A Conservative Approach to Health Care Reform

The following is an excerpt from our 2011 Annual Report.

health care reform

Information Systems Director Sean Patrick sits amid the old way of keeping patient records – paper files – and the new way to come – electronic medical records updated by providers via new laptops or even iPads.

As lawmakers embark on an ambitious schedule to create a health care exchange required under the federal Patient Protection and Affordable Care Act by 2014 and a Vermont single-payer system by 2017, Gifford is mindful of its role as a community care provider.

The laws seek to bend the health care cost curve, in part through information technology, advanced primary care and payment reform.

Through the implementation of Vermont Blueprint for Health initiatives, Gifford is embarking on reform initiatives including care coordination for the chronically ill and recognition of Gifford’s five primary care practices as Patient-Centered Medical Homes.

The medical center has chosen an electronic medical record (EMR) vendor and is progressing toward both the installation of an EMR system and meeting federal requirements for “meaningful use” of electronic health records (EHRs). EMRs are internal electronic medical records. EHRs can be viewed by appropriate outside entities, including specialists and providers from other hospitals.

Gifford’s modest budget requests and responsible spending also align with reform, notes Trustee Paul Kendall, who actively follows reform legislation.

But the non-profit community medical center is by choice not at the forefront of reform efforts.

Gifford Administrator Joe Woodin likens health care reform to a passing ship. Where others might be quick to jump on – appropriately, the region’s larger health care providers – Gifford is waiting to ensure the medical center commits to the best choice for
Gifford’s size, patients and rural area.

“Gifford is more inclined to stay on the dock and wait for the boat to come around on health care reform,” Joe says. “It takes a lot of fortitude to humbly wait for the boat to make a reiteration.”

“We continue to be watchful of what’s going on and gradually position ourselves to do
what is right and appropriate,” agrees Paul, noting some initiatives like information
technology upgrades can require huge investments of time and financial resources.

conservative approach to health care reformGifford also strives to be a voice in discussions leading up to reform legislation. Leadership is suggesting cost-saving ideas the state could pursue now. They continue to set a standard
for financial stability and maintaining strong relationships with other hospitals, state and federal lawmakers, and health care organizations, like Bi-State Primary Care and the Vermont Association (VAHHS).

VAHHS represents the state’s nonprofit hospitals before lawmakers and the Green Mountain Care Board, which was created by the Legislature in 2011 to oversee the creation of a single payer Vermont system. Bea Grause, VAHHS president and chief executive officer, sees small hospitals’ role in health care reform as one of preserving local access to high-quality care.

“Hospitals are seeking to create reform opportunities by working with the Green Mountain Care Board and federal lawmakers that will balance the need to contain costs with the need to ensure sufficient revenue that will help hospitals meet their local missions,” she says. “Issues such as recruitment and retention of physicians and other health professionals, improving quality, ensuring access and long-term financial sustainability are just a few of the challenges small hospitals will face as Vermont and the entire industry prepare for a decade of continued change on all levels.”

Gifford’s work with Bi-State Primary Care in part addresses the recruitment piece.

Bi-State Primary Care is a nonprofit membership organization of Vermont and New Hampshire rural health care providers working to support primary care practices in medically under-served areas. Its members represent more than 175,000 Vermonters. This equates to one in four residents, or 46 percent of Medicaid enrollees and 52 percent of the state’s uninsured.

The organization is working on Gifford and small, rural primary care practices’ behalf to improve access by recruiting providers to underserved areas. They are also working on health information exchanges and quality improvement initiatives.

The ultimate challenge the state – and likely hospitals by default – will face for successful health care reform, however, will be answering the question: “What can we afford?”

“There are a lot of uncomfortable issues with health care reform that we don’t talk about. The most common issue is ‘what can we afford,’” Joe says, hoping lawmakers will address that question. If they don’t, it will fall on hospitals, which will be given limited funds to provide care. They will have to make tough choices on what care they can afford to
provide.