UVM Medical Center’s decision to close the operating rooms at its Fanny Allen Campus at least through January has raised concerns about patients missing their deductible deadlines and has created a “mess” for surgeons and medical staff working in new locations.
Surgeries have been rescheduled for Saturdays and second shifts at the main campus in Burlington and at hospitals in Berlin and Middlebury to accommodate hundreds of patients who have been “bumped” by the closing.
UVM Medical Center has kept surgeries in the UVM Health Network rather than having doctors use an independent surgery center 3.6 miles from the Fanny Allen campus.
Hospital officials say Fanny Allen, located in Colchester, will not be reopened until the end of January as it investigates two air quality incidents. One occurred in October and another in late November, sending a total of 24 health care workers to an on-site clinic for carbon monoxide testing. At least four staff members tested positive for low levels of carbon monoxide.
UVM Medical Center is working with the Vermont Occupational Safety and Health Administration and an independent air-quality consultant to resolve the issue. Annie Mackin, a spokesperson for the hospital, said Tuesday the cause of the incidents remains a mystery.
About 650 surgeries at Fanny Allen were affected, based on average counts for December and January cited by hospital officials. The outpatient facility, run by UVM Medical Center, is used for eye, orthopedic, gynecological and other surgeries.
In December, most of the surgeries were moved to the main campus at UVM Medical Center. Some patients were sent to Porter Hospital or Central Vermont Medical Center, which are both in the UVM Health Network.
Approximately 35 patients could not be accomodated, according to an internal document from the hospital, potentially putting their end of year deductibles in jeopardy.
Dr. Steve Leffler, newly named president and chief operating officer of UVM Medical Center, wouldn’t say how many Fanny Allen patients set to be seen in December had to reschedule their surgeries into January.
“Literally on a daily basis, that number is changing,” Leffler said. “Some are being moved into January because that makes the most sense.”
Leffler said the hospital is doing everything it can to minimize disruption and prioritize patients who need surgical procedures before their deductible deadlines run out at the end of the year. Insurers typically reset deductibles Jan. 1.
“We’re working that into our matrix to get them done,” Leffler said. “I’ve been told twice that every one who has a deductible” will be scheduled before the end of the year.
However, UVM Medical Center is not moving surgeries to the nearby Green Mountain Surgery Center, which has operating room vacancies.
One patient who was set for orthopedic surgery in December was rescheduled twice, according to her mother. On the third try, she got in last week. The mother, who asked to remain anonymous for fear of reprisals, was worried about her daughter failing to meet her deductible before the end of the year.
When she found out that UVM Medical Center could have used the operating room at Green Mountain Surgery Center and gotten her daughter in two weeks prior, she was incensed. The family faced hundreds of dollars in out-of-pocket costs and changed its plans twice when “there’s this facility sitting empty,” she said.
In a patient form provided to VTDigger, surgeons are asked to rate the necessity of the procedure and determine whether surgeries can be “bumped out” two to three months. But according to talking points developed by UVM Medical Center officials, patients who are worried about meeting deductibles have been asked to consider waiting for up to a year for surgery.
“Who is going to cover the out-of-pocket cost I will now have since I had met my deductible for 2019 but now you are moving my case to January?” says a hypothetical question.
“While we want to minimize the inconvenience of rescheduling your surgery, we cannot cover out-of-pocket costs,” officials wrote. “If you would like to reschedule out into late next year when you believe you will have hit your deductible again, we are happy to try to accommodate that request if both you and your surgeon agree your procedure can wait.”
Kevin Mullin, chair of the Green Mountain Care Board, which regulates hospital spending in Vermont, said John Brumsted, UVM Health Network’s president and CEO, has assured him that no one has lost out because their deductibles have expired.
“Dr. Brumsted said that anybody who wanted to get their surgery done in December was able to get in,” Mullin said. “That was a phone conversation. I would think he knows what he’s talking about.”
Frustrated doctors and patients
VTDigger interviewed five doctors for this story, all of whom were concerned that UVM Medical Center was emphasizing keeping surgeries in the network over short-term patient access. They all asked not to be identified for fear of retribution.
Mackin said to her knowledge, surgeons have not made a formal request to leadership to use the nearby surgery center.
Surgeries are typically booked months in advance, and rescheduling is a nightmare for surgeons and patients, the doctors said. In all, about 20,000 surgeries and 13,000 endoscopies are performed in UVM Medical Center and Fanny Allen operating rooms each year.
One doctor said rescheduling surgeries “is really potentially huge for patients.”
“For some patients, it would mean doing it now or waiting to see what happens next year,” she said. “Especially in a state like Vermont where sometimes deductibles are like $10,000.”
Patients are frustrated and nervous. “They’ve taken time off,” the doctor continued. “Their families have taken time off. There’s no assurance they’re going to have surgery.”
UVM Medical Center has begun a second shift for surgeries on the main campus for Fanny Allen patients starting at 3 p.m. Other surgeries have been scheduled on Saturdays at the main campus, according to Mackin.
