MIDDLEBURY — Two of the state’s most prominent health care CEOs on Monday gave Porter Medical Center’s nascent affiliation with University of Vermont Health Network (UVMHN) a sterling six-month checkup and promised the new collaboration would produce big changes in Middlebury as it matures during the next five or six years.
It was in May that Porter officially became an affiliate with UVMHN, an association of six medical centers that now includes Porter; University of Vermont Medical Center in Burlington; Alice Hyde Medical Center in Malone, N.Y.; Central Vermont Medical Center in Berlin; Champlain Valley Physicians Hospital in Plattsburgh, N.Y.; and Elizabethtown (N.Y.) Community Hospital. Porter officials reasoned the partnership could offer PMC such things as long-term financial stability, more diverse health care services, a new medical office building and an upgrade to its electronic medical records system.
That payoff is starting to come through, UVM Health Network CEO Dr. John Brumsted and Porter President Dr. Fred Kniffin told the Addison Independent during an interview on Monday.
“If you didn’t know, you couldn’t tell,” Brumsted said of the seamless way Porter and UVMHN officials have blended their talents.
“There is really no grinding of the gears at all.”
Brumsted and Kniffin gave their affiliation update just a few hours before soliciting feedback on that process from members of the Porter Medical Center community Monday evening.
During the interview, Kniffin confirmed he will be part of a UVMHN contingent that on Nov. 6 will urge the Green Mountain Care Board to green-light a $150 million plan over six years to convert PMC and three other network affiliates to an Epic electronic records system.
Being part of the Epic network would allow Porter patient records to be shared seamlessly between other network affiliates at which these patients might seek care.
“This is a huge part of affiliation,” Kniffin said of Epic. “This was a deal-maker. It really makes it all make sense from a physician’s point of view and a patient’s point of view.”
Brumsted stressed the advantages of the UVMHN affiliates being able to better communicate with each other.
“Anybody with a need to know will be able to figure out where someone else has been in the system, which will be a thing of beauty, having practiced here for more years than I care to admit,” Brumsted said with a smile. “To be able to go on the desktop and figure out what happened to this person when they were in Northern New York and then slipped over the bridge and made a little stop at the Middlebury ER, would be great. It’s all there in one spot.”
Officials also discussed planning for a new medical office building as part of a new master plan for future capital upgrades on the Porter campus. The new building would help consolidate some physicians offices and medical services — such as physical therapy, podiatry, orthopedics, pediatrics and obstetrics — in a single location.
Kniffin said he and others will begin sharing some details of that master plan with Porter medical staff and trustees during the next few weeks. The Independent will report that news as soon as it is made public.
“We don’t have enough space,” Kniffin said. “We have just been moving the deck chairs around and around during the past 15 years.”
The long-range capital plan will also underscore the need for upgrades for the emergency department and medical surgery area, where there are currently no private rooms for patients, according to Kniffin said.
ECONOMIES OF SCALE
Affiliation advocates cited savings advantages through economies of scale. Kniffin confirmed those savings are starting to materialize, largely thanks to UVMHN’s considerable buying power.
“We have documented $200,000 to $300,000 in savings in these first six months, just in terms of medical-surgery supplies,” Kniffin said.
Officials at Helen Porter Healthcare & Rehabilitation have reported a 2-percent discount on food, directly attributable to UVMHN affiliation.
“It’s not a ton of money, but it’s 95 people, three meals a day, 365 days a year,” Kniffin said. “It starts to add up.”
Porter hasn’t laid off any workers since affiliation took effect, according to Kniffin. At the same time, the organization has been trimming some jobs through attrition. It has not filled two vice president posts recently vacated.
“We probably would have replaced (the two VP posts) if we were independent,” Kniffin noted.
ONCOLOGY SERVICES
Brumsted and Kniffin spoke enthusiastically about new and improved services that affiliation might bring to Porter. Among them: Treatment for cancer patients.
