More help on the way for opiate addicts, Bristol doctors to serve more Suboxone patients

MIDDLEBURY — Porter Medical Center and the Counseling Service of Addison County (CSAC) will join forces to substantially expand the county’s only Suboxone program to help opiate addicts, a move that will allow Bristol Internal Medicine to deliver the much-needed service to 80-90 patients, up from the current 25.
The Porter board approved the expanded Suboxone program last week, and did so even with the prospect of a $200,000 annual budget hit.
Porter officials said they had been led by the Vermont Department of Health Access to believe that there would be some additional state funding for a standalone Suboxone clinic on the hospital campus. When the Department of Health Access ultimately declined, Porter and CSAC pursued the initiative through Bristol Internal Medicine.
“When we learned we would not be able to pursue the independent clinic approach, Dr. (Emily) Glick and some of the other providers on the medical staff approached us and said, ‘We would like to expand on the successful program being offered (in Bristol) and serve the patients that need to be served,’” Porter Hospital spokesman Ron Hallman said. “It was a great pivot.”
Suboxone is a medication that has proven effective in reducing the symptoms of opiate dependence. But Addison County currently has only one physician — Glick in Bristol — prescribing the drug. Glick has had to cap her Suboxone-related patient load at around 25, which unfortunately is but a small fraction of the requests for service that she receives. Indeed, Jean Cotner, vice president of Porter Practice Management, pointed to state statistics indicating there are 80 to 90 Addison County-based, Medicaid-eligible patients who must seek opiate addiction treatment in other counties.
So in an effort to better meet local needs, Porter and CSAC officials have agreed to almost quadruple the volume of patients that will be able to participate in the medication-assisted treatment program at Bristol Internal Medicine. A total of four primary care physicians based at Bristol Internal Medicine will soon be able to prescribe Suboxone, which will not be kept on premises. A substance abuse coordinator and a case manager will also be added to the office to make sure the patients receive ancillary services — such as counseling and job search assistance — to assist them in their overall recovery from opiate addiction.
The new prescribing physicians will be Drs. Gretchen Gaida-Michaels, Lynn Wilkinson and Will Porter, according to Cotner. The four physicians combined will be able to handle a patient load of 80 to 90, Cotner said. Organizers stressed the new duties would not preclude the participating physicians from maintaining their existing patient rolls.
“(These physicians) had some capacity to absorb some additional patients,” Hallman said. “It allowed them to serve more patients without expanding their hours.”
Local officials hailed the expanded medication-assistance program at Bristol Internal Medicine as a major development. Prior to Dr. Glick stepping forward, Addison County had been the only county in the state without a Suboxone/buprenorphine prescriber, confirmed Beth Tanzman, Blueprint for Health assistant director with the Department of Vermont Health Access.
“It’s great news that Porter and the Counseling Service are continuing to work together to bring this clinic to fruition,” Tanzman said on Tuesday when informed of the expanded Suboxone initiative through Bristol Internal Medicine.
The United Way of Addison County has earmarked $25,000 from a special account — known as the Addison County Funders’ Collaborative for Emerging Needs — to help Porter and CSAC with start-up costs for the expanded program. Fortunately, those start-up costs will be less than they would be for a new clinic because of the infrastructure and employee base already in place at Bristol Internal Medicine.
“I think everyone is pretty excited about this, to have this additional tool in the community,” said United Way Executive Director Kate McGowan, whose organization helped launch the Five-Town Drug and Safety Alliance–Treatment Committee, a coalition of citizens, community and religious leaders and members of the counseling and medical community in the Bristol area concerned about drug abuse.
“We are hoping this is just a first step, that this option will be embedded throughout the Porter health care system and not just at one practice,” McGowan said.
Some state funding will be available to finance the case manager and substance abuse coordinator that will be added to the office, Cotner said. It’s the same state funding that is available to all physician offices that elect to take on medication-assisted treatment programs.
Still, it will present another financial hit to a nonprofit, community hospital already facing tough financial challenges. The state’s rural hospitals have been operating with razor-thin financial margins while contending with chronic under-funding through the federal Medicaid and Medicare programs. They have had to adjust to ongoing state and federal health care reforms and new responsibilities — such as a requirement that they periodically host psychiatric patients when the state’s mental health system is short of residential placements.
“Porter has estimated the direct and indirect expenses for providing this program at Bristol Internal Medicine will be in excess of $700,000,” reads a fiscal year 2015 budget narrative from Porter Medical Center to the Green Mountain Care Board, which is charged with approving all of the state’s hospital spending plans.
“The net result is an overall practice deficit of approximately $200,000.”
Gov. Peter Shumlin made national headlines this past January when he stressed the battle against opiates as his top priority in his 2014 state of the state address. Porter officials haven’t forgotten that speech.
“It is really hard to get around the fact that 80 percent of the state of the state address focused on opiate addiction and the primary mover here is the Agency of Human Services — a billion-dollar enterprise — couldn’t find $127,000 to make this happen in Addison County?” Porter Hospital President Jim Daily said.
             JIM DAILY
Hallman agreed.
“It’s fair to say we had anticipated some potential funding,” Hallman said. “It ended up not materializing. That caused us to step back and rethink our approach. To be candid, we were disappointed that the money did not come through. However, we now feel like our providers and the Counseling Service and hospital getting together and stepping up and going forward with an alternative plan has resulted in a really good model that will allow us to take care of our patients.”
Tanzman said state funding was not awarded for start-up of the county’s initial plan for a stand-alone clinic because it differed from the current model of prescribing Suboxone/buprenorphine through individual physician practices. She said the Bristol Internal Medicine model will qualify for the same annual support that flows to other practices. Tanzman said that Bennington County — which has roughly the same population as Addison County — currently has seven physicians prescribing Suboxone to a combined total of 170 Medicaid recipients.
Cheryl Huntley, CSAC’s operations director for youth, family and emergency services, stressed that the expanded Suboxone program should only be seen as a start in addressing a growing drug addiction problem in the state.
“Vermont will still struggle with inadequate treatment capacity,” she said. “But this is a great start.”
Reporter John Flowers is at [email protected].

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