MIDDLEBURY — Porter Medical Center officials will spend the next few months determining whether the county’s health care hub should remain independent or pursue affiliation with the University of Vermont Health Network (UVMHN). And some key PMC stakeholders and health care industry observers indicated this week that they are already leaning toward supporting affiliation.
As first reported earlier this week in the Addison Independent, the PMC board has decided that if Porter affiliates itself with a larger medical institution, it will likely be with the University of Vermont Health Network (UVMHN). But the decision-making process is in the preliminary phase. The board will continue to solicit input from the public and Porter employees on whether PMC should affiliate or continue to run independently over the next couple of months, and then meet with attorneys to craft a more detailed letter of intent. A final decision is not expected to be made until the spring of 2017.
Proponents of affiliation contend such a relationship with UVMHN would net PMC more on-campus amenities (such as a new medical office building), electronic medical records, a wider array of patient services and more financial stability in these changing times in the health care industry.
Still, some remain concerned that a partnership would mark an end to 91 years of PMC calling its own shots, and instead having to defer to UVMHN on some major decisions — such as crafting the budget and the hiring of a new Porter CEO.
PMC includes the hospital, Helen Porter Healthcare & Rehabilitation and 12 physicians’ offices throughout the county.
The Independent this week reached out to several people within the PMC community to get their respective takes on a possible partnership with UVM Health Network.
DR. KRIS ANDERSON: Medical staff president
Porter Medical Staff President Dr. Kristofer Anderson said that while he and his fellow physicians are eager to hear more details about affiliation, there appears to be ample support for such a move. Speaking as an individual physician, Anderson believes affiliation with UVMHN would be “a good idea. It’s going to make the hospital strongest, longest.”
Area physicians, Anderson believes, are well aware of the financial pressures PMC is facing and the chance of ameliorating those troubles by partnering with a larger medical institution.
“Overall — not just with Porter, but throughout the country — the way to keep the hospital intact and to continue to provide the kind of services we are proving in Addison county, it really is more likely that affiliation will be able to do that than continuing to try to do it alone,” Anderson said. “With the way Medicare is going and the way the feds are changing regulations, there are certainly things a small hospital is not going to be able to do alone.”
Proceeding independently would require PMC to make substantial cuts and explore new revenue streams, according to Porter officials. Anderson is concerned that such cuts might not be sustainable in the ever-changing health care landscape, both in Vermont and nationally.
“A lot of people see that consolidation in the medical industry seems to be a trend throughout the country, and even if people are skeptical about possibly affiliating with UVMHN, they are certainly aware that that might be the way the world is going, and that (affiliation) might be the right choice at the right time,” Anderson said.
He said he is not aware thus far of any local physicians who are “completely” opposed to affiliation. And he understands why UVMHC finds a potential partnership with Porter appealing.
“We are the biggest hospital closest to them that is not part of their system,” Anderson noted. “A lot of Addison County patients are already going to (UVM Medical Center) for tertiary care.”
There would be substantial details to work out if partnering ends up as the PMC board’s preferred path for the organization.
“There are a lot of folks who are going to want more information from UVMHN, in terms of what affiliation would mean in terms of access to services at facilities here, versus up there (in Burlington),” he said. “Will services here be limited so that it will be harder for (physicians) to do their jobs for patients?”
Anderson is optimistic, however, that an affiliation with UVMHN would improve services for Addison County patients, in terms of being able to offer more specialized care at Porter, while making additional services more easily available at UVM Medical Center.
 “There’s obviously some trepidation when you don’t know what that final picture is going to look like,” Anderson said. “The way I am looking at it, this is only the first step in a conversation.”
ALICE LEO: President of Porter’s nurse’s union
Alice Leo is President of the Porter Federation of Nurses and Health Professionals, Local 5753. The PMC nurses officially unionized in December of 2013. Union representatives want more details on the possible affiliation before weighing in on the issue, according to Leo.
“Porter nurses demonstrate daily their commitment to a safe, high-quality healthcare environment for all patients,” Leo said through a written statement. “This will remain our number one priority regardless of whether Porter affiliates with another healthcare system. At this point, we only know that Porter has chosen the UVM Health Network pending ongoing negotiations and a vote by the board of directors. Until more details are released on the terms of the affiliation, it is hard to comment; however, we will continue to push for nurses to have a voice in the process and for patient access to primary and specialty care services located in Addison County.”
DR. CARRIE WULFMAN: Chief medical officer for PMC
“While it seems to be the general opinion among the medical staff that our biggest potential loss in the event we affiliate with UVMHN is a decrease in autonomy,” said Dr. Carrie Wulfman, chief medical officer for PMC, “it is my perception the providers believe that the multiple improvements in patient care through collaboration with specialists; integration of our population health efforts; quality and risk management; payment reform requirements; and an improved electronic health records system, would be real gains.”
“Aligning with UVMHN could assist in bringing some of our off-site practices, as well as specialty coverage, onto our medical center campus, enhancing coordination of care and efficiencies,” she added. “Although the financially stabilizing effect of this affiliation is the overriding draw, I think Porter’s mission can be more effective and widespread with this potential relationship, leading to improved health in our entire community.”
SEN. CLAIRE AYER
Sen. Claire Ayer, D-Addison, is a member of the PMC Legacy Project Community Advisory Committee that has been studying possible affiliation for Porter. Ayer also chairs the Vermont Senate Health & Welfare Committee, which is at the front lines of Vermont’s health care reform efforts. She is also a Registered Nurse and once worked in the office of her late husband, Dr. Alan Ayer.
“It sounds like a good idea to me,” Ayer said of a possible Porter affiliation with UVMHN.
Like others, Ayer believes affiliation would give PMC more stability.
“I’m not an expert in the finances of Porter, but all hospitals that offer up-to-date care have to look at continuously re-equipping and remodeling and re-training and re-tooling,” Ayer said. “We could probably make it (independently) day-to-day, but I don’t see how we can put aside the kind of funds that it takes to continually update the services that we offer. I see it as a real bonus, having a financial backup — because it’s in (UVMHN’s) best interest to be able to do the ‘special’ (procedures) and then move their patients to a great place for further recovery.”
Affiliation, she said, continues to be the wave of the future in the health care industry.
“When you look at the number of hospitals we have for the number of people, it’s important to make sure that not every hospital tries to do everything,” she said.
Ayer acknowledged that autonomy is not easy to give up, but she believes PMC could still maintain a degree of freedom in a partnership with UVMHN.
“As a former member of the Porter community, we have a culture there that’s pretty special, and it sounds like that’s something we’re going to be able to maintain,” she said. “To me, it sounds like we get to continue to do the things we do well, and that patients who can’t be treated here for one reason or another get care that seems more proximate and more closely related… and they will be able to come home faster.”
PMC has scheduled an open community forum on affiliation for Wednesday, Aug. 24, at 7 p.m. at the Middlebury Regional EMS headquarters at 55 Collins Drive. All area residents are encouraged to attend.
Reporter John Flowers is at [email protected].