By Erin Mansfield
State regulators have approved a permit for an independent surgical center in a controversial case that has dragged on for two years.
The Green Mountain Care Board issued the permit, called a certificate of need, in a 4-1 decision issued late Monday night.
Con Hogan, the lone dissenting vote, said the decision would erode the board’s cooperative relationship with hospitals. Board member Robin Lunge said she agreed to endorse the project “with reservations.”
The decision allows a group of independent doctors — most of whom remained anonymous during the legal proceedings for fear of retaliation from hospitals that opposed the project — to break into a general surgery market that has been exclusively controlled by hospitals.
The board issued 29 conditions for the running of the facility, called the Green Mountain Surgery Center. Investors have already bought land on Hercules Drive in Colchester near Costco.
One condition requires the center to participate in a payment model through an accountable care organization, such as OneCare Vermont, which is owned by the University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center.
Another requires the surgical center’s administrators to make quarterly reports to the Green Mountain Care Board in the first few years of the project. The center is also required to disclose the ownership interest of any doctors performing surgeries there.
Other conditions require the investors to make good on promises they made during the regulatory process, such as creating a website that transparently lists prices for consumers, negotiating prices with commercial insurance companies that are below what hospitals are paid, and accepting patients without regard for their ability to pay.
The board is also requiring the surgical center to contract with emergency medical services for cases in which patients need to be taken to the local hospital and to give patients their surgeons’ 24/7 contact information.
Throughout the case, two of the closest hospitals to Colchester — the UVM Medical Center in Burlington and Northwestern Medical Center in St. Albans — have said they could lose revenue from outpatient surgeries if the independent center were built. The board dismissed that argument.
“This Board regulates the hospitals’ budgets, and we do not foresee calamitous and irreversible financial implications resulting from decreased surgical volumes,” the board wrote. Members argued that hospital revenues would not suffer given that both exceeded the revenue caps the board set in fiscal years 2015 and 2016.
While the Green Mountain Surgery Center met the burden of proof for the permit, the board said, the decision “does not, however, and should not, be viewed as an open door for any similar health care entity that seeks to operate in this State.”
“With the conditions we impose today, we seek to hold the applicant to its pledge that it will lower health care costs, increase access to care, and maintain or improve the quality of health care in Vermont,” the board wrote.
“I feel great about this decision,” said Amy Cooper, the lead investor on the project and executive director of HealthFirst, a group representing independent doctors. “I feel great for the patients. I feel great for Vermonters. I feel great for the businesses that supported us. I feel really encouraged that the board listened to all of the public input and made a decision that is really in the best interest of the community at large.”
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