State lawmakers are considering whether the Green Mountain Care Board should regulate a relatively new type of health facility – independent urgent care centers.
The Office of the Health Care Advocate is proposing that the care board review significant construction and expansion projects at “freestanding walk-in clinics,” as it does at hospitals.
Ironically, the proposal to increase regulation comes as lawmakers consider ways to streamline the care board’s “certificate of need” review process. But some House Health Care Committee members say it makes sense to simultaneously expand the board’s authority.
“I never understood why urgent care centers were not under the regulation of the state, in terms of the Green Mountain Care Board,” Rep. Bill Lippert, D-Hinesburg and the committee’s chairman, said Tuesday.
When Vermont health care facility administrators propose a substantial investment in buildings, equipment or technology, they must first seek permission from the Green Mountain Care Board via a certificate of need.
Examples of recent certificates issued by the board include a $151.7 million medical records project at four University of Vermont Health Network hospitals and a $22.7 million expansion at Brattleboro Memorial Hospital.
But care board officials want to tweak the certificate of need process to eliminate what’s been characterized as “unnecessary red tape” and to reflect inflationary increases in health care costs. Lippert has introduced H.669, which addresses some of those concerns.
For example, a hospital proposal to add a new piece of diagnostic or therapeutic equipment valued at more than $1 million currently triggers a care board review. Lippert’s bill raises that threshold to $1.5 million.
Also, H.669 says a new service or technology with an annual budget of more than $1 million would require a certificate of need, up from the current threshold of $500,000.
With an eye toward efficiency, the bill also would exclude from the certificate process any “routine replacements of nonmedical equipment and fixtures including furnaces, boilers, refrigeration units, kitchen equipment, heating and cooling units and similar items.”
Chief Health Care Advocate Mike Fisher has weighed in on the proposed changes, arguing that the revisions shouldn’t impair hospitals’ accountability and transparency.
Fisher also wants to give the care board oversight of projects at urgent care facilities, which would be an entirely new review category.
Current state law exempts physicians’ offices from the certificate of need process. And the care board has declined to regulate urgent care centers, as in a 2014 decision when New Hampshire-based ClearChoiceMD sought to open five such care centers in Vermont.
Fisher believes that’s a gap in state regulations. His proposal says free-standing walk-in clinics that are not affiliated with Vermont hospitals or a federally qualified health centers should be subject to certificates of need.
Walk-in clinics connected to hospitals or federally qualified health centers have budgets that are regulated in other ways, while independent clinics can build or expand as they please.
Fisher said one purpose of his proposal is “to keep in check the medical arms race, and to recognize that a regulator has a role to make sure that we’re not overbuilding and adding expense to the system.”
A Green Mountain Care Board staffer told the Health Care Committee that the board is taking no position on the proposal. But some committee members were skeptical.
Rep. Doug Gage, R-Rutland, worried that the state would be unfairly singling out independent walk-in clinics.
“We should have the same criteria for them and not carve out a particular regulation or hoop to jump through just because we perceive them as being something different. I think they fill a need that other people do not,” Gage said.
“I think if we add the cost of doing a (certificate of need) on them unnecessarily, we’re putting them at a disadvantage,” he added.
Some say independent clinics provide much-needed competition in the health care market. They offer evening and weekend access and may be “crucial … in keeping costs down,” said Rep. Annmarie Christensen, D-Perkinsville.
Fisher argued, though, that free-standing walk-in clinics are “really a very different business model.” And Lippert seemed to be leaning toward more regulation, saying such clinics are “clearly a medical facility and not just a doctor’s office.”
The committee did not vote on H.669 Tuesday and did not decide whether to add Fisher’s walk-in clinic language to the bill. Lippert asked for more legal research and “a chance for further reflection.”