Nurses and scrub techs at the main operating rooms at UVM Medical Center don’t know where things are, one of the doctors said.
“Their orientation was like five minutes before the day they started,” the doctor said. If a hospital code is called for an emergency alert, they don’t know where to go, she added.
Officials at UVM Medical Center say the Fanny Allen staff was oriented “with the support of main campus staff.”
“They are working on their own cases, which should be contained within the areas where they have been trained,” Mackin wrote in an email. “Leaders are continuing to meet with staff to answer questions and provide support.”
In addition, scheduled surgeries are being conducted in operating rooms at UVM Medical Center that are usually held for trauma surgeries.
The operating rooms at UVM Medical Center are at full capacity in order to manage overflow surgeries from Fanny Allen, Mackin said. “As a Level 1 Trauma Center, there is no impact on our ability to care for trauma patients who come to us,” she wrote.
“It’s a mess,” the doctor said. A few days in advance of her surgeries, “No one could tell me who my patients would be.”
“The sentiment of rage right now runs deep and not just for us,” another doctor said.
Pay for surgeons could also be affected. Compensation for staff doctors at UVM Medical Center is based in part on the number of surgeries performed.
“Our goal and plan is to catch up completely on all surgeries, and if we meet that goal, there should not be a change to relative value units,” hospital officials wrote. Relative value units are reimbursement formulas used for doctors.
Leffler said he appreciates the flexibility of the staff who have agreed to work at the main campus.
“We’ve worked hard to orient our staff here, they’re doing an amazing job, and we’re fully committed to getting caught up and meeting the needs of the patients we serve,” he said in a statement.
Keeping surgeries in the network
In order to operate in a different location, surgeons have to be credentialed for that facility, work with a different nursing and anesthesiology team and get oriented to new equipment and surroundings.
For the time being, surgeons have been asked to use two other hospitals in the UVM Health Network — Central Vermont Medical Center in Berlin and Porter Hospital in Middlebury.
One orthopedist has been asked to perform surgeries at CVMC for the next six months.
While the independently owned and operated Green Mountain Surgery Center offered operating room capacity to help with the backlog, Amy Cooper, CEO and co-owner of the center, says UVM Medical Center has yet to make plans to use the facility.
“We looked at operating room times available for December and sent the days and times to Steve Leffler,” Cooper said.
Leffler toured the facility recently and asked on Dec. 20 if the surgery center could take non-surgical gynecological procedures, specifically pregnancy terminations, from the main campus. But he said whether the Burlington hospital will use the Green Mountain Surgery Center for surgery is an open question. Cooper said the center has not made a decision about whether to accept the request to perform abortions for UVM Medical Center main campus.
Green Mountain Surgery Center can offer surgeons emergency credentials within one to two days, according to Cooper. The typical credentialing process takes a month.
Mackin said credentialing was not the issue. She said the equipment used at the Green Mountain Surgery Center was different that what is used at UVM network hospitals, and therefore made training more complicated.
“It’s a matter of getting training and orientation for staff comfort,” she said.
Officials from the Vermont Association of Hospitals and Health Administration, which represents the UVM Health Network, aggressively opposed a permit for the independent surgical facility when it was debated two years ago.
In testimony to regulators in 2017, VAHHS said the new facility was not needed because UVM Medical Center had excess capacity with 17 operating rooms on the main campus and five at Fanny Allen.
The Green Mountain Care Board approved the permit (known as a certificate of need) for the independent surgery center in July 2017, with comments about how the additional operating rooms in Chittenden County would be duplicative.
After issuing an unrestricted certificate of need to the Green Mountain Surgery Center, the care board later placed conditions on the permit, limiting the kinds of surgeries that could be performed to plastic surgery and certain eye surgeries, and procedures for pain management, gastrointestinal issues, gynecology, orthopedics and general surgery.
GMSC appealed the order that the GMCB issued on June 4, 2019 curtailing surgical procedures. The lawsuit is now before the Vermont Supreme Court. The center opened for business in July.
The types of outpatient surgeries typically performed at Fanny Allen are similar to those currently allowed at the independent surgery center.
“The closure of Fanny Allen underscores how important it is to have more supply of operating rooms and procedure rooms in the area,” Cooper said.
A surgeon who uses the GMSC operating rooms said in an email that the Fanny Allen crisis “should be a wake up call of sorts to the Green Mountain Care Board and that the opening of GMSC in no way ‘duplicates services.’ If anything we’re making surgeries more available.”
“Access to surgeries at UVMMC was poor months ago and is going to be much worse without the Fanny available to those surgeons,” she said.
Leffler says the Fanny Allen situation is a “short-term crisis.”
“We are looking at all of the different ways we could meet the needs of patients,” he said. “Everything is on the table.”
CORRECTION: The Green Mountain Surgery Center opened in July, not September.
Editor’s note: UVM Medical Center called after the story was published to say that it would consider sending non-surgical pregnancy termination procedures to the Green Mountain Surgery Center.
