Dr. Fay Homan: Concerted effort needed to strengthen primary care in Vermont

This commentary is by Dr. Fay Homan, who’s with Little Rivers Healthcare in Wells River. Homan is a board member of the Vermont Academy of Family Physicians and a member of the Green Mountain Care Board's Primary Care Advisory Group.

There was a startling headline in VTDigger last month; “UVM Medical Center ER overwhelmed, urges patients to seek treatment elsewhere.”

This was not due to an unexpected event such as a mass accident or a sudden Covid surge. The only explanation offered in the article was that “respiratory viruses in general are higher than normal this time of year.”  

UVM Medical Center issued a statement that day encouraging patients to go to its own Urgent Care Center in Colchester. It included a link with guidance on when to go to urgent care instead of the emergency room. 

That guidance illustrates a significant problem with our health care system. Of the 13 conditions listed in the link for which the hospital suggests urgent care, 100% can be managed in most primary care offices. 

UVM Medical Center missed a chance to send out an important message: Most health care conditions, both acute and chronic, can be handled by a primary care provider, and that’s where patients should think of going first. This would not only reduce the pressure on emergency departments, but it is undisputed that getting primary health care is more cost-effective with better long-term outcomes than getting it through emergency or urgent care visits. 

It’s time for a concerted statewide effort to strengthen primary care in Vermont. This could start with public education. While most people know that they can get preventive and chronic disease care at their primary care provider, it’s possible that many don’t know the full scope of what’s available in most offices. 

Here is just a sample: suturing, wound cleaning, dressing changes, splinting, joint injections, skin biopsies, EKGs, antibiotic injections for serious infections, family planning including IUDs and implants, Pap tests, counseling, medication-assisted treatment for substance use disorder, assistance with accessing aid programs, and a sliding fee scale for those without insurance. 

Furthermore, most primary care offices have on-call staff after hours to give phone advice on whether ER care is needed. That’s a service you won’t find at an urgent care center.

A coordinated statewide campaign to strengthen primary care would not only decrease the cost of health care, but would also ensure that our emergency and specialty care providers (who have likewise been in the news lately) are available when needed. 

Such a campaign will require a commitment to changing the status quo by many state, public and private entities. 

For UVM Medical Center, this might mean encouraging patients to go to primary care providers first, rather than referring to its own urgent care center. Most primary care offices save same-day appointments for urgent issues. 

For OneCare (the state’s only accountable care organization, tasked with promoting cost-effective, quality health care in Vermont), it would mean moving more of its existing resources to primary care, which will decrease overall cost and improve health outcomes. 

The Green Mountain Care Board, which regulates hospital budgets, could require hospitals to increase their spending in primary care. 

It was heartening to read recently that the new chair of the Green Mountain Care Board, Owen Foster, said, “A good agreement (with OneCare) for Vermonters would be one that provides a shift to more of a focus on preventative care, management of chronic diseases.” That’s a great plan, and that’s what primary care is all about.

Our state professional organizations, such as the Vermont Academy of Family Practice and the Vermont Medical Society, could team up to educate Vermonters about the breadth of care available, and the benefits of having a consistent primary care provider who knows your history. 

On a state government level, meaningful support for primary care might mean establishing an office of primary care, a “czar” of primary care so to speak, to direct and support these efforts. An important aspect of that work would be to keep a publicly accessible database of primary care providers statewide who are open to new patients. A great message to the public would be that everyone should have a primary care provider.

On that note, it’s worth describing what all of us can do as Vermont citizens. Get a primary care provider and see them occasionally, even if you feel healthy. You’ll receive preventive, chronic and acute care, and have somewhere other than an ER to turn when a health problem occurs. 

Getting established with a primary care provider is a challenge in many parts of the state, so start now, and get on a wait list if necessary. 

It's true that there aren’t nearly enough primary care providers in the state. Sometimes even those with a primary care provider may have difficulty getting in for a timely appointment. That’s another subject for the leadership in health care reform to tackle: how we train, educate and attract more primary care providers to our state. 

If you hit a roadblock in looking for a primary care provider, let your state legislator know. The Legislature, too, has a role to play in strengthening primary care in Vermont, and needs to hear from you about the severity of the problem. The legislators’ emails are listed here.

We’ll all need to work together to make our overpriced, fragmented health care system more efficient and affordable. The goal is the right health care in the right place at the right time. 


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