This article by Tommy Gardner was published in the Stowe Reporter on Sept. 24.
Construction is underway on a Stowe clinic for people struggling with substance use disorders that its CEO aims to turn into a “world-class” facility on par with the Betty Ford Center or Mayo Clinic
Silver Pines, a 32-bed medically supervised detoxification clinic, broke ground this week at 3430 Mountain Road, on the site of the former North American Hockey Academy.
William Cats-Baril, the center’s CEO, said he thinks Stowe is the perfect place for people from New England, Quebec and beyond to come for cutting-edge treatment.
“Stowe is a place that, in my view, is therapeutic. It’s beautiful,” Cats-Baril said in an interview last October, when the clinic passed through the local zoning process. “It’s a place that makes you happy to be alive. As you know, some of these people are in great despair, and I believe that beautiful nature helps.”
Eight months after gaining town approval, the clinic cleared a much higher hurdle, gaining approval from the Green Mountain Care Board, Vermont’s health care regulatory body.
The board issued Silver Pines its certificate of need June 23.
Bullrock Corporation of Shelburne started construction on the clinic on Sept. 17.
Learning and growing
Silver Pines will provide 24-hour supervision and care at a nearly one-to-one staff-patient ratio, with short-term (seven to 10 days), high-intensity, medically supervised withdrawal and treatment services.
The proposed treatment system is proprietary. Cats-Baril refers to “neural network-based algorithms, using machine-learning principles” that customize each patient’s treatment regimen, which he said would mark a “new approach to treating addiction.”
The model tracks and learns “the patterns of recovery trajectories of very large numbers of patients and can augment the experience and knowledge of health professionals to improve clinical decisions,” according to the application to state health care regulators.
“As individuals complete the program, outcomes will be tracked and added to the experience of the algorithm, which the applicant asserts will increase the consistency of decision-making and care across all health care professionals and staff at Silver Pines.”
In other words, the algorithm will learn as more patients pass through Silver Pines.
The Green Mountain Care Board noted that the health department has expressed concern that “machine learning and neural network models have not been fully tested on the population (Silver Pines) will be serving,” but Cats-Baril assured the board that the model won’t be relied on as the primary source of care until enough patients have been treated to gather enough data to prove itself helpful.
“Until then, the applicant asserts that the model will merely provide ‘an extra layer of safety,’ ” the board noted.
The clinic anticipates serving 365 people in the first year, including 39 Vermont residents; roughly doubling that in the second year; and increasing to more than 900 patients in year three. All along, the breakdown will likely be a 90-10 split between out-of-staters and Vermonters, although preference will be given to Vermont residents who meet admission criteria.
Drugs, alcohol tough to kick
According to the care board’s findings, substance use disorder is a big problem — in 2018, more than 67,000 Americans died from drug overdoses, and 88,000 people die annually from alcohol-related causes, making alcohol the third leading cause of preventable deaths in the nation.
It’s bad in Vermont, too, with roughly 10 percent of the over-12 population having substance use disorders — on a single day three years ago, 7,015 Vermonters were enrolled in treatment.
After patients are treated at the Stowe clinic, they’ll be discharged, but Silver Pines will still work with them for up to 12 months.
“Addiction is a chronic medical condition and management of withdrawal is only a step in the journey to recovery,” the findings state.
Since surveys show that nearly half of people with substance use disorders also have some sort of psychiatric disorder like depression or anxiety, Silver Pines will also integrate mental health care into its service, such as cognitive behavioral therapy, dialectical behavioral therapy, trauma-informed care, acceptance and commitment therapy, motivational enhancement therapy, guided mindfulness, validated stress-reduction and resiliency building techniques, emotional freedom techniques, sleep hygiene, 12-step groups and gender-focused groups. There will also be things like acupuncture, massage and nutrition counseling.
The health department also raised worries about a lack of connection between Silver Pines and the rest of the state’s treatment network. Cats-Baril told the board the clinic “will seek to form robust relationships with treatment providers at all levels of care in Vermont to facilitate seamless transitions of care.”
Burden on the system?
The Green Mountain Care Board’s approval wasn’t unanimous. Board members Robin Lunge and Tom Pelham dissented, arguing that Silver Pines doesn’t address Vermonters’ current or future needs; doesn’t align with the state’s health care payment and delivery system; and might negatively impact other Vermont providers.
“We acknowledge that substance use disorder treatment is a need of Vermonters. This facility, however, is not structured in such a way to serve Vermonters and is designed to primarily attract out-of-state visitors from the United States and Canada with a national reputation,” Lunge and Pelham wrote. “We applaud the applicant’s entrepreneurial spirit and desire to assist in the fight for quality substance use disorder treatment, however, when we weighed the small number of Vermonters served and the potential harms to Vermont providers, we were not able to conclude that the project was in the public good.”
Answering concerns that Silver Pines might add a burden to Copley Hospital and Vermont’s in-patient psychiatric programs, the clinic argued it will actually decrease demands on those facilities by providing effective treatment.
There are three Vermont facilities that provide withdrawal management — Brattleboro Retreat, Valley Vista in Bradford and Serenity House in Wallingford. Silver Pines said that since it only has 32 beds and requires up-front payment, it’s unlikely to erode other Vermont facilities’ volumes.
The treatment won’t be cheap. Initially, Silver Pines planned on working with Blue Cross Blue Shield and accept payments from other third-party payers, but those plans changed during the review process, the clinic will now require 100 percent payment from all patients prior to their admission.
The clinic also plans to recruit employees from out of state so as to not lure skilled doctors away from Vermont medical providers.
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