Healthcare providers express concern over unanswered questions

by Angela Chagnon

The Senate Health and Welfare Committee took testimony from healthcare providers Thursday night regarding the proposed Green Mountain Care plan, bill numbers H.202 and S.57.

The room was packed, with some attendees having to stand outside the doors. Many of those who testified, mostly doctors, expressed concern over the many questions the bill leaves unanswered. Each person testifying was given two minutes to make a statement.

Dr. John Rumstead, Chief Medical Officer at Fletcher Allen Hospital and a practicing OB-GYN in Vermont since 1981, said that the hospital was “supportive of elements of reform that are under way” but that they “have concerns about H.202 as well.”

Rumstead wondered how the program will be funded, and why that question was not being answered. He said that the hospital had heard from physicians earlier in the week about H.202 and outlined the questions they had brought up.

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“I don’t see how I’m actually going to save any money from an administrative standpoint. It’s really difficult for me to see how this is actually going to work.”

— Dr. Julia Brock

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“We heard concern expressed over the lack of detail in the bill,” Rumstead reported, “we heard worries about whether a five-member board can really do all the work outlined in the bill, we heard grave concerns…about the lack of details on how the plan will be funded, and how providers will be paid.”

“Most importantly and most worrisome,” continued Rumstead, “we heard as a result of these uncertainties physicians young and old expressing doubt about committing to staying and practicing in Vermont.”

He told about a young medical student who had previously decided to stay and work in Vermont, but due to the uncertainties surrounding the proposed healthcare system, had only signed a short-term contract with Fletcher Allen because “she did not want to be tied to a long-term commitment.”

Deb Richter, an ardent supporter and lobbyist for a single-payer system and the one responsible for bringing Dr. Hsaio to Vermont to conduct his study, also gave brief testimony claiming that doctors would come to practice in this state should Vermont adopt a single-payer system. When she finished, she was applauded by red-shirted members of the Worker’s Center who were in attendance. This group continued to applaud those who testified in favor of single-payer even though Senator Kevin Mullin (R- ), the hearing officiator, admonished them to refrain from doing so several times throughout the hearing.

Dr. Julia Brock, a gynecologist with a private practice, presented the perspective of a doctor and business owner. Her husband, also a doctor, is one of only three Gynecological Oncologists in the state.

“I will not say if I am for or against a single-payer system, what I’m in favor of is careful, thoughtful planning before we take on something which can potentially hurt our ability to practice medicine in this state,” Brock remarked. She said that she and her husband chose Vermont because they wanted to live here, knowing that they would not make as much money as they could out of state.

“But when I look at the open door of what my reimbursements are going to look like, what my payroll taxes are going to look like, administrative costs which are supposedly going to be lower – I only have one billing administrator in my office, I’m not going to fire her,” Brock declared. “So, I don’t see how I’m actually going to save any money from an administrative standpoint. It’s really difficult for me to see how this is actually going to work.”

“I don’t want to leave Vermont,” she continued. “We would really like to stay here, this is a good place for us to be. But I think it is very quick to move, in moving legislation through without healthcare providers being on board.”

Brock concluded with a suggestion that the legislature make sure that healthcare providers and the public are on board with any reforms legislators move ahead with.

Dr. J. Chris Nunnink is a cancer specialist in Burlington. He provided the Committee with copies of a published study he had completed on over 9,000 cancer patients. The study looked at access to care in rural communities in Maine, New Hampshire, and Vermont.

“We found that, unlike Great Britain and Scotland, where there is actually stage migration and increased mortality in patients in rural communities that don’t have access to care, we found in these three states that the rural communities actually provided pretty good care compared to their counterparts, i.e. the population living around Dartmouth,” said Nunnink.

He advised the Committee to look at the bill carefully. “With the funding mechanism still up in the air, paying attention to the details is really, really critical,” Nunnink stated.

He began to talk more about his study but ran out of time. He quickly concluded, “My point is, don’t throw out the baby with the bathwater.”