At the Rutland Regional Medical Center, the administrators wish to combine two different parts of the hospital for a long time: the birth center and the unit of women and children.
The two units are separated by a corridor, which means that patients are transferred to a new unit shortly after childbirth – “a configuration for poor patient experience,” Jonathan Reynolds, hospital vice -president for clinical operations last month.
And, because having two distinct units means that the hospital must maintain two different pools of practitioners with skills overlapping, combine them would save around $ 1 million in labor costs per year.
But the consolidation of the two units will result in additional expenses: that of obtaining a certificate of need.
Under the state law, the Vermont health care facilities are required to obtain a Need certificate – Indeed, a legal authorization slip – whenever they want to build, renovate or buy installations or obtain more expensive medical equipment than certain threshold amounts.
But as the prices of construction and medical equipment are increasing, more and more projects – including the consolidation of the two Rutland Regional units – require such certificates, linking health establishments and state regulators in long and expensive bureaucratic processes.
“Rutland Regional is handcuffed, and we are unable to take the initiative right now to reduce the cost of health care due to the process,” Reynolds told legislators.
Now legislators seek to soften these requirements. Last week, the Vermont house spent A bill, H.96This would increase the monetary thresholds necessary for a certificate of need – a decision which, according to supporters, will reduce health costs and make care more accessible to state residents.
“The dollar amounts that trigger the process have extraordinary charges to hospitals, independent providers and other essential health care entities,” said representative Mari Cordes, D-Lincoln, the main promoter of the bill, upstairs on March 11.
Regulatory certificate on needs, that exist in most statesare intended to reduce unnecessary health care expenses and to avoid double medical services.
The process “is intended to protect the public, and it does by ensuring that the projects built have a sufficient need and are at an appropriate price,” said Owen Foