Leaders of the Green Mountain Surgery Center have filed initial plans for a second independent surgery center that they say will increase availability of outpatient surgery in Chittenden County and help lower health care costs.
The proposed 9,000-square-foot, $3 million Collaborative Surgery Center would have four new operating rooms managed by physician-owners and will offer a range of outpatient surgeries, said Amy Cooper, owner of the Green Mountain Surgery Center and part of the management team for the new building.
The new operating rooms will provide surgeries “in a more efficient way, allowing Vermonters more choice, but also doing that all at a much, much lower cost,” said management team member Liz Hunt, who also works as operations manager for the Green Mountain Surgery Center.
Cooper, Hunt and Susan Ridzon, executive director of HealthFirst, an advocacy group for independent health care practices, submitted a letter of intent to the regulatory Green Mountain Care Board on Thursday afternoon for the project. They plan to submit a formal application by June, Cooper said.
The Collaborative Surgery Center will not ultimately be affiliated with the Green Mountain Surgery Center. Cooper said the management team will transfer ownership once it’s built. But the two facilities will be located in adjacent buildings connected by a corridor. They will also share some resources, such as a central sterile supply room and a medical gas room.
The shared history and common leadership may prove to be contentious: Cooper’s first project faced fierce opposition from area hospitals and a protracted three-year regulatory process.
A Vermont Supreme Court decision in the fall limited the services that the Green Mountain Surgery Center could provide. Now, many of those services could be offered at the new facility next door.
“Circumnavigating the Supreme Court appeal loss is not our mission here,” Hunt said.
Instead, she argued it will help fill the gap left by the closure of the outpatient operating rooms at the University of Vermont Medical Center’s Fanny Allen campus. The hospital closed the unit until further notice in late 2020 after staff members repeatedly reported symptoms of nausea and dizziness.
The Collaborative Surgery Center will also provide medical care at lower cost, Cooper said. She said the Green Mountain Surgery Center has saved Blue Cross Blue Shield an estimated $5 million since it opened two years ago. Her center charges a facility fee of $1,000; UVM Medical Center, the primary alternative site for surgeries, charges $3,000 in facility fees for the same procedure, she said. (UVM could not immediately confirm the pricing.)
“If you want to lower health care costs, the most direct way to do it is to provide the same services at a lower cost,” Cooper said. “And we would certainly argue it’s a better service for less money.”
Based on Cooper’s previous project, the approval process could be fractious.
After the Green Mountain Surgery Center filed its application in 2015, the project faced vocal opposition from the University of Vermont Medical Center, the Northwestern Medical Center and the state’s hospital association. The opponents argued that it would draw business away from already financially strained hospitals.
The regulatory process dragged on for four years before the Green Mountain Care Board approved the project in 2017.
The Green Mountain Surgery Center opened in March 2019, and its areas of services include gastroenterology, retina and gynecology.
But its legal challenges weren’t over. A fight over what services the center could provide and the authority of the Green Mountain Care Board to decide went all the way to the Vermont Supreme Court. In October, the court ruled in favor of state regulators, effectively prohibiting the surgery center from offering certain services — such as podiatry; ear, nose and throat surgery; urology; and other specialities — for five years.
Cooper said she didn’t know how the regulatory process would go but would put forward an application that would serve Vermonters well.
Once the management team files its application, the Green Mountain Care Board has 90 days to gather information and an additional 120 days to make a decision. In some cases, the process may be expedited or extended, according to board Chair Kevin Mullin.
Mullin said he would weigh the case on its own merits — without taking into account the previous case.
“I don’t go into this with malice or prejudgment,” he said. “If it meets the statutory requirements and if it’s good for Vermonters, the board will likely approve it. If it is detrimental for Vermonters, the board will likely disapprove it.”
UVM Medical Center spokesperson Neal Goswami said the hospital is “focused on our planning for the future.”
“We strongly believe that our nonprofit model of providing a full range of outpatient surgery services in a lower-cost setting responds to the health care needs of our community,” he said in a statement. The hospital is working on finding immediate and long-term solutions to the closure of the Fanny Allen operating rooms, he said.
Cooper said once the application is approved, she expects to complete construction within a year.
The new center would be a small company aimed at lowering the cost of health care and saving money for Vermonters as well as helping to support other parts of the medical system, she said. It will look for physician owners or may partner with a nonprofit hospital to rent or own some of the space. Another nonprofit may also be interested in purchasing equity in the building, she said.
Regardless of the ultimate legal organization, “a significant portion of the profits will be sent to a community or social need,” such as free services or primary care, Ridzon said.
The specific services or surgeries that are offered will be determined by who wants to own or work in the space, she said.
Ridzon said she’s optimistic there would be patient demand for the new site. She receives calls regularly from doctors who say their patients cannot get surgeries in a timely manner and from Vermonters struggling to schedule appointments.
The three management team members said they couldn’t predict how long the approval process might take or whether they would face opposition similar to the Green Mountain Surgery Center.
“I don’t think that we have any real good projections about what’s going to happen here,” Cooper said. “We know that we have a great thing to offer and a new idea that we want to try in partnership.”