Kniffin said fewer than 20 percent of Addison County cancer patients are currently served locally. That means the vast majority of local cancer patients — already weakened physically and emotionally — have to travel varying distances for treatment.
“People are traveling up and down the road for treatments that can be done safely here,” Kniffin said. “I find that unacceptable. It’s not going to be a quick fix, but I would say if we tried to build our own cancer treatment program going it alone it would be impossible, or at least a big challenge.”
He explained Porter hasn’t been able to offer chemotherapy at its Middlebury infusion center in large part because it is not equipped with an Epic-brand Beacon software that helps oncologists document a patient’s disease and prepare personalized treatment plans.
That is one of the reasons why conversion to an Epic electronic medical records system is one of the top priorities in Porter’s affiliation portfolio.
“(Chemotherapy at Porter) is a huge, multi-phased project,” he said. “I would never promise that this will happen in any specific timeframe. But it seems like a really worthy service.”
Porter, according to Kniffin, could use around three days of oncology services per week, as opposed to hiring two or three on-staff oncology physicians. That would mean “integrated services” with some care in Middlebury and “wrap-around services” delivered in Burlington.
He warned such programming can’t happen overnight, however. He hopes PMC will be able to offer chemotherapy treatment within five years.
Brumsted agreed it would be a good idea to have better oncology services Addison County.
“There’s a basic tenet that we’re trying to keep care local, whenever appropriate,” Brumsted said. “(Oncology) is a really good example. It does take some work on the labor and facility sides. If you’re going to do chemotherapy, you’ve got to have a special branch of your pharmacy and so you’ve got to factor in all of these things.”
PALLIATIVE CARE
Kniffin and Brumsted cited palliative care as a service that has grown at Porter during the six months since affiliation.
The program is being led by Dr. Diana Barnard and includes respite care at the hospital and Helen Porter Healthcare & Rehabilitation, run in collaboration withy Addison Respite Care Home, Ltd. Kniffin hopes to gradually increase Barnard’s time on the Porter campus.
Officials added PMC will benefit from some other, statewide initiatives spearheaded by UVMHN:
•  Opioid addiction programming. The clinical faculty at the University of Vermont Medical Center has developed an Addiction Treatment Program to serve prescribers across the entire state — regardless of whether they work within the UVM Health Network — to disseminate best practices and promote Medication Assisted Treatment.
•  UVMHN leaders are working with the Agency of Human Services and the Department of Mental Health to partner on strategies that would address access to appropriate mental health services.
PAYMENT REFORM
And it’s clear that Porter and UVMHN are on the same page when it comes to health care payment reform.
Porter has, since February, been piloting a “next generation” payment model for its Medicaid patients. Porter spokesman Ron Hallman said Porter is believed to be the only critical access hospital in the country to have volunteered for this new payment model, through which PMC has received around $4 million in Medicaid funds to pay the medical costs of around 2,600 at-risk, Addison County patients who are enrolled in that federally subsidized health insurance program.
This new pilot program epitomizes the current health care payment reform effort that is being advanced by the state of Vermont and through the federal Affordable Care Act. At its center is the notion of giving hospitals incentives to take preventative measures that will keep their population base healthy, as opposed to the current system that rewards medical institutions for performing often-costly medical procedures.
Kniffin, in his most recent weekly message to the PMC community, said Porter is upping its ante in the payment reform arena.
“In fiscal year 2018 we will be going ‘all in’ with this model involving payments to Porter from Medicare, Medicaid and Blue Cross all coming through the all-payer model,” he wrote. “This is about a quarter of our total patient revenue.”
Brumsted praised Porter’s budgeting innovations.
“I’m obviously a big believer in moving the acute care delivery system and other components in the continuum of care to more of a capitated, global budget approach,” Brumsted said. “It puts pressure on the delivery system to reduce costs and be as efficient as you possibly can. The best way to do that is to keep people healthy so they don’t need services. For me, it aligns incentives in the absolutely right way. If you’re a physician and believe in keeping people healthy … that really is the right way to go.”
Reporter John Flowers is at [email protected].