[A]fter years of planning and permitting, construction is set to begin on Vermont’s second independent surgical center.
Crews may begin building the Green Mountain Surgery Center in Colchester before the end of this month, said project manager Amy Cooper. Opening is projected for this time next year, if all goes well.
The center has been the subject of debate regarding state licensing and regulation — talk that has resurfaced toward the end of the 2018 legislative session. But Cooper is hoping to get her project off the ground before any such decisions are made.
“Our center is a new experiment for Vermont,” Cooper said. “My take has always been, let’s go one step at a time here.”
In granting the center a permit last year, the Green Mountain Care Board said that ambulatory surgical centers “have become commonplace in other states” and have been eligible for Medicare reimbursement since 1982.
But in Vermont, the concept has been slow to catch on. Just one such center — the Vermont Eye Surgery and Laser Center in South Burlington — is operational, and it opened a decade ago.
In contrast to the eye facility, the Green Mountain Surgery Center has a much broader mission. The care board’s permitting decision says the center initially will focus on gastrointestinal procedures including colonoscopies.
There also will be pain management, obstetrics/gynecology, orthopedic and general surgery, state documents say.
Cooper said there will be 22 staffers, 19 of whom will be clinical. Surgeons are not counted as staff because they will not be employed by the center.
The surgery center — primarily catering to Chittenden County, with Franklin County as a secondary service area — will operate in direct competition with area hospitals.
Hospitals have lobbied against both of the state’s surgical centers. Aside from potential impacts on their revenues, hospital administrators have argued that there’s no clear need for independent centers, and there’s concern that their operations could raise the overall cost of health care.
But advocates of independent surgical centers say they can offer lower-cost services and better access.
“We’re talking about a new surgery center with a few million dollars of revenue, which is tiny on the health care scale,” Cooper said. “But it’s a big step for Vermont in that it’s a new and innovative way of approaching the health care cost and access problem. We’re hopeful that it will be an example of the way we could do things more efficiently and more patient-friendly in the future.”
Green Mountain Surgery Center received a permit for 12,879 square feet including two operating rooms, four procedure rooms and 14 pre- and post-operation beds. The care board’s decision says the facility was “intentionally sized larger than is needed to allow for future growth and to ensure that physicians have surgical room availability to allow for unexpected or last-minute cases.”
When the care board granted a certificate of need to the Green Mountain Surgery Center last July after a two-year permitting process, the board also imposed a list of conditions.
Cooper recently appeared before the board to provide an update on the center’s progress in complying with those conditions. That includes the ongoing development of a “consumer-friendly website” that features a variety of information about physicians, procedures, prices and policies.
The care board has agreed to amend the surgery center’s certificate of need to delay requirements that the facility be certified by the Centers for Medicare and Medicaid Services and have a transfer agreement in place with a local hospital.
Previously, those conditions were supposed to be met before construction began. The new deadline is “prior to commencing operations.”
Cooper says construction should take about nine months, with an additional few months required to get through Medicare and accreditation inspections.
She’s a lot more optimistic about that schedule than she was just a few months ago, when state lawmakers proposed new financial and regulatory requirements for ambulatory surgical centers.
While proponents pointed out that the state does little to regulate those centers, Cooper and her counterparts from the eye center argued that the proposed taxes and fees could jeopardize their existence.
The Senate Health and Welfare Committee eventually scrapped that bill.
“Once that was voted down, that gave us a lot more confidence to continue moving forward over the last month,” Cooper said. “We’ve been doing a lot of work preparing for construction.”
But the regulatory conversation has continued at the Statehouse.
Senate Health and Welfare on April 13 endorsed a bill, H.912, after inserting a provision for a working group that would examine “whether and how the state should license and regulate ambulatory surgical centers, freestanding birth centers, urgent care clinics, retail health clinics and other freestanding health care facilities.”
The legislation also says the group, which would be convened by the Agency of Human Services, should look at “whether and to what extent these facilities should participate in Vermont’s health care reform initiatives.”
Cooper was concerned about initial committee language regarding the possible implementation of a provider tax. That levy was a key point of contention in the previous legislative debate.
But that tax reference is now gone, and some committee members say it’s fair to have a discussion about where independent surgical centers fit into the state’s health care landscape. Surgical center representatives are listed as members of the working group.
“I think this (bill) does work, and it allows the people who are involved in the issue to engage in conversation and make recommendations,” said Sen. Ginny Lyons, D-Chittenden.
The Senate has not yet voted on the bill, so it’s not clear whether the working group will convene. Cooper said she’s fine with the idea of having a regulatory discussion, but she will continue to fight against new financial requirements.
“We are not opposed in general to the idea of a working group,” she said. “We are opposed to additional taxes and fees, particularly when small centers like ours already pay property taxes and income taxes which other health care facilities don’t.”
