Editorial: Porter’s future: As hospital regains its footing, potential for affiliation is on the horizon

As Porter Medical Center rights it ship under interim CEO Dr. Fred Kniffin, there is an exciting opportunity for the community to participate in the hospital’s future — and a pressing reason for the average resident to be increasingly engaged.
The opportunity is during the upcoming discussion concerning a potential affiliation or partnership with one of the two larger medical centers in the region.
At issue is determining whether Porter Hospital will be stronger and serve the greater Middlebury-area better by affiliating with a larger hospital, or remaining independent?
If the answer is that affiliation will make Porter more viable in the long term, then the follow-up question is whether an affiliation with Fletcher Allen in Burlington or Dartmouth-Hitchcock in Hanover would be the most advantageous for Addison County residents and medical staff.
These are not easy questions, and the answers will be complex. An affiliation with either larger medical center would likely mean a loss of some medical services now being practiced at Porter. The economics of the medical industry is such that expensive machinery and expensive medical procedures would likely be consolidated at the larger institution. By extension, that reduces the need for medical staff and those facilities at Porter. The downside is significant for the medical community, but also to the patient. If I, as a patient, have to travel to Burlington or Hanover for my heart test, or to fix a bum shoulder, that requires more time traveling — and likewise for family members who are accompanying the patient or going to visit if it’s an overnight stay. That’s more time off work, more time on the road, more time away from home — all disincentives to small town living.
But it could be a two-way street. It could be that Porter could serve as the regional center for other procedures (birthing, for example, or family practices), thereby creating more business and need for medical staff in those areas.
A key question in this discussion is which affiliation would provide Addison County patients the services they most want to keep at Porter. An obvious benefit with partnering with Fletcher Allen is that it’s roughly an hour closer than Dartmouth Hitchcock, but that proximity could also be reason for more consolidation of services offered by Fletcher Allen, leaving Porter providing fewer services locally. Theoretically, Dartmouth-Hitchcock might see Porter Hospital as its northwestern outpost (Southwestern Hospital in Bennington is its southwestern outpost), and might subsidize medical services here in order to expand its range and network.
Why is the hospital in Middlebury a likely target for affiliation? Consider that Porter Hospital has an annual revenue stream of about $90 million, and we represent a fairly healthy and educated demographic. In a capitated system (rather than the current fee-for-services system) the finances will soon be based on the wellness of that population; that is, the area that Porter now serves will provide $90 million in revenue (or whatever the amount will be) to the hospital that provides service to those residents. The healthier the population, the less money will be used to “cure” those who are sick and the more “profit” that hospital will make. Creating larger networks and setting up systems to keep residents healthy is one key to containing future healthcare costs.
And that’s why the average Addison County resident needs to be engaged in the discussion — and their own future health care. If wellness is the goal and figures into the future method of allocating resources to cover health care costs, can Porter serve its own community better going solo or with an affiliation? If, for instance, we as a “Porter community” are healthier than the “community” Fletcher-Allen serves, then we are partly subsidizing those patients; and vice-versa.
One thing is for certain: the future of medical care will increasingly be about educating the public to prevent illness, and about encouraging healthy activities and practices as a community. Seemingly, that could bode well for smaller institutions serving more finite demographics.
What’s exciting is that in the midst of this national change in health care practices and policy, Porter Hospital is also at a crossroads. Viable options exist to create strong and profitable health care facilities in Middlebury and Addison County. The question the Porter Hospital board — and the broader community — will be discussing this summer and beyond is which option makes the most sense. If you care, come to those discussions or share your thoughts, concerns and suggestions via letters to the editor or to the committee leading those discussions. For more information about those meetings and discussions, stay tuned. We’ll have regular updates as the discussion gets underway.
— Angelo S. Lynn

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