Editorial: An irony in the fight for care

Talk isn’t always cheap, especially when it’s the state that backs down on its word. In a recent case with Middlebury-based Porter Hospital, the state, through the Department of Vermont Health Access, led hospital administrators there to believe they would be substantially supported through state funds to help establish a Suboxone treatment center in Addison County — the lone county in the state without a treatment center for opiate addiction.
The promise of state aid wasn’t much—somewhere south of $200,000, depending on when it was being discussed over a four-month period—but significant to a rural hospital pressured by the changes of health care reform and the constant press of the state to cut expenses. As it is, the hospital operates on a slim margin.
It was a shock then, when a few weeks before Porter officials and the hospital board were to announce the formation of a stand-alone opiate treatment clinic, that the Vermont DHVA abruptly called Porter’s CEO Jim Daily with news that the department didn’t have funds to share and Porter would have to finance the project on its own, plus convince the Green Mountain Care board that they should allow for the added expenses and the projected $200,000 hit to the hospital’s budget.
The irony is more than frustrating for Porter officials and the county’s medical community.
Not but five months ago, Gov. Peter Shumlin grabbed national headlines with his State-of-the-State speech addressing Vermont’s struggles with opiate addiction. He spoke at length about the growing problems the state faced and his determination to do something about it. Money would be spent, he said, to help those afflicted, to consider the addiction a disease and treat it accordingly, and to help those in need get off the drugs and reclaim their lives as best as possible through prevention and addiction recovery programs.
To its credit, the state has moved forward on parts of that commitment. Money has been spent, which is why the state’s word to help Porter Hospital was convincing. Here was a hospital trying to follow what the governor advocated; the appropriate department (DHVA), which has helped other hospitals in their efforts to fight opiate addiction, agreed to help finance the start-up part of the costs of a program that officials now estimate will cost about $700,000 annually (through direct and indirect expenses). Even the low-ball pledge of $127,000 from the health care department would be a welcome pledge.
But no dice. Out of a billion-dollar budget, not a penny could be spared directly to the fight against opiate addiction in Addison County.
That’s not quite fair, of course. While the state did turn its back on its pledge with Porter Hospital to help build the proposed stand-alone Suboxone-treatment facility, the state will finance the case manager and substance abuse coordinator through the Counseling Service of Addison County to help handle the growing case load that Dr. Emily Glick and the Porter-owned practice at Bristol Internal Medicine anticipate when they expand the existing program. They are, by the way, going to expand programs in Addison County to fight opiate addiction (see story here), but the current caseload of about 25 patients to between 80 and 90. Hopefully, more as the need can be met.
In fact, the good news is that more local physican practices have stepped up to fill the void since the state’s action scuttled the planned clinic that would have been operated by a rotating staff of hospital doctors. Integrating opiate treatment into existing practices had been the original plan more than a year ago, but tight case-loads and a wariness to take on the patients at each practice prompted area physicians to prefer the stand-alone model.
Intergrating the treatment into existing practices also works better for the state, which will, state officials said, reimburse Medicaid patients for Suboxone just as the state does for other Medicaid treatment—at a fraction on the dollar, but still far better than nothing.
The silver lining on the whole affair is that more members of Porter’s medical staff are dedicated to helping address the problem, said Porter Vice President Ron Hallman, and doing so in a manner that is more cost-effective for the hospital.
But words do matter. When dealing with health care reform, the issues are sensitive and the stakes are high. Addison County residents have a right to expect adequate care for all members of the greater community, and to expect it from health care professionals they can easily access, who understand their local situation and who will deliver reliable service.
When the state reneges on a handshake with an established and well respected community hospital, another figment of trust is broken with the state, and that could become expensive in the future fight for reform.
— Angelo S. Lynn

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