Editor’s note: This commentary is by Dr. Stephen M. Leffler, who is chief medical officer at Fletcher Allen Health Care. It was first published on the Fletcher Allen blog on May 8, 2014.
The Green Mountain Care Board has determined that several proposed urgent care centers do not need certificate of need (CON) reviews before they go forward. Some groups have applauded that decision, saying it is responsive to Vermonters’ needs for lower-cost care in more efficient settings. Others have decried it, pointing to the fact that these new centers won’t reduce any of the expenses incurred by Vermont’s nonprofit hospital system in making care available 24/7 – meaning that our prices will have to increase to cover the fixed costs of having emergency departments, nurses, physicians and diagnostic equipment available to serve fewer individuals in pain or distress who come to us for help.
My understanding is that the GMCB didn’t assert CON jurisdiction because, right now, the law is written in such a way that they simply couldn’t review these new expenses.
In response, the Vermont Legislature is considering changing the CON laws to make sure that urgent care centers are subject to review before they can be set up. This is the right thing to do.
Like the human body, systems work best when they are coordinated, integrated, and all parts are working towards the same end. They don’t work when foreign elements are introduced that disrupt that system.
Fletcher Allen’s reform work – making sure patients have a medical home, investing in an electronic health record, ensuring continuity of care for patients no matter where they access it – is focused on working with other regional providers to develop a system that promotes the health of the patients we serve at the lowest possible overall costs.
Like the human body, systems work best when they are coordinated, integrated, and all parts are working towards the same end. They don’t work when foreign elements are introduced that disrupt that system.
Vermont’s CON law has been around for more than three decades, and is designed to make sure that we – collectively, through taxes and premiums – are asked to support only those expenses that Vermonters really need. While the CON law was developed in a different era, it holds true today; it supports Act 48’s vision of a true “system of care” that serves all Vermonters’ needs at an affordable cost.
I applaud the Legislature’s view that urgent care centers – a new element in Vermont’s health care system – should be subject to CON review. Asking our nonprofit hospital system to reshape how we deliver care, and how we get paid for it, while letting state policy promote free-for-all competition just doesn’t make sense.
