A community hospital in Morrisville is under regulatory scrutiny for its popular orthopedic surgery program.
Members of the Green Mountain Care Board have been considering for weeks whether Copley Hospital is in violation of a permit the board issued in February 2016 for the hospital to replace its surgical center.
Kevin Mullin, the chair of the Green Mountain Care Board, said Friday that the panel would decide in the coming weeks if it should hold a hearing on whether Copley Hospital is in violation of its permit, called a certificate of need, or CON.
“We continue to look into that, and it’s an ongoing discussion with the board,” Mullin said. “They agreed in the CON to adhere to the guidelines that were given to them, and then they didn’t adhere to them.”
Art Mathisen, the CEO of Copley, said in a statement: “Copley Hospital has always worked closely with the Green Mountain Care Board. We continue our collaboration with them.”
This is the second year in a row that board members have criticized Copley’s surgical program. In 2016, members told administrators at Copley, located about an hour’s drive from Burlington, that the hospital’s doctors are performing complex surgeries that would be more appropriately performed at a larger hospital.
The board said it based its February 2016 CON approval on information from the hospital that it performed 1,800 surgeries annually and, in the board’s words, did not anticipate “any appreciable change in projected surgical volumes” as part of the project.
Additionally, the board told Copley it must “meet all growth caps, targets and other conditions and guidance imposed by the Board for each of its hospital budget submissions” through February 2019, and that the hospital could not increase charges to commercial insurance companies to compensate for project cost overruns.
Mullin said Friday the hospital is now taking in more money from the surgical center than was originally approved as part of the CON process. During its fiscal year 2018 budget hearings, Copley told the board it would take in more revenue from patient care than the board wanted because of increased utilization in the surgical center.
At a board meeting Sept. 7 to discuss Copley’s budget, Jessica Holmes, a board member, commended the quality of Copley’s surgical program but expressed disappointment that the hospital wanted to take in more revenue than the board originally asked for during budget guidance.
“I was here for the CON and, you know, we took Copley at its word,” Holmes said. “And I know times change and things change, (but) this wasn’t that long ago that there was a commitment to abide by the board’s guidance.”
At the Sept. 7 meeting, Mathisen described the hospital’s orthopedic surgery center as a “center for excellence.” He said the care is so good that the center is getting more patients through word of mouth.
Mathisen, who managed military hospitals before joining Copley, said his focus on efficiency also could have contributed to volumes. “I don’t know another way to run a hospital than to make it as efficient as possible,” Mathisen said. “If there was error, it wasn’t knowingly.”
However, Robin Lunge, a board member, said the situation “really bothers” her. “When we consider the CON, the utilization estimates need to be solid,” she said. “I’m not comfortable with the board issuing an order with a condition and then having us not follow that.”
Maureen Usifer, another board member, said Copley seems to be getting more patients from Chittenden County, where the University of Vermont Medical Center in Burlington serves as the local community hospital.
“It seems when I talk to anyone in the Burlington area, anyone who gets a surgery goes to Copley,” Usifer said. “If it is in fact coming from elsewhere, we need to see that offset in the system at other hospitals.”
Mathisen said he does not expect surgeries to keep increasing so much in the future. “I think in the next couple of years, my estimate is that we are going to flatten out,” he said. “We’re not hiring any orthopedic surgeons.”
To bring the anticipated revenue down from what Copley originally requested, the board decided to cut how much Copley is allowed to charge patients and insurance companies for services in fiscal year 2018 by 3.4 percent.
Even with that price decrease, the hospital will bring in more revenue than regulators asked for in the 2018 budget guidance, according to Mullin.