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UVM Health Network wants to build a surgery center to reduce wait times

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Last Friday, Dr. Stephen Leffler, president and chief operating officer of the University of Vermont Medical Center, issued an open letter to the community encouraging support for a $130 million outpatient surgery center. UVMMC wants to build on Tilley Drive in South Burlington, revealing he gets calls and letters every week from patients “saying they are waiting too long for care, especially surgical care.”

The Outpatient Surgery Center is a “big part” of the solution for these long-suffering patients, according to Leffler. In his letter he calls it a ‘must-have’. The surgery center will not only reduce waiting times by increasing operating room capacity, but will also reduce costs by keeping patients out of the hospital. Still, significant opposition to the Surgery Center is coming from two small rural hospitals — Copley Hospital in Morrisville and Northwestern Medical Center in St. Albans — and from AFT-VT Healthcare, the union that represents 5,000 health care workers.

The hospitals in Morrisville and St. Albans fear that the Surgery Center will steal so many surgical patients from them that their financial stability will be jeopardized, further endangering rural Vermonters’ access to health care. The union wonders where the 166 FTEs needed to run the Surgery Center will come from, as the UVM Medical Center is already severely understaffed and its twenty ORs are operating at full capacity.

A state report confirms that Vermonters are experiencing long wait times for appointments with medical specialists

Leffler’s recognition that patients in Vermont wait too long for care, especially surgical care, is undisputed. In February 2022, the state of Vermont released an 80-page report confirming what patients had long known: that they would have to wait months for specialists ranging from dermatologists to urologists.

As part of the state investigation, the Department of Financial Regulation made 1,000 “secret customer” calls, in which state employees requested appointments in 21 different specialties without revealing their true identities to mimic the experience of an average patient. Hospital administrators were not amused, saying the calls were unnecessarily taking up “valuable staff time.”

More: State survey confirms long wait times; Vermont hospitals say it’s old news

However, the calls showed that the average wait time for a specialist in Vermont was 61 days, but varied widely by specialty, from 29 days for general surgery to 140 days for dermatology. Springfield Hospital had the shortest average wait time at 29 days, while UVM Medical Center had the longest at 101 days.

Leffler: The backlog of surgical patients will reach 4,000 if nothing is done

The timing of Leffler’s letter seems coincidental, given that there will be a public hearing on May 20 for the certificate of need he needs the Green Mountain Care Board to issue for the surgery center to be built. In Vermont, no major health care project can be built without a CON from the Care Board. The idea is that nothing is built that doesn’t need to be built, keeping healthcare costs low. It is up to the Healthcare Board to solve that puzzle.

As the Care Board itself notes, the $130 million Outpatient Surgery Center is the most expensive project for which UVMMC has sought approval since the Board granted a CON to construct the seven-story Miller Building for inpatient care at a cost of more than $187 million.

The outpatient surgery center would replace the five operating rooms on the Fanny Allen Campus, which have been plagued by air quality problems for years, and add three additional operating rooms, bringing the total to eight. In addition, UVMMC would build a “peeled space” to allow for the addition of four more ORs in the future, for a total of 12, more than double Fanny Allen’s capacity.

The new ORs will also be better than the old ones at Fanny Allen, allowing for complex surgeries such as joint replacements. Leffler notes that Vermont’s population is “growing and aging,” increasing the demand for surgeries, especially in an outpatient setting.

“If current population trends continue as predicted – aging throughout the region, growing population in Chittenden and surrounding counties – by 2030, our current surgical case backlog will exceed 4,000 operations per year,” Leffler wrote. “That’s 4,000 people in need of care, who will wait longer than necessary for surgery, leave the state for care, or worse, go completely without the care they need – with potentially serious consequences for their health as result.”

Union President Asks Where Staffing for the Surgery Center Will Come From Given Current Hospital Staffing Issues

Deb Snell, president of AFT-VT Healthcare, wrote a letter to the Green Mountain Care Board last March asking that the union be granted “interested party” status in the CON process for the Surgery Center. Stakeholder status is granted to “individuals or organizations … who demonstrate that they will be substantially and directly affected by a new healthcare project under investigation,” according to the Healthcare Council.

An interested party has the right to propose questions that the Council may ask the applicant, the right to submit information prior to the hearing and participate in the assessment process, and the right to appeal the decision of the Council.

The Health Board granted the union interested party status over the objection of UVM Medical Center, saying, “The proposed project will require 166 FTEs, approximately half of whom will transfer from UVMMC’s main campus and the Fanny Allen campus. nurses and health care professionals) have an interest in how the proposed project will affect staffing levels, which in turn may affect the quality of care problems will be exacerbated by (its) members in providing safe medical care amid labor shortages”.

Snell points out that there are already 300 open bargaining positions at the UVM Medical Center. Additionally, she told the Burlington Free Press in an email that the 20 ORs on the main campus can only be 75% staffed by UVMMC nurses. The remaining 25% of nurses – about 30 – are travel nurses, itinerant workers hired at high costs.

“We are concerned that new operations will have inadequate staffing levels or that there will be an over-reliance on temporary nurses, without long-term commitment to our patients and nurses,” Snell wrote in her letter to the Green Mountain Care Board .

In an email to the Burlington Free Press, UVMMC spokeswoman Annie Mackin said about half of the staff needed for the outpatient surgery center will come from Fanny Allen’s ORs when they are closed to use the space for other services . She said the hospital would need to recruit 29 new registered nurses for the Surgery Center.

“For context, in the last 18 months we have added a net of 120 LPNs and RNs,” Mackin wrote.

Rural hospitals remind Green Mountain Care Board to worry about more than just Chittenden County

The two rural hospitals, Copley and Northwestern, made similar arguments in their successful efforts to obtain interested party status, which was unopposed by UVMMC. Northwestern points out that it is only about a 35-minute drive from St. Albans Hospital to the Tilly Drive location in South Burlington. UVMMC is proposing the Surgery Center. Copley says it’s only about a 54-minute drive for their patients. Both journeys are very easy to do, the hospitals imply.

Both hospitals say they have OR capacity that is not recognized in UVMMC’s CON application.

“As the GMCB moves through the CON process, they must keep in mind that operations that can be properly performed at Copley must remain at our facility,” wrote Copley CEO Joseph Woodin. “Our ability to maintain financial sustainability in both fee-for-service and value-based models depends on the efficient use of our existing infrastructure. Any loss of operations from our facility weakens Copley.”

Northwestern makes the same argument about its operations, and both hospitals implore the Green Mountain Care Board to ensure that in assessing whether the Surgery Center serves the public interest, it does not consider “solely the good of Chittenden County.”

Mackin responded in an email that UVMMC’s plan for anticipated need is “completely driven by our primary service area.”

“We have not anticipated any immigration of surgical cases from our neighboring hospitals,” she wrote.

Contact Dan D’Ambrosio at 660-1841 or [email protected]. Follow him on X @DanDambrosioVT.

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