Porter affiliation with UVM network yields gains

MIDDLEBURY — Approximately a year and a half into its affiliation with the University of Vermont Health Network, Porter Medical Center is reaping the promised rewards of a more stable budget, more streamlined operations, shared resources, and improved technology.

And within the next three or four years, the partnership is expected to yield some major new amenities for PMC, including a state-of-the art electronic medical records system, a new medical office building and a more modern transportation system for critically ill patients.

Those were among the major takeaways from an extensive interview on Monday, Sept. 24, with Porter Medical Center President Dr. Fred Kniffin and Dr. John Brumsted, CEO of the UVM Medical Center and the UVM Health Network. The pair of top executives took some time to chat with the Independent prior to the ceremonial unveiling of a $900,000 renovation project at Helen Porter Rehabilitation & Nursing facility (See story in Monday’s Addison Independent).

Brumsted praised Porter officials for their contributions to the affiliation effort, a process that will continue to unfold for several more years.

“In the grand scheme of changes in health care and health care delivery, a year and a half is about a nanosecond,” Brumsted quipped. “But at the same time, the integration of PMC into the UVM Health Network, and the importance of having (Kniffin) and his team integrated into what we’re doing at the health network has been amazing.”

Brumsted said Porter’s transition to affiliation has been one of the swiftest he’s seen in the network, which now includes six medical centers in Vermont and New York.

That rapidity has had its plusses and minuses, officials acknowledged.

“From our point of view, the biggest complaint we’ve been getting is that things might be going too fast,” Kniffin said. “And the things we’re talking about are good things.”

Here are some of those good things, according to Brumsted and Kniffin:

•  Two years of stable Porter budgets after a period of financial turmoil and layoffs only three years ago.

The Green Mountain Care Board earlier this month endorsed a new PMC budget calling for $86,193,572 in expenditures during fiscal year 2019, which begins Oct. 1. That spending plan reflects a 3.2-percent increase in net patient revenue, a 4.9-percent boost in expenses and — for the second year in a row — no increase in its charges for medical services.

It wasn’t that long ago that PMC was losing physicians, nurses and other staff to retirement and other medical centers with rosier futures.

Affiliation and a healthier financial standing have helped turn that around, according to Kniffin.

“We’re doing a lot of co-recruiting (with UVM Health Network), particularly for specialists,” Kniffin said. “And hiring and employing specialty physicians is going to become harder and harder for community hospitals. The days of having one or two specialty physicians who worked together or were perhaps self-employed, that’s going away. Cardiology, general surgery and anesthesia are three examples of areas where we’ve been able to post a position as part of a ‘UVM Health Network medical group,’ and people are coming here. They’ll be based here in Middlebury, at Porter, but know they’re part of something bigger. They have colleagues up the road, they have the medical center. That’s turning out to be a real draw.”

•  Transition to an Epic-brand electronic medical records system. The new software will allow patients’ histories — including medication lists, past procedures and hospital stays — to be seamlessly transferred and viewed by health care professionals within the entire network.

The Green Mountain Care Board in January approved UVM Health Network’s request to spend $151.7 million to buy and install Epic software at its six member-hospitals. Those benefitting hospitals will share in the project payback through a formula tied to patient counts. Porter’s ultimate charge has been estimated at $1,985,148. Porter will need to absorb Epic costs within the annual budget-growth targets prescribed by the GMCB.

Brumsted said Porter is at the cusp of what he called the “first stage” of Epic implementation. He said the PMC physician offices and accounting services will be the first to transition to the Epic software, on Nov. 1, 2019. Brumsted anticipates the balance of PMC functions — including hospital and out-patient services — will “go live” with Epic around nine months after that.

Kniffin is pleased with the Epic progress to date.

“This thing has gone as fast as anyone could have imagined it would go,” he said. “It’s really moving.”

•  Planning for a new medical office building.

PMC officials two years ago included on their affiliation wish list the addition of a modern, on-site medical office building that could consolidate some of the county’s physicians’ practices and accommodate visiting specialists. UVM Health Network officials have agreed to that request, though its construction is at least four years away, according to Brumsted.

