Vermont health professionals are struggling with the ethics and economics of the state’s health care system — some are going private, and some are leaving the state, in order to provide quality care for patients.
Dr. Mark Healey, surgeon at his private Mountain View Surgery in Colchester, is relocating to New York.
“I am at a tipping point.” Healey told Vermont Watchdog. “Because of the difference in remuneration by insurance companies, I can no longer compete and still give the care I would like.”
Third-party payers like Blue Cross Blue Shield, Medicare, and Medicaid negotiate their payment rates with individual providers. Because public systems continue to grow larger, hospital monopolies can negotiate better pay rates than private practices can attain. The pay equity difference, says Healey, is as large as 240 percent.
In Vermont, Medicaid pays doctors only 60 percent of the cost of providing services, while Medicare pays 80 percent. This means private practice doctors who serve large numbers of those patients stand to lose money because they have few options for making up the difference. The challenge of running a successful private practice in Vermont is reflected in the fact that about 20 percent of Vermont doctors are independent, compared to more than 50 percent in the rest of the nation.
Healey came to Vermont in 1999, when he was hired as director of the Surgical Intensive Care Unit at the University of Vermont Medical Center. Though UVM is luring other specialists into the public system, Healey says he will not go back.
“I would not be able to provide the style of care that I would like,” said Healey. “(Studies show) that when you compare public practice to private, responsiveness and appointment availability go down, while wait times and cost go up.”
Healey is not the only medical professional disenchanted with the state’s health care system. Nurse practitioner William Goodwin of Danby says he left Community Health Centers of the Rutland Region to start his own practice.
“My dream is the idyllic notion of the old country doctor,” said Goodwin. “The public system is cold, clinical and impersonal. It makes patients nervous because they feel they have no power. It robs them of personhood.”
Operating from his home, Goodwin makes visits using the old house call model, driving to patients for appointments. He brings his clinic supplies with him for visits and, like public practices, outsources lab work.
Goodwin believes personalized medicine is the key to cutting costs.
“By getting to know my patient, I save them money,” he said. “If I get a call from a patient saying they feel dizzy, I can recognize that symptom and connect it to what I know about them — that they are prone to anxiety and panic attacks. If they call a doctor who doesn’t know them, they will unnecessarily send them to the ER for an EKG, costing thousands of dollars.”
Goodwin said he supports the Green Mountain Care Board’s view that preventive medicine is a way to cut costs. He added that individualized preventive plans can save patients and the state money by solving problems before they happen.
“Even something as simple as flossing your teeth daily has been proven to decrease risk of heart disease by a large percentage,” he said.
Healey disagrees, and he even cited the GMCB’s emphasis on preventive care as one reason he is leaving the state.
“Preventive care is bogus,” said Healey. “It has a role, but a small one. It’s not going to prevent appendicitis, or a gall stone or a broken leg. We already know preventive methods. But if I tell a patient to stop smoking, he tells me to shut up.”
Both Healey and Goodwin agree that one of the most important policies for Vermont’s health care future is to create an environment where private practices are allowed to thrive.
“The cards are stacked so hard against us,” Healey said. “The community is losing out. Competition is good. When a monopoly develops, responsiveness decreases.”
Contact Emma Lamberton at elamberton@watchdog.org.
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