Porter responds to public discontent, trustees admit ‘rushed’ process on physician contracts

MIDDLEBURY — Members of Porter Medical Center board on Wednesday conceded what they now believe was too rapid a roll-out of new contract terms for the organization’s 33 physicians, and they vowed to become more inclusive and transparent in communicating what have been some major changes within Porter’s hospital, nursing home and 12 physicians’ practices.
Declaring a “mea culpa,” they said they said they would take the current contract with physicians off the table and start anew.
PMC board Chairwoman Maureen McLaughlin and executive board member Patrick Norton made those promises in the wake of growing discontent among hospital physicians, nurses and staff about recent layoffs, funding decisions and a perceived lack of candor by board members and senior administrators on the future direction of the medical center.
“The roll-out of the process probably was too quick; there wasn’t enough time to get providers on board,” Norton said. “We need to now go back and do an old-fashioned do-over on the contract process, and make sure now we start with a fully on-board compensation committee of providers and administration to iron out what this contract should look like and be educated along the way.”
The extent of the public discontent is captured in a letter to the editor in today’s Addison Independent that alleges “a culture of fear, retaliation, and bullying has permeated the ongoing restructuring effort” at Porter Medical Center. (Read the letter by clicking here.)
Porter officials confirmed the recent departures of eight PMC providers, and the hiring of three new ones. While PMC declined to provide names, they said the departures include three retirements in the area of pediatrics and family practice; two in the hospitalist and family practice departments who are leaving due to family issues; and three in the family practice and internal medicine departments who are departing due to an impending transition in the manner in which physicians will be compensated.
Of the three incoming providers, one is joining the hospital and the other two are joining family practices.
“The administration might have chosen a more inclusive path, one that would have helped the hospital’s key stakeholders understand the reasons for the painful changes that were to come,” reads the letter, signed by around 120 community members. “Instead of offering a thoughtful, detailed explanation of the financial difficulties confronting the hospital, the administration simply acted.”
The letter came on the heels of a flyer that the Porter Federation of Nurses and Health Professionals circulated at Middlebury town meeting on March 1, alleging that recent cuts and layoffs at the local hospital are jeopardizing the quality of patient care. It was about a month ago that PMC announced the elimination of 17.5 full-time equivalent positions — including 8.5 nursing posts — mostly within the 12 physician practices owned and operated by the health care organization.
Signatories of today’s letter to the editor have asked the PMC board to provide:
•  “An independent review of the tactics and effectiveness of the Senior Administrative Leadership team; and whether their compensation package is aligned with the long-term success of the hospital.”
•  “A comprehensive community engagement process that includes both care-providers and the broader public.”
•  “A thorough explanation of the current budget challenges and a more transparent and open budget process, with public access to financial the information needed to make informed and prudent decisions.”
•  “A clear articulation to ALL stakeholders of a broader strategic vision.”
McLaughlin and Norton, during an interview at theIndependent Wednesday morning, said PMC should be able to fulfill all of the requests except release of compensation details for the senior administrative team, including CEO and President Lynn Boggs, who has presided over the recent reductions.
The two board members voiced contrition for what they now believe was, in retrospect, a hasty roll-out of new provider contracts that tie compensation to state and regional benchmarks for productivity, quality of care and patient satisfaction measures, rather than fixed salaries.
McLaughlin said the idea of new contracts was discussed at a board retreat this past January and distributed to providers soon thereafter. The contracts were scheduled to take effect this May. It’s a compensation shift that has already been made at numerous hospitals in Vermont and throughout the country, according to McLaughlin.
While they said the change garnered some positive feedback at the retreat — which they said included providers — it became clear recently that there was some substantial discontent.
“I think there is some admittance on management’s part that it wasn’t rolled out in the way that would have been the best way to roll it out,” McLaughlin said. “But they knew it was coming. The reality of it was, it was just shocking. ‘My productivity has to improve and there’s going to be some of my pay at risk.’”
Norton said he believes providers are resigned to the changes in their contract, but that they might have appreciated more communication and more time to absorb the transition.
The priority going forward, according to McLaughlin and Norton, is that the administration and providers work together on the roll-out of the contracts.
“It was a rushed process,” Norton added, “and a rushed process is not a good process … We all want to see true collaboration in this process, so the product is something they can stand behind.”
Porter Medical Center board officials formally made that commitment to providers at a meeting of medical executive staff held Wednesday evening. Meanwhile, the PMC board is scheduled to meet Thursday, March 10, and at a gathering with all PMC medical staff on Tuesday, March 15, to listen to concerns.
“We are also very open to meeting with members of the community,” Norton said, describing a possible combination of large forums and/or small groups. “We’ve got to get past this and say, ‘We are going to do certain things over — like the contract process — in order to move forward.” Both board members said the hospital’s annual meeting in two weeks (March 30) would be an opportunity for such community engagement.
Board members acknowledged that some in the community have been critical of Boggs and the austerity measures she has begun to implement at PMC. McLaughlin and Norton said Boggs was vetted and approved by a committee that includes board members and several providers.
McLaughlin acknowledged a perception among some members of the public that Boggs was hired to make systematic changes at PMC and then leave, but said that certainly was not the case.
“We needed someone with the framework to ‘march you along to where you need to get to be in order to survive in this changing environment,’” McLaughlin said.
That changing environment, according to McLaughlin, includes a new emphasis on ambulatory (out-patient) care, as opposed to hospital stays.
“Lynn has great clarity about what operational improvements Porter needs to undertake in order to thrive, to be here to serve that community,” McLaughlin said in a follow-up statement to Wednesday’s interview.“That clarity, that strategic thinking, is what Porter needed. What we need to improve on is the pacing and engagement.”
McLaughlin also confirmed PMC is working with a consultant to explore potential affiliations with other medical institutions. She and Norton acknowledged that PMC needs to regain better financial health before an affiliation could be explored, if that is indeed the route chosen by the hospital community.
“We are working with consultants to approach what we think might be potential affiliation partners out there and have a conversation,” McLaughlin said. “It’s just a conversation.”
Reporter John Flowers is at [email protected].

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