Public asks medical center execs about the future of health care

MIDDLEBURY — While the heads of Porter Medical Center and University of Vermont Health Network came to Monday evening’s community forum to talk about how the affiliation of the two institutions has gone over the past six months, many of those at the event were looking at their health care going forward.
One prominent question from the audience of around 60 at the Middlebury Regional EMS building was how their care will change as Porter transitions to an “all-payer” system.
Under such a system doctors and hospitals sign up to manage their payments through an Accountable Care Organization (ACO) that allocates insurance money on a per-capita basis, rather than the standard “fee-for-service” reimbursement model. The hope of such a system is to encourage health care providers to collaborate on keeping people healthy since they are paid per person rather than per procedure.
In May Porter officially became an affiliate with UVMHN, an association of six medical centers in Vermont and upstate New York.
On Monday, Dr. John Brumsted, president of the UVM Health Network, and Dr. Fred Kniffin, president of Porter Medical Center, asserted that in just a few years, under an all-payer system doctors were going to be financially rewarded for keeping a panel of patients healthy rather than treating the sick and injured, a symptom of the fee-for-service model that relies on unhealthy patients for financial sustainability.
This incentive alignment is what Kniffin and Brumsted are most excited about, and as they repeated, are “just getting started.” At the start of 2018, they said, the transition to the all-payer system is kicking into high gear. Brumsted was very clear that the new all-payer model is “totally intertwined” with the goals of Porter/UVMHN integration and with improved population health.
The UVM Health Network is taking on a significant portion of the patients adopted into the new system and is “totally at the table” to make sure that primary care stays accessible and high quality with sufficient funding.
Brumsted and Kniffin said they expected that the average patient may well see little change in their own health care other than better access to preventative programs, while patients requiring complex care will benefit from better communication and integration.
Porter’s new walk-in Urgent Care facility was presented as a win-win on the financial side as well as improving care, which tied in to the all-payer discussion. Community members at Monday’s meeting expressed the concern that Urgent Care was being used as an “overflow” for patients who weren’t able to see their primary care doctors in a timely fashion.
Dr. Carrie Wulfman, from Porter’s Primary Care Brandon office, spoke up to say the doctors’ offices were still doing everything they could to see as many patients as possible, even if Urgent Care provided a helpful backup. Wulfman also gave a convincing anecdote that provided her perspective on the merits of integrated, all-payer care that are changing the incentives for doctors and helping pay them to keep people healthy.
“I want (my patients) not to need me,” she told the audience.
Brumsted and Kniffin also hit on other aspects of the affiliation, telling the full house that this new union couldn’t be stronger.
Both leaders took some time to address the progress toward five goals the affiliation was intended to advance. Those goals are to improve healthcare access, integration, savings, facilities improvements and reform.
Kniffin highlighted the arrival of a new cardiologist as evidence of improved access to care. He also sketched some long-term goals for leveraging the UVM Health Network’s resources to bring new services to the Middlebury area to eliminate the patient’s burden of traveling to either Rutland or Burlington.
As explained by Brumsted, a critical goal for achieving strong integration across the network is making sure that every practice and hospital uses the same medical records software. A proposal is in to finance the implementation of top-of-the-line software made by Epic over the next three years. It is up for approval by the Green Mountain Care Board and Brumsted says “we are in the starting blocks” and waiting for the green light.
On the financial front, Kniffin said “we are realizing savings” promised by the new affiliation, including savings of several hundred thousand dollars in medical-surgical supplies and a 2 percent kickback from food distributors for dining, which he said adds up when serving nearly 100 meals every day year round.
Kniffin described the conclusion of a six-month master facility planning process carried out by his office with a consulting team made possible by the new affiliation. The plan resulted in an affirmation of the need for a new medical office building, which will begin a more concrete planning phase soon, but it also brought some new goals to the forefront.
Brumsted spoke about the seamless transition of Porter staff and trustees onto the new boards and teams the affiliation has demanded. He emphasized that when it comes to affiliates, his priority is to work with health care providers who share “the same burning desire to serve our communities as best we can” and are trying to “thoughtfully look at the way we deliver care across the region.”
Community members working in substance recovery and emergency medical services wanted to know if new doors for collaboration and support would be open soon. Kniffin and Brumsted assured them that they were always open for conversation even if they could provide no guarantee on the financial side. They pointed to experiments like the UVM Medical Center’s recent purchase of a motel in collaboration with the Champlain Housing Trust as proof of the possibility for well-thought-out preventative projects that made savings possible.
Mental health was a discussion topic. Brumsted and Kniffin both acknowledge the “ongoing problem” of lack of counselors and availability of psychiatric beds, saying “we’re working really hard on this.”
Paramedics were vocal about the need for special attention for complex patients who were “frequent flyers” on the ambulance system, a debilitating drag on critical resources. Community care providers spoke up about the round tables that had already begun through the Blueprint for Health and invited further discussion in this venue.
Brumsted also pledged to fight for policy at the state level that would provide paramedics the flexibility to transport patients to the appropriate care facility in order to reduce strain on the emergency department.
Editor’s note: John Flowers spoke with Drs. Kniffing and Brumsted before Monday’s meeting. Read his story by clicking here.

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