largest hospital, made the comments during a meeting at OneCare Vermont, where another lawmaker asked if the surgical center would be allowed to join the organization’s network of providers.
Investors in the Green Mountain Surgery Center have been seeking a permit for the project from regulators for nearly two years. Regulators have said they plan to decide on the project in August.
The Vermont Association of Hospitals and Health Systems and Northwestern Medical Center in St. Albans have opposed the project throughout the permit process. In April, an executive for the University of Vermont Medical Center testified against the proposed surgical center.
Rep. Carol Ode, D-Burlington, brought up the surgical center when speaking to leaders of OneCare about their vision for the future of health care. Ode asked how the surgical center could fit into OneCare’s vision of an integrated network of hospitals and doctors offices.
Todd Moore, the CEO of OneCare, said he would be open to discussing whether the surgical center can join OneCare, as long as the system needs capacity and the facility is willing to receive fixed monthly payments instead of individual payments for each surgery performed.
“That’s the rub … do we need the capacity or not?” Moore said. “But if the data is that we need the capacity, we bring them in. But guess what, I don’t want them paid” for each individual surgery performed.
“I don’t want them incented to generate more units of care than are necessary,” Moore said. “So if they’re willing to come in and talk about being on a fixed-revenue model like the (OneCare) hospitals are, then, yeah, we could have that discussion.”
Brumsted — who is married to Dr. John Brumsted, the CEO of the UVM Health Network and the UVM Medical Center, and does volunteer fundraising for the hospital — then entered the conversation. She used her family’s experience with getting colonoscopies to explain why she thinks health care costs would go up and nurses could be laid off.
“I think of this as my mother in Rhode Island where there is colonoscopy sites outside, and my brother and his wife and those folks, when they turned 50, they went to the place that was the cheaper colonoscopies, right, because they weren’t having any problems or secondary issues,” she said.
“But my mother has diabetes, has liver disease, had breast cancer, and she tried to go there too because it would be cheaper, less copay,” she said. “Guess what they said? ‘No way, you need to have your colonoscopy done in the hospital because something bad could happen.’”
“But the hospital has to charge a lot more in Rhode Island now,” she said. “Because why? Because they can’t spread the cost off at all on all those people who are getting colonoscopies and they don’t have all those secondary issues.”
“The reality is that the true cost of a colonoscopy really is the bigger picture,” she said. “It’s not so simple, is my point, and when you’re a community that wants to take care of everyone, you have to think about that.”
“If it’s capacity — that’s a different issue — if the hospitals can’t handle it all,” the lawmaker continued. “But even then, do you want the hospitals to be just taking care of all the really high-end folks and not be able to spread out the costs, because what will happen is they might have to lay off the nurses in the pre-op or post-op because now they’re going to go work at the (other facility).”
She added: “It shifts a lot of things. It’s not a simple answer.”
With regard to Jessica Brumsted’s comments, she said patients with complex medical conditions are sometimes best suited for inpatient surgery, but there is no reason that perfectly healthy people can’t get their care through a small outpatient surgical center.
“It seems as though the hospitals are speaking out of both sides of their mouths when they say that their goal is to provide the right care in the right setting at the right time,” Cooper said.
“A small outpatient surgery center is obviously the right setting for patients who are able to have procedures there at much lower cost, but when we suggest a surgery center that’s not owned by the hospital, then they think of all the reasons why it’s a terrible idea,” Cooper said.
“You can’t have it both ways,” she said. “Either we’re going to make innovations that lower costs here, lower health care costs for Vermont consumers, or we’re not.”
“I want the hospitals to figure out ways to lower their cost structure,” she said. “Hospitals in every other state have been working on this, and that’s what hospitals in Vermont are going to have to do if we’re ever going to get ourselves out of the health care cost crisis.”
Cooper also said the surgery center would see patients with all different types of insurance, including Medicaid, and that there would be a charity care policy for people who cannot afford to pay for the service.