He said the network simply can’t marshal the capital for a new PMC building right now, in large part due to its current outlay for Epic and the new Robert and Holly Miller Building at the UVM Medical Center campus.

“Epic and the Miller Building being completed in Burlington really are a big draw on the capital,” Brumsted explained. “We knew this. But as those (projects) come on line in 2019 and 2020, we will allocating resources to capital projects, including ones here in Middlebury… In early 2019, we’ll be going back to all the master facilities plans to figure out what our priorities are.”

•  Medically assisted treatment.

Kniffin and Brumsted noted that PMC has made big strides in delivering medically assisted treatment, known as MAT, to patients battling addiction to opioids.

“This is a great story,” Kniffin said. “Two years ago, we had the lowest MAT per capita availability in the state, and we had a (patient) waiting list of 150 waiting for treatment.”

That waiting list has now been whittled to zero, according to Kniffin, as other primary care providers within PMC have joined Dr. Emily Glick of Bristol Primary Care in treating patients who previously had to travel to programs in Rutland or Burlington.

Porter currently offers medically assisted treatment at some of its primary care practices in Middlebury, Vergennes and Bristol, and soon in Brandon, according to Kniffin.

And there’s more good news to come, he noted. Porter is developing a medically assisted treatment program for expectant mothers struggling with addiction,

“We’ve previously referred (expectant moms) to Burlington,” Kniffin said. “We’re setting up our own program here with our obstetricians and pediatricians leading that project.”

•Planning for a regional transportation network to get the most critically ill patients the care they need more quickly.

As it stands, Porter is one of five hospitals within the network that send their most serious cases to UVM Medical Center. Each has its own transportation service; in PMC’s case, it’s Middlebury Regional EMS and a handful of other mostly volunteer rescue organizations in the county.

“The protocols are inconsistent, staffing is inconsistent and the medical instruments are inconsistent,” Kniffin said. “We’re in the process, as a network, of building a system so that as soon as the patient rolls into a UVM Health Network site, they get the same level of care, whether they’re coming from Malone (N.Y.), or Porter or Central Vermont (in Berlin). It’s really about setting that up as a system.”

Brumsted said plans call for expanding and dispersing the network’s fleet of its most sophisticated ambulance vehicles, along with acquisition of a helicopter to whisk away the most gravely ill patients.

“For a long time, the UVM Health Network had a couple of essentially ‘ICUs on wheels’ — really, really fancy ambulances that are set, with their crew, to take the most critically ill patients from one hospital to the academic medical center in Burlington,” he said. “We’re increasing that fleet, and are in the process of going from two or three (sophisticated ambulances) to five or six.”

Plans call for those rigs to be spread out throughout network hospitals in order to reduce response time.

“With a couple of rigs dispatched out of Burlington, if you go four hours into northern New York or three hours into the Northeast Kingdom, it’s six hours at a minimum before the patient gets back to the academic medical center,” Brumsted said. “So it’s having these rigs dispersed so they’re already halfway there, or close to it, if we’re going to do ground (transport).”

The network has partnered with Dartmouth-Hitchcock Medical Center and a consortium in Boston for a helicopter, based in Burlington, that began flying around a month ago.

He promised training and other support to local EMTs and paramedics who will work with the new transportation amenities.

•New psychiatric beds for mental health patients. Porter is among a long list of Vermont hospitals that must house some psychiatric patients who require residential placements but cannot find such an opening with Vermont’s stressed mental health system. Porter accommodates such patients in its Emergency Department until a bed opens up at the state hospital.

Brumsted said help will soon be on the way.

He confirmed on Monday UVM Health Network will help subsidize an acute inpatient mental health facility on the campus of Central Vermont Medical Center in Berlin. The network will commit at least $21 million to such a project, likely to include 29-35 beds for adult patients only, according to Brumsted.

“We will do what we can to try and have those beds on-line within four years,” he said. “This is a real need for the state and has been needed since Hurricane Irene took the state hospital off line.”

Reporter John Flowers is at johnf@addisonindependent.com.


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