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Gregory Dennis: Our hospital seeks a port in a storm

If Porter were a patient, you would say she needed continuing medical attention.
The nurses have been unhappy with working conditions for several years, and this year the medical system’s doctors have gone public with their own concerns.
Lynn Boggs, brought in as president and CEO after the retirement of longtime CEO Jim Daily, resigned last week after less than a year on the job. She departed the medical center in the wake of public displeasure at the laying off of 17 nursing, clerical and management staff. Her brief tenure also saw cuts in insurance benefits for some part-time employees and a vote of “no confidence” by Porter physicians.
Addison County residents have long been justifiably proud of Porter. Few communities as rural as ours can boast such a community resource. Porter has for many years provided high-quality care close to home. It’s a large employer and has been an anchor of security.
So what is to become of this institution that has so long been a part of our lives?
I’ll note here that I don’t have any special insight into recent events. All I know is what I’ve read in this newspaper’s solid reporting by John Flowers.
Nonetheless, after more than 20 years working in healthcare communications, perhaps I can offer some perspective on the factors at play here.
(For the record, my small group of public-relations professionals represents healthcare organizations, most of them technology companies. We talk regularly with nurses, physicians and other hospital personnel around the U.S. I have no financial stake in what happens at Porter.)
I’ve always received excellent care in the Porter system, and I have a deep appreciation for its dedicated staff and volunteers, including the board.
As we contemplate Porter’s future, it’s helpful to understand what’s happening in healthcare generally.
The Affordable Care Act (Obamacare) is on balance a huge step forward. Beyond expanding healthcare to millions of Americans, though, it’s introduced new mandates. Hospitals are awash in a new alphabet soup of ACOs, MACRA, EHRs, PPACAs and other programs that complicate the delivery of services. As Medicare and other payers increasingly scrutinize costs, everyone from hospital CEOs to custodians is feeling the pressure.
Nurses have long borne the brunt of delivering care. Their frustration has boiled over here in understandable and justifiable efforts to gain some measure of control by unionizing.
Recently, physicians have begun to experience similar pressures.
Having sold their practices to the Porter system — which owns more than 12 practices — many of our local doctors are now employees. They’ve been able to dispense with some of the uncertainties of running their own businesses — but they’re now subject to new demands.
Porter needs to be sure the delivery of care is as efficient as possible, and that can entail additional requirements imposed upon doctors. These may involve additional expectations to see a certain number of patients, and to demonstrate the delivery of high-quality, evidence-based care.
As Porter strives for efficiencies, the economic impact is a personal one for many residents.
The part-time employees who lost their benefits are neighbors, family and friends. So are the nurses who had the rug pulled out from under them when they were laid off. Then physician employees were handed stricter employment contracts (since withdrawn by Porter).
As unhappy as everyone is about these steps, the cost pressures won’t go away. So where are we?
Here are a few educated guesses:
• The board’s decision to retain Dr. Fred Kniffin as acting president and CEO was a wise one. He’s got the local cred to work with the medical staff as the system evolves.
• Porter absolutely needs to right its financial affairs. I wouldn’t be shocked to see some service cuts over time.
• A merger or acquisition may be in Porter’s future. I don’t know anyone who wants to see that happen after so many decades of community governance. But M&A is not just a Wall Street phenomenon anymore. It’s the way of the world in healthcare, with the hope of containing costs without sacrificing quality. And yes, it’s sad that we even have to contemplate such a possibility.
• Lower-paid personnel may continue to replace RNs in jobs that require fewer nursing skills — just as nurse practitioners are performing some duties once reserved for physicians.
• The Porter board and management have learned they need to move more slowly and communicate more effectively with employees and the public.
Whatever comes next, both Porter and the public will, unfortunately, have to endure more changes as this “patient” is put on the path to healing.
Gregory Dennis’s column appears here every other Thursday and is archived on his blog at www.gregdennis.wordpress.com. Email: gregdennisvt@yahoo.com. Twitter: @greengregdennis.com.

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