Small hospitals and the union push back against proposed outpatient surgery center

Last Friday, Dr. Stephen Leffler, president and chief operating officer of the University of Vermont Medical Center, posted an open letter to the community to encourage 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 "who say they are waiting too long for care, especially surgical care."

The Outpatient Surgery Center is a "big piece" of the answer for these long-suffering patients, according to Leffler. He calls it a "must-have" in his letter. The surgery center will not only cut wait times by increasing operating room capacity, but will also keep down costs by keeping patients out of the hospital. Yet, 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 representing 5,000 health care workers.

The hospitals in Morrisville and St. Albans fear the Surgery Center will steal so many surgical patients from them it will threaten their financial stability, further endangering rural Vermonters' access to health care. The union asks where the 166 FTEs required to run the Surgery Center are going to come from, since UVM Medical Center is already severely understaffed, with its 20 ORs running at full capacity.

State report confirms that Vermonters endure long wait times for appointments with medical specialists

Leffler's acknowledgement that patients in Vermont wait too long for care, and especially surgical care, is undisputed. In February 2022, the state of Vermont released an 80-page report confirming what patients have long known − that they face months-long waits to see specialists ranging from dermatologists to urologists.

As part of the state investigation, the Department of Financial Regulation made 1,000 "secret shopper" calls, with state employees asking for appointments in 21 different specialties without revealing their true identities in order to mimic the experience of an average patient. Hospital executives were not amused, saying the calls unnecessarily consumed "precious staff time."

More: State investigation confirms long wait times; Vermont hospitals say it's old news

The calls did reveal, however, the average wait time for a specialist was 61 days across Vermont, 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: Backlog for surgical patients will balloon to 4,000 if nothing is done

The timing of Leffler's letter would seem to be fortuitous, given the fact that a public hearing is coming up 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 will get built that doesn't need to be built, keeping down the cost of health care. It's up to the Care Board to figure out that puzzle.

As the Care Board itself notes, the $130 million Outpatient Surgery Center is the most expensive project UVMMC has sought approval for 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 at the Fanny Allen Campus that have been plagued with air quality problems for years, and add three more ORs for a total of eight. In addition UVMMC would build a "shelled space" to accommodate the addition of four more ORs in the future, for a total of 12, more than double the capacity of Fanny Allen.

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

"If current population trends continue as projected − aging throughout the region, a growing population in Chittenden and surrounding counties − by 2030, our current surgical case backlog is going to be more than 4,000 surgeries annually," Leffler writes. "That's 4,000 people who need care who will wait longer than they should for surgery, leave the state for care, or even worse, go completely without the care they need − with potential serious impacts to their health as a result."

Union president asks where the staff for the Surgery Center will come from, given current staffing problems at hospital

Deb Snell, president of AFT-VT Healthcare, wrote a letter to the Green Mountain Care Board last March, asking the union be granted status as an "interested party" in the CON process for the Surgery Center. Interested party status is granted for "persons or organizations … who demonstrate that they will be substantially and directly affected by a new health care project under review," according to the Care Board.

An interested party has the right to propose questions for the Board to ask the applicant, the right to file pre-hearing information and participate in the review process, and the right to appeal the Board's decision.

The Care Board granted interested party status to the union 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 Fanny Allen campus. The Union's members (i.e., nurses and health care professionals) have an interest in how the proposed project will impact staffing levels, which may in turn affect quality of care. In her request for interested party status, Snell expressed concern that 'the new facility will exacerbate the ongoing difficulties experienced by (its) members in providing safe medical care amidst worker shortages.'"

Snell points out there are already 300 open bargaining unit positions at UVM Medical Center. In addition, she told the Burlington Free Press in an email that the 20 ORs at the main campus can only be staffed up to 75% by UVMMC nurses. The remaining 25% of nurses − about 30 − are travel nurses, itinerant workers hired at great expense.

"We are concerned that any new operations will be staffed either at inadequate levels or overreliance on temporary nurses without long-term commitment to our patients and nurses," Snell writes in her letter to the Green Mountain Care Board.

In an email to the Burlington Free Press, UVMMC spokeswoman Annie Mackin said about half the staff needed for the Outpatient Surgery Center will come from Fanny Allen's ORs when they're 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 Chittenden County

The two rural hospitals, Copley and Northwestern, make similar arguments in their successful bids to be granted interested party status, which were unopposed by UVMMC. Northwestern points out it's only about a 35-minute drive from the St. Albans hospital to the Tilly Drive location in South Burlington UVMMC is proposing for the Surgery Center. Copley says it's only about a 54-minute drive for their patients. Both drives are highly doable, the hospitals imply.

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

"As the GMCB works through the CON process, they must consider that surgeries, which can be appropriately done at Copley, should remain at our facility," writes Joseph Woodin, Copley's chief executive officer. "Our ability to maintain financial sustainability in both fee-for-service and value-based models depends on efficient use of our existing infrastructure. any loss of surgeries from our facility weakens Copley."

Northwestern makes the same argument about its surgeries, and both hospitals implore the Green Mountain Care Board to make sure in assessing whether the Surgery Center serves the public good that it's not "solely the good of Chittenden County" taken into account.

Mackin responded in an email that UVMMC's plan for projected need is "driven entirely by our primary service area."

"We have not projected any in-migration of surgical cases from our neighboring hospitals," she wrote.

Contact Dan D’Ambrosio at 660-1841 or ddambrosi@gannett.com. Follow him on X @DanDambrosioVT.

This article originally appeared on Burlington Free Press: UVM Health Network wants to build a surgery center to cut wait times