Health forum explores hospital costs

MANCHESTER - Physicians and administrators from Southwestern Vermont Health Care held a meeting in the gymnasium of the Maple Street School in Manchester on Wednesday night to discuss the future of healthcare, and how their partnership with Dartmouth-Hitchcock Putnam Physicians will help shape that future.

The panel was made up of Dr. Trey Dobson, chief medical officer and the site medical director for Dartmouth-Putnam, Scott Erickson, director of satellite operations, Dr. Josh Samuelson, medical director of the SVMC Northshire Campus, Dr. Robert Schwartz, physician at the SVMC Northshire Campus, and Dr. Lynn Mann, pediatrician at the upcoming Medical House.

The discussion was facilitated by Tom Dee, president and CEO of SVHC's health system. He opened the meeting with a slide show detailing the current state of Vermont, and national, healthcare, and where it is projected to end up in the coming years.

The first slide was a graph of the rising cost of healthcare.

"An average family of four, in 2002, was spending $9,200 a year on healthcare," he read from the slide. "But in 2011, the most recent figures we have, the same average family of four was spending around $20,000 a year... out of pocket."

The graph projected that if things continued the way they were headed, the same family would be paying $42,000 a year for healthcare by the year 2021.

The biggest way to change these numbers involves Vermont potentially becoming the first state in the country to implement a single-payer health care system.

Under a single-payer system a single body using a single fund, such as a state or federal government body, would pay for the healthcare costs, rather than multiple private insurance companies.

However, Dee urged that this is not a guarantee; the federal government still has to approve the single-payer system.

In addition to the potential implementation of the single-payer system, they outlined many different strategies to combat these rising costs, which all fell into one of two categories: things healthcare providers can do, and things that patients can do.

Some of the ways that they said healthcare providers can ultimately lower how much their patients pay included finding new ways to pay providers - such as with a system that gauges the overall health of a population or by if a patient is well instead of by each test or operation needed - and transferring all medical records to electronic storage.

These things are on their way to implementation, in part, thanks to SVHC's partnership with Dartmouth-Hitchcock.

According to their pamphlet on the partnership, all physicians will simply become employees of Dartmouth-Hitchcock; there are no changes in where patients have to seek out care, and there will be no affect on their insurance.

New options for treatment from SVHC doctors will be available through this partnership, in addition to allowing the Northshire Campus to be open longer hours. The two companies have merged their cancer centers and are looking into electronically hosting all of their patients' medical records.

While creating electronic records can cost the groups up to $15 million, according to Dee, the electronic records will be able to play a part in lowering costs down the road.

Dr. Schwartz used an example of scheduling a leg MRI for a patient using electronic records. He explained that when he goes to schedule the test, a box will pop up with a list of symptoms that would require, or necessitate, an MRI.

"And, if the symptom isn't on the list, then I would think, 'well, do I really need to order this test'," he said. This would reduce the amount of unnecessary tests performed, and thus the amount of money a patient would need to pay.

Limiting the amount of unnecessary, or duplicate, tests is just one of the strategies that they explained could be utilized to reduce spending. The others include improving management of chronic care, so that a patient does not have to use the ER often, but can instead take advantage of a primary care doctor. Also listed was the concept of improving the access to primary care, ensuring proper ER usage, which ties into properly managing chronic care, and focusing on wellness rather than illness.

All of these strategies were encompassed under a goal of taking ten years to reduce the amount of money given to hospitals by $150 billion, which would then in turn lower the amount households are paying for healthcare.

They emphasized that there are also things that patients can do to help bring down their healthcare costs. Patients are encouraged to take advantage of the availability of primary care centers, including the Northshire Campus, so that they do not have to use the ER as frequently.

One member of the audience asked if there was an urgent care center in Manchester, citing the distance to the closet hospital as a problem in certain situations.

While there is no specially designated urgent care center in Manchester, the panel pointed out that their hours have been extended, from 8 a.m. to 8 p.m. Monday through Thursday and from 8 a.m. to 5 p.m. on Friday, and they do function as an urgent care center within those hours.

"If you have a small laceration or you have a cold, you can come [to the campus]," said Samuelson, "and we'll take care of you."

They also mentioned that they are willing to take in part-time residents, tourists, or other non-permanent residents to the area for urgent care if needed. However, after hours one would have to go to the ER rather than the Northshire Campus.

In addition to extending their hours, they have plans to add exam and procedural rooms to the building, without changing the building's footprint, to accomodate more patients.

The next meeting on the subject will be held in Arlington on July 18. For more information, visit


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