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Dan D'Ambrosio | Free Press Staff Writer | July 27, 2017

WILLISTON - Dr. Joe Haddock has been practicing primary care medicine at Thomas Chittenden Health Center since 1978. Haddock's office is unpretentious and homey, with a creaky rocking chair for visitors and farming posters on the walls. 

Haddock, 70, grew up on a hog farm in western Illinois, which explains his choice of words to describe the disparity between the reimbursements he gets from insurance companies compared to the reimbursements the University of Vermont Medical Center receives. 

"We get stuck sucking hindquarter, we really do," Haddock said. 

Haddock says his practice is paid $80 to $85 by Blue Cross Blue Shield of Vermont for a regular office visit to treat a simple illness, versus about $180 for the same visit to UVM Medical Center. 

The difference is even bigger for specialists, Haddock said. For a colonoscopy at the UVM Medical Center Blue Cross Blue Shield pays the physician about $1,600 opposed to about $800 when the procedure is performed by an independent practitioner,  despite being done in the same room at the hospital with the same equipment and staff. 

Andrew Garland, vice president of client relations and external affairs for Blue Cross Blue Shield of Vermont, said the insurer doesn't discuss specific contract terms with providers, including reimbursement amounts.

"However, I can confirm that the numbers you cite do roughly align with the typical reimbursement differential we see between academic medical centers and all other providers," Garland added.

Haddock said the enhanced reimbursements for the medical center made sense when they were put in place in the 1970s. UVM Medical Center provides essential services, like the emergency department, that increase its overhead. It maintains physicians on staff, like a pediatric neurologist, which Vermont wouldn't be able to support without a large hospital to absorb the costs.

But over the years, Haddock said, a small difference in pay has become a dramatic difference.  

Independent doctors say this problem threatens their existence and therefore health care choice for Vermonters. 


Erin Mansfield | VTDigger | May 4, 2017

A national group that has worked with the Federal Trade Commission to stop hospital mergers that would create monopolies says opposition to a proposed independent surgical center may be “anti-competitive.”

The Association of Independent Doctors, which just started a Vermont chapter, has weighed in on the controversial case involving the proposed Green Mountain Surgery Center as part of the Green Mountain Care Board’s public comment process.

Investors have been seeking permission from the regulatory board for nearly two years to open a six-room surgical center in Colchester. The process to obtain a permit called a certificate of need is designed to stop duplication of health care infrastructure.

Judy Henkin, general counsel for the Green Mountain Care Board, said she could not comment on whether the board has concerns about competition because the surgical center case is pending.

The Vermont Association of Hospitals and Health Systems is intervening to oppose the project, as is Northwestern Medical Center in St. Albans. They have said the project would cause them to lose revenue from profitable services; they say those profits are needed to offset the cost of things like running emergency rooms.

Marni Jameson, the executive director of the Association of Independent Doctors, wrote on Monday, the final day for public comment, that she had consulted contacts at the Federal Trade Commission who agree the opposition to the surgical center “appears to be anti-competitive.”

On Wednesday morning, the Green Mountain Care Board’s website, which includes most public documents on the certificate of need, had a copy of the letter as part of all the public comments received.

The public comments appeared to have been removed by Wednesday evening.

Henkin said Thursday afternoon she didn’t know why, but that she would look into the situation. The comments were posted again later Thursday.

In her letter, Jameson described her past collaboration with the FTC. “I have shared this situation with my contacts at the Federal Trade Commission, an agency I have worked with several times over the past few years to successfully fight health-care consolidations in other states that would form monopolies and harm consumers,” Jameson wrote.

“The FTC along with the Office of Policy Planning agree that this situation also appears to be anti-competitive, and joins me in encouraging you to decide in favor of increased competition,” she wrote. The policy planning office is part of the FTC.

Jameson said in an interview that she has a longstanding relationship with the FTC and is speaking on its behalf but could not connect VTDigger with her contacts.

“Furthermore,” she wrote to the Green Mountain Care Board, “the officer I spoke to suggested I cite for you recent arguments the FTC and Department of Justice presented in Alaska regarding its CON law, regulations that in general have proven to be a mixed blessing.”

Those arguments, written in April, said laws “can restrict entry and expansion, limit consumer choice, and stifle innovation” and “can be exploited by incumbent firms to thwart or delay entry by new competitors … harming free markets and consumers.”

The Federal Trade Commission’s website says that “anticompetitive practices include activities like price fixing, group boycotts, and exclusionary exclusive dealing contracts or trade association rules, and are generally grouped into two types: agreements between competitors, also referred to as horizontal conduct; (and) monopolization, also referred to as single firm conduct.”

In Act 48 of 2011, the Legislature gave the Green Mountain Care Board the power to create and regulate health care entities. The law instructed the board to practice oversight to ensure compliance with antitrust laws.

“To the extent required to avoid federal antitrust violations, the board shall facilitate and supervise the participation of health care professionals, health care facilities, and insurers in the planning and implementation of the payment reform pilot projects,” the law says. “The board shall ensure that the process and implementation include sufficient state supervision over these entities to comply with federal … antitrust provisions.”

Jameson said this of her reason for sending the letter: “I did not know whether the Green Mountain Care Board would see the consumer value of adding the surgical center, and I felt it was necessary to put the heat on them so they would.”


