Op/Ed

Opinion: UVM affiliation boosting Porter

In late November, I was interviewed by a reporter who asked for my perspective regarding the topic of hospital “consolidations” and to discuss some national studies that indicate that hospitals coming together means higher prices for patients. The reporter wanted to hear about our experience as an affiliate of the UVM Health Network since we joined the Network in early 2017. 
I am not a healthcare finance expert nor a student of national trends. I am, however, intimately familiar with our finances here at Porter and what is happening locally and in our region. Each of the three years since affiliation, Porter has had a zero percent increase in price for patients. The rates that we have negotiated with third-party insurance payers have been in the range of 2.5% to 3% — well below the rate of medical inflation. Our budget, which includes both the Price and Rate, has been within the guidelines laid forth by the body charged with containing health care cost in Vermont, the Green Mountain Care Board. I cannot prove that a 0% price increase is a direct consequence of affiliation but I am confident that our relationship within the UVM Health Network played a significant part. So, from a Porter perspective, the premise of the interview did not align with our actual experience. 
To be sure, driving down the cost of healthcare for patients is certainly essential and is in fact a strategic priority of the UVM Health Network. Porter is a Critical Access Hospital leader in payment reform initiatives and in the efficient delivery of clinical services, and we are proud of that. But there is far more to affiliation than dollars and cents. 
Porter has been an independent, nonprofit healthcare organization since our beginnings in 1925. William Henry Porter, a trustee of Middlebury College, established Porter Hospital as a resource to provide much-needed medical care for the citizens of Addison County. We were an independent hospital for more than 90 years and the decision to give up our independence and join UVM Health Network was not taken lightly. On the contrary, we went through an extensive and inclusive process, engaging our staff, providers and community. In the end, we determined that affiliation, rather than independence, would provide three key benefits to the people we serve: improve local access to necessary healthcare services, improved integration of healthcare services in our region and improved clinical facilities for our patients. Two and a half years into our experience as a UVM Health Network affiliate, we are recognizing progress on all three fronts. 
With regard to access, simply maintaining access to services in a small community hospital is a challenge. Keeping the doors open and the lights on is not a simple task. There are eight critical access hospitals in Vermont and most are facing serious financial challenges, most notably Springfield Hospital. And yet since affiliation, we have lost no clinical services and have actually added or expanded services while meeting our budget targets. We have been able to leverage the UVM Health Network expertise in palliative care to bring this important service to our community. Also, many Addison County patients were traveling to Burlington for cardiac rehab or simply forgoing this important care. Working with our Network cardiology colleagues, we have built a successful cardiac rehab program here, locally. We have added a new ExpressCare service and are exploring Telemedicine initiatives for primary care. Losing a specialty physician — a surgeon or a cardiologist — on short notice can be devastating to a community hospital and its ability to serve its community. The Health Network has worked with us to fill these sorts of needs faster than we could do it alone. 
In terms of clinical integration, until very recently the average complex patient in Addison County had five separate medical records — an ER record, a Porter Hospital record, a provider office record, a record at Helen Porter and a record at the UVM Medical Center — and these records did not communicate. This is not an uncommon scenario for a community hospital but the fact that it is common does not make it right. We are currently implementing the Epic electronic health record and going forward, our patients will have one medical record providing seamless communication between various sites of care. The benefit this advance provides for patients cannot be overstated and we could not have done this without Network support. 
Additionally, the UVM Health Network made it clear to us that if they were going to put their sign on our door, our patient care facilities need to be respectable — and we want great facilities for our patients. Since affiliation, we have worked together to create a Master Facility Plan for our Porter campus to address our most pressing facility upgrades together in the coming years. 
The last point I will make is in regard to the efficiencies we have gained at Porter through affiliation. We have saved significant dollars on medical supplies through Network purchasing. We share back office administrative functions in a way that allow us to have lower, not higher, administrative overhead. The savings go to our bottom line allowing us to reinvest in our people our facilities and our clinical services. We are a more stable organization — our entire community is more confident we will be here to provide crucial healthcare services when the need arises. 
As stated earlier, Porter joined UVM Health Network in 2017 to improve access, integration and facilities for our patients. This will sound politically incorrect, but it is true — we did not affiliate to simply reduce the cost of healthcare. But now that we are part of the Network, I can say that focusing on the cost of healthcare is a top Network priority. We understand the spiraling cost of healthcare is unsustainable. We are committed to driving cost down through collaboration and efficiencies.
I cannot explain why what we are experiencing here in Addison County through affiliation is not the nationwide experience. Is it because we are nonprofit? Is it because what we are doing here in our region is on a smaller scale? Many think of the UVM Health Network as a behemoth but in reality, compared to national health care systems, we are small. The UVMHN is our local effort to create efficient, high quality, integrated care locally, Vermont style and avoid national chains. Is the national data based on mergers and not affiliation type relationships? I’m just not sure. But of this I am sure — as a result of the affiliation with the UVM Health Network, we are providing better access to care for our community, integrating care and stabilizing our finances. And the data shows that these benefits are coming at no additional cost to our patients. As a Network, we are stronger together and better able to meet our mission of improving the health of our community. 

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