‘Care’ Board to Copley: We’ll Regulate, So You Can’t Innovate!

By David Flemming

UVM economist Art Woolf has a must-read piece in the Burlington Free Press titled, “Vermont’s record on health care spending deflates confidence.” In it he notes, “Over the last two decades Vermont went from being a low health-care cost state with a small percentage of uninsured to one of the highest spending states.” Certificate of Need laws as exemplified by The Green Mountain Care Board vs. Copley Hospital is a good example of why that is.

According to patients, Copley Hospital in Morrisville, Vermont, is a model of quality healthcare. When the GMCB issued a Certificate of Need (CON) to Copley Hospital for replacing its surgical center in February 2016, it did so expecting that there would not be “any appreciable change in projected surgical volumes.” Copley had been completing around 1,800 surgeries annually. In the past few months, however, Copley has begun “taking in more money from the surgical center than was originally approved as part of the CON process” because of an increase in surgeries. This money has nothing to do with price increases, since Copley is “one of just three hospitals in the state… that did not propose to increase prices in the upcoming year.” Rather, there has been an increase in demand for Copley’s services through “word of mouth.”

That Copley is efficiently meeting a pretty clear “need”, providing superior service at lower price, is irrelevant to state regulators. What matters to the Green Mountain Care Board (GMCB) is that Copley is taking in more revenue than expected, in violation of their bureaucratic spread sheet. And, taking business away from the Crown Jewel of bureaucratic design, UVM Medical Center. This cannot be allowed to stand!

In an era of ever increasing healthcare costs in Vermont, it would seem like a foregone conclusion that GMCB would ask Copley how they are increasing their surgery services with the same resources, so that they can advise other hospitals to do the same. Art Mathisen, CEO and President of Copley Hospital remarked “we’re not hiring any orthopedic surgeons. Rather, Copley is completing more surgeries with the same staff.

Shockingly (or, actually, not so shockingly), instead of praise, Copley has received condemnation from the GMCB, and the GMCB is currently considering whether to rescind the CON approval for Copley’s new construction.

Dr. Allan Ramsay, a former GMCB member, claims that Copley Hospital is not equipped to handle complex surgeries. “That’s not a trend that we want to see in a smaller community hospital… it does generate revenue, but there are other surgical facilities that are better suited to do complex surgical cases.” Translation: We want UVM Medical Center to get that money regardless of what patients want.

Maureen Usifer, a current GMCB member, says that “when I talk to anyone in the Burlington area, anyone who gets a surgery goes to Copley.” Her comment is intriguing: Vermont’s largest hospital, the University of Vermont Medical Center is in Burlington, and has long been seen as the standard in Vermont healthcare. Not only are patients in the surrounding area flocking to Copley for surgery, patients from outside the area are as well. The patients have voted with their pocketbooks to undergo surgery at Copley. Now, the Green Mountain Care Board is attempting to overrule their decisions because it deems certain medical facilities as “better suited” than the ones patients frequent.

The Certificate of Need process is an antiquated-old relic of a failed federal policy. The Federal Trade Commission has implored states to abandon it – as most states have — because it “pose(s) serious anticompetitive risks that usually outweigh their purported economic benefits.” The best way for the Green Mountain Care Board to show leadership in healthcare innovation is to call for the legislature to repeal Certificate of Need, which would remove the temptation to micromanage hospitals like Copley that are already leading the way in healthcare.

{ 5 comments… read them below or add one }

Tom Evslin October 13, 2017 at 9:08 pm

In other words the Green Mountain Care Board is saying that people from Chittenden County should be refused the opportunity to go to Copley for orthopedic surgery even if these people are going because they hear that Copley does a terrific job. These people, the Board seems to be saying, belong to UVMMC. Not only don’t we have school choice; we apparently don’t have hospital choice either.

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Robert October 13, 2017 at 9:56 pm

It is an incredible and tragic irony that the unthinking who clamor for and scream “quality heath care for all” believe it can only be achieved by turning health care over to the government to administer. The truth is, of course, that as this article points out, once the government runs something, the process becomes more important than the outcome, and winners and losers become the whim of bureaucrats. Stated another way, the unthinking and ignorant who vote will ensure the demise of quality heath care in Vermont, and the nation.

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Jim Bulmer October 14, 2017 at 12:55 pm

Do we rally need or want the Green Mountain Care Board? Seems that it’s primary function is to impede progress. Perhaps it’s time to move on. Never happen as long as the current make up of the legislature remains as is.

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Ronald Court October 14, 2017 at 5:03 pm

Try finding out what an MRI or EKG costs at various hospitals and clinics around the state or country. Good luck! Hospitals won’t or can’t tell you, because of the complex rules they live by (or did, when I had both, several years ago.).
Neither of these in most instances are emergency diagnostic procedures. They can be scheduled. Still, only after the fact, when the bill comes in, can you see what the charge is. Several years ago, for an EKG, a simple 10 minute start to finish heart test, UVMMC charged me $1,150! There was no rationale then, and probably even less today.
The certificate of need prevents radiation technicians from buying their own MRI machines and offering their services at generally 30% less than an hospital might charge. CON = Competition Not Wanted Here.

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Elise Johnston Bolda October 14, 2017 at 11:06 pm

Please visit the Hospital Compare site in Maine. Maine Health Data organization has a legislative nandate to make information available to the public.

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