by Mike Smith Nearly two years ago, as an April Fool’s joke, I announced on my radio program that I had to take two weeks off because in Vermont if your ratings are better than your competition then you must throttle back on your success to allow other stations to catch up. “It’s a regulatory requirement imposed by the state,” I told the audience in jest. Since I was taking the next two weeks off for vacation it was a perfect time to try to pull off this prank.
But in health care this isn’t a prank.
Here’s what’s happening. Copley Hospital in Morrisville has gained a stellar reputation in orthopedic surgery. As a result, an increasing number of Vermonters, as well as others, have selected Copley for these types of surgeries rather than having them done in other hospitals. This generates more revenue for Copley, but that revenue has exceeded the limit imposed on the hospital by the Green Mountain Care Board. The GMCB is now deciding what penalty to impose upon Copley for violating conditions of its certificate of need by exceeding those revenue targets.
In other words, Copley Hospital is faced with the possibility of being punished for being too successful. Of course, it seems counterintuitive to many Vermonters that an institution that has achieved success might be asked to throttle it back.
Responsible regulation in the health care industry is important to ensure that costs are reasonable and high quality and access to care is maintained. And there are very good reasons for a certificate of need process in Vermont that ensures these regulations are enforced.
But if success is penalized then what is the motivation to innovate, to be at the cutting edge of medical advancement, or to be better at something than someone else?
If curtailing one’s success is good public policy then someone needs to explain this policy to Vermonters because right now many are shaking their heads in disbelief.
I have mentioned before that in health care our officials are failing to adequately communicate with Vermonters. Terms like payment reform, delivery system reform, fee-for-service, and population health are all terms that cause confusion, if not outright skepticism with Vermonters because few know what these terms actually mean. And they have every right to be skeptical.
Often in health care, politicians, advocates and even providers tend to over promise and under deliver. Usually they are promising that different reforms or programs will reduce health care costs. Yet, those savings almost never materialize, or at least not in the amounts that have been promised.
Vermonters have two basic concerns in health care: They want access to quality care, and they want health care premiums that they can afford as opposed to seeing annual increases in premiums rise at rates that far exceed wage increases.
So far, the goal of affordability has not been achieved and punishing Copley because Vermonters choose to go there instead of elsewhere, gives an impression that access to top-notch health care is being restricted, too.
With an upcoming election in 2018 there’s a good chance that many Vermonters will focus on fiscal issues. And although Vermonters have shown enormous restraint and patience with their politicians in the area of health care — even enduring massive blunders made by policymakers — it will be interesting if their patience wanes, especially absent any well-articulated policy in a language that Vermonters can understand.
Policymakers can start by trying to explain why success is a failure and why successful hospitals need to be punished.
Mike Smith is a regular columnist for vermontbiz.com, Vermont Business Magazine and VTDigger. He hosts the radio program “Open Mike with Mike Smith” on WDEV 550 AM and 96.1, 96.5, 98.3 and 101.9 FM and is a political analyst for WCAX-TV and WVMT radio. He was the secretary of administration and secretary of human services under former Governor Jim Douglas.