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Porter ramps up services, confronts deficits

MIDDLEBURY — With COVID-19 activity on a steady, downward trend in Addison County, Porter Medical Center continues to ramp up services, including elective surgeries.
And while Porter has been assigned the task of mopping up $5.7 million of the $152 million in COVID-related red ink the University of Vermont Health Network is projected to incur by Sept. 30, PMC officials are confident they’ll be able to do that — and more — without layoffs.
“Our overarching message at this moment in time to our community is that we are here for them, and that they shouldn’t delay necessary care,” said Ron Hallman, Porter’s vice president for public relations. “We have put into place lots of new policies and protocols to invite folks back for elective-type services across the spectrum. We will provide a safe environment for them, our staff and we’ll try to deliver services that people have been delaying… Our message today is, ‘Please don’t delay necessary care. Reach out to your provider.”
Thankfully, a lot of folks have already gotten the message that Porter is back open for business for virtually all services — albeit with health-preserving precautions that include patients and staff screenings before they enter this building, mandatory face masks, and a process through which some patients are whisked from their cars to procedure rooms.
Members of Porter’s leadership team outlined the organization’s resurgence during a May 22 phone conference with the Independent.
Dr. Carrie Wulfman, UVMHN Porter Medical Center regional physician leader, said Porter’s primary care clinics and provider practices are now operating at around 80% capacity, while specialty clinics were functioning at around 50% last week.
Telemedicine — allowing for virtual patient-provider meetings — still accounts for roughly 70 percent of the “visits” with PMC primary care providers, according to Wulfman.
“Our goal in the next two or three weeks is to get to 60% telemedicine and 40% in-person visits,” she said.
Dr. Anna Benvenuto, PMC’s medical director for primary Care, estimated late last week that operating rooms were functioning at 30-50% capacity. Meanwhile, labs are fully operational, with radiology functioning at 40-50%, officials said.
“We are open to almost all business now,” Benvenuto said. “The two standouts we have not started this week — but that will start in the next week or two — are joint replacement surgeries and screening colonoscopies. We have plans during the next couple of weeks to open up the full range of services.”
It was last week that Porter expanded increased activity in surgical services area to work through some of the backlog of non-emergency procedures that were postponed when hospitals were ordered to make COVID-19 response their top priority. Still, Benvenuto stressed Porter’s operating room has continued to host emergency surgeries through the pandemic.

NEW ADMISSIONS PROCESS
PMC has reworked its perioperative procedures in order to resume “normal” operations. That process includes:
•  All patients are screened for COVID-19 prior to coming in for surgeries. Those who pass the screening process come directly into the hospital’s surgical services suite.
“They don’t spend any time in the waiting room, either before or after their procedure,” Benvenuto said.
•  Clients scheduled for the ambulatory clinic, lab and radiology services and operating room are given a phone number to call when they arrive on PMC campus. They call the number and are asked a number of screening questions. Then they’re greeted by a member of the clinical staff, who takes their temperature prior to coming into the hospital, and they are led to the appropriate space.
“If they don’t come with a mask, they’re given one upon entering the hospital,” Benvenuto said.
Early during the pandemic, all patients were funneled through the emergency department entrance. That’s no longer the case, but Benvenuto noted all hospital entrances/exits are locked to ensure everyone undergoes COVID-19 screening.
“In every care setting, we’re looking at the flow of patients through our service area to reduce any exposure, so we can maintain physical distancing in all areas,” Benvenuto said. “We’re really trying to do it in a streamlined, patient-centered way, so we can make people feel safe and welcomed no matter where they’re coming to get care.”
Local health care officials had been concerned that some patients might delay needed treatment due to fears of contracting COVID-19.
So are the patients now arriving at Porter sicker than usual?
“In the primary care setting, I haven’t heard providers say that so far,” Wulfman said. “And I have not experienced that, because I think the patients who needed urgent or emergent care during the crisis did get that appropriate care at Porter.”

FINANCES HIT, NO LAYOFFS
Porter’s finances have taken a hit during the pandemic, as have all hospitals affiliated with UVMHN — and pretty much all health care institutions throughout the country.
Jen Bertrand, PMC’s chief financial officer, explained that ideally Porter tries to end each fiscal year with a surplus of $2.5 million to $3 million. But due to COVID-19 factors — such as the suspension of non-essential surgeries and other procedures during the pandemic — Porter is anticipating a $5.7 million loss.
“Once we knew we needed to identify $5.7 million in what we call ‘margin improvement initiatives,’ we came together as a team and started to identify areas where we could have improvement,” Bertrand said. “Those areas included expense control, salary savings and the federal stimulus grants to help offset the deficit.”
Recognizing the financial problem could last beyond the end of this fiscal year, PMC officials have actually identified around $9 million in reductions and enhanced revenues, in the following categories:
•  $515,000 in “expense improvements.” Porter officials have found most of that money through insurance savings.
•  $1 million in revenue adjustments. Officials have already identified that money within the OneCare Vermont Accountable Care Organization (ACO) of which Porter is a member.
•  Salary Changes: $987,500. John Brumstead, president and CEO of UVMHN, has ordered immediate reductions in base pay for leaders, amounting to 5% for directors and 10% for vice presidents and above.
•  Applying $6.5 million in COVID-related federal stimulus aid that’s been allocated to PMC.
While the situation remains fluid, layoffs aren’t in the current plans.
“We are continually evaluating that, but currently, we continue to adopt the philosophy of doing what we can internally without having to lay off any of our workforce,” Bertrand said.
Porter Medical Center — which includes the hospital, Helen Porter Nursing & Rehabilitation and around a dozen affiliated provider practices — currently counts around 800 full- and part-time workers.
“There are a lot of unknowns with COVID and what the future may bring when we talk about a potential second wave (of illnesses),” Bertrand said. “Right now we’re in OK shape, with the caveat that we are in a constant state of flux with COVID. It could change at any point, if we have some kind of surge or second wave.”
Bertrand and her colleagues are forecasting PMC will return to a “somewhat normal” financial state between June and September.
“Thankfully, we are seeing patients scheduling quite a bit of surgeries during the month of May, and that’s giving us hope for the remainder of the fiscal year,” Bertrand said.
Interim PMC President Tom Thompson is proud of the work Porter officials have done during the pandemic. He believes the organization is back on track.
“What we’re looking to do is emerge as a better version of ourselves, to capitalize on opportunities, to be even more patient- and resident-centered — which we have learned thorough this process — and see if we can codify that into our DNA,” he said.
“Our whole goal here is to provide that trusted care folks have come to rely on, and to do it in better ways coming out of the COVID crisis,” he added.
While most PMC operations are reopening to the public, Helen Porter Rehabilitation & Nursing is taking a more conservative approach in order to ensure the safety of senior clients who are most vulnerable to COVID-19.
“We are continuing with the same level of visitor restrictions and staff screenings and we are focused on electronic communication between families and residents,” Helen Porter Administrator Mary Jane Nottonson said. “We’re ramping up people’s technology skills. There’s no reopening right now at Helen Porter. We’ll be working closely with the Vermont Department of Licensing & Protection and will address any reopening in collaboration with the Vermont Department of Health.”
Reporter John Flowers is at johnf@addisonindependent.com.

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