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Community Forum: Dr. Fred Kniffin, UVM affiliation would help patients

This week’s writer is Dr. Fred Kniffin, CEO of Porter Medical Center in Middlebury.
Regarding the proposed affiliation between Porter Medical Center and the University of Vermont Health Network: Months of communication and due diligence are paying off. This important project is now in the homestretch. We are close, really close, to a deal that serves PMC and our community well. An update is in order.
Let’s review where we have been. One year ago, we started a strategic dialogue about Porter’s future. We asked: how do we position Porter to create the best future possible; how do we assure the strongest Porter possible, for years and years to come; how do we build a Porter that can offer the absolute best services for our patients/residents, both quality and quantity? From the start, and to this day, this journey has been about our patients and the community we serve — how can we be all that we can be for our most important stakeholders, our patients and residents?
One year later, after many, many meetings, extensive review of all available information and, most important, dozens of forums with our employees, medical staff, and community, it’s become clear to those of us responsible for this decision that partnering with the UVM Health Network will create opportunities far greater for our organization and community than we can reasonably hope to create on our own.
Let me explain why we would consider this. It is important to remember that if we affiliate, most of what you know will remain the same. This is not a “merger.” As a “member” of UVM Health Network, we will remain our own separate entity. Our board of directors stays our board of directors, and our leadership team stays our leadership team. Porter employees remain Porter employees. We will offer the same services and do the same work. Our patients stay the same. In short all the things that make Porter special — our workforce, our mission, and who we serve all stay exactly the same.
Yet, there are several areas we are expecting to see change, all for the better.
Access
We are very fortunate to have available the primary and specialty care services we currently offer in our hospital, nursing home and the PMG practices. The community has made it clear to me that we need to do whatever is necessary to maintain these services. We don’t simply want the status quo — we all want to grow our services and improve access to care.
I am convinced that it will become increasingly challenging to offer specialty care as a stand-alone community hospital. I’ve been involved first-hand in the recruitment of specialty physicians to Porter, and I can say it is an ongoing challenge. We will be better served if we partner with a larger organization to maintain these critical services for this community.
Some examples: With the help of the UVM Health Network, we have recently added palliative care, something we could not do on our own; in oncology, we currently have two physicians practicing separately in our community. Working with UVMHN, can we expand these services to those in our community living with the challenges of cancer? There are other opportunities like this — services our community needs — all of which will be more likely to achieve as a member of a network.
Integration
Currently we have four electronic medical record systems on the Porter campus. None communicate well with each other, much less with UVM Medical Center. Half of the patients we care for at Porter receive some portion of their care at UVM Medical Center. Our work for our patients is deeply connected, while our medical records remain disconnected. With this affiliation, the UVMHN would install the EPIC medical record system, a best-of-breed product, to provide seamless information transfer across PMC and with UVM Medical Center (and other Network hospitals) — a linchpin in this negotiation from day one.
Facilities
Porter is like so many community hospitals and all Vermont hospitals — we are closing in on our 100-year anniversary. We have some great facilities (surgical services, labor and delivery) and some facilities that need work. To be as good as we can be we need an infusion of capital in the range of $15 million to $20 million to update our facilities.
As a standalone community hospital, I can say it will be a long time, (a very long time) before we have the resources to make such an investment. A commitment to make a significant capital investment in our facilities has been another key piece of our negotiations with UVMHN.
The project which has been on our list for nearly a decade is a medical office building; state-of-the-art, comfortable, convenient and efficient for staff and our patients. It makes sense to Porter and to the UVM Health Network, and we have recently agreed on a plan to make it happen.
Finances
I’ve been asked, “Can we survive on our own?” My response to that question has evolved over time and now is — “yes, but it’s a long perilous path.” We can most definitely get by financially for the foreseeable future (which realistically is three to five years) but there is not much margin for error, and at the risk of continued capital spending suppression. Any misstep, bad event, or major health care policy shift in D.C. could put us in a difficult situation. If we affiliate, we still have to focus on our financial performance. We will not get a free ride. What we will get is a cushion, a safety net so to speak.
What is the price of admission for affiliation? In a word, autonomy. There is no free lunch. After an affiliation, the UVM Health Network will approve our budget and without a doubt have more say in our future than they would have otherwise. There is risk in our future whatever path we choose — let’s choose the path that creates the least risk and the greatest benefit for our community.
What is the road forward? Our board of directors meets in mid-February to review what we expect to be a final agreement. Our PMC annual meeting is March 15, at which time our community members will review and approve the necessary bylaws changes. An April 1 closing date is possible. It is starting to feel real.
As I stated at the beginning of this message, we are in the homestretch of negotiations. We have completed our due diligence and are very close on the final membership agreement. Once we resolve the final outstanding issues related to Information Technology and more specific language about the proposed EPIC conversion timeline, we will have an agreement which is very attractive to both Porter and UVM Health Network. We will have an agreement with the potential to make Porter as strong as possible, to allow us to offer the best services, both quality and quantity. We will have an agreement which will position Porter to meet our mission of caring for community for many years to come.
This has been a great project, a strong team effort from our board, management, medical staff, employees and community. Last spring I was skeptical. By summer I was curious. By fall, I was cautiously optimistic. I am now excited. We have a great opportunity in front of us; a deal about as good as we could ever hope for to advance our mission. We need to finish this up, celebrate our success, and carry on with the important work of caring for our community.

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