Erin Mansfield | VTDigger | Apr. 13, 2017

Investors seeking to build a surgical center in Colchester faced stiff opposition from hospitals Thursday while trying to persuade state regulators to grant them a certificate of need. 

Representatives for Northwestern Medical Center in St. Albans and the Vermont Association of Hospitals and Health Systems framed the proposed six-room surgical center as a “for-profit,” “unregulated” project that would hurt community hospitals and drive up health care costs.

The local investors had spent nearly two years in a regulatory battle for this opportunity to make their case to the Green Mountain Care Board. The investors want to spend $1.8 million to open a 12,800-square-foot surgical center in Colchester for surgeons who would prefer not to operate in a hospital setting.

The investors argue such centers save patients and insurance companies money because both Medicare and private insurers pay them less than hospitals for the same procedures. These types of facilities are called ambulatory surgical centers and are both licensed and regulated by the U.S. Centers for Medicare and Medicaid Services.

But allowing the new facility, called the Green Mountain Surgical Center, to open would let these independent doctors penetrate a general surgery market that to date has been exclusively controlled by hospitals. And hospitals say that could be detrimental to the health care system as Vermonters know it.

Amy Cooper, the executive director of HealthFirst, was the main witness for the surgical center. She said Vermont ranks dead last in the country in the number of surgical procedures performed at these types of small centers, which are paid less than hospitals and often perform surgeries more quickly.

Cooper estimated that, because the proposed facility would charge less than hospitals for basic surgical procedures, it would save insurance companies, Medicare and Medicaid a total of $5.5 million a year. She also said the facility would be subject to income tax and property taxes because of its for-profit status.

Cooper said the surgical center would accept patients who cannot afford to pay, just as hospitals do. She said its pricing philosophy is to try to have Medicare, Medicaid and insurance companies pay the same price, if the center can negotiate that. Additionally, she said the surgical center wants to have a price transparency tool on its website so patients can shop around.

“This project is not against the hospitals,” Cooper said. “This project is for the patients. We in the independent practice community here believe there is space for all providers in the health care landscape.”

“It’s going to be a building of 12,800 square feet,” she said. “That’s much smaller than any new (hospital) building project or renovation that I can remember that’s been approved by the board recently.”

“This is really an incremental step I think in the evolution of the Vermont health care system,” she said. “It’s not going to drastically alter the landscape here in the state of Vermont.”

Read full story here.


Erin Mansfield | VTDigger | Apr. 24, 2017

Independent doctors have started an organization in Vermont dedicated to helping them keep their small practices in the face of what they consider pressure to sell out to hospitals.

Doctors have created a Vermont chapter of the Association of Independent Doctors, a national nonprofit organization started in Florida in 2013 that says, “We fight a fight that doctors have neither the time, means, nor clout to pursue.”

The Vermont chapter will have 15 members, who are all current or former board members of HealthFirst, the nonprofit organization that represents the interests of independent doctors at the state level.

Independent doctors are self-employed and own their own practices, as opposed to working in a hospital or for a practice that a hospital or hospital system owns. Insurance companies often pay independent doctors less money than hospital-employed doctors for performing the same procedures.

The Vermont Legislature has passed three laws since 2014 seeking to have the Green Mountain Care Board, which regulates health insurance prices, force insurers to pay independent and hospital-employed doctors equitably. Some legislators say those laws have not led to meaningful progress to protect independent doctors. Read full story here.


VTDigger | Erin Mansfield | Dec. 11, 2016

Dr. John Brumsted, the chief executive officer of the University of Vermont Medical Center, speaks at a hearing in South Burlington. Brumsted's base salary went up, but he and other executives at the hospital saw their overall compensation drop during the period examined because a bonus payout had inflated it the previous year. 

Chief Executive officers at Vermont hospitals made an average of $548,000 in salary and benefits in 2014, a 6.4 percent increase over the year before.

The numbers come from a VTDigger analysis of each hospital's public tax return, called Form 990, which the institutions must file with the Internal Revenue Service because of their nonprofit status.

VTDigger reviewed the most recent tax forms for all 14 hospitals in Vermont, plus Dartmouth-Hitchcock Medical Center, which is in Lebanon, New Hampshire, but gets 40 percent of its patients from Vermont.

Among the 15 hospitals, only two of the CEOs were women in 2014. Among the 40 highest-paid administrators in 2014, five were women. All administrators who made more than $1 million in 2014 were men.

Al Gobeille, the chair of the Green Mountain Care Board, which is charged with controlling health care costs, including hospital budgets, declined to comment of this story. He pointed VTDigger to the Vermont Association of Hospitals and Health Systems, a lobbying group.

"It's critical for hospitals to attract and retain the most skilled employees, at every level, to maintain the highest quality of care," said Jeff Tieman, the CEO of the Vermont Association of Hospitals and Health Systems. "That means providing competitive compensation for all positions, including leadership."

"Hospital boards, which include members of the community, set salaries for hospital leadership using clearly defined policies to ensure fairness and stay consistent with the overall market for this unique and specialized skill set," Tieman said.

Vermont Leadership


Amy Cooper, MBA              Paul Reiss, MD

National News...

In one new Oklahoma City surgical center prices are 1/6 to 1/10 the amount charged by hospitals. Everyone pays the same price for the same procedure. Total charges are often less “than the deductibles on the Obamacare plans.” Patients are not asked: “What insurance do you have?” Real life evidence that “legitimate” pricing is the cure for a sick healthcare system. Please share and help to more here.

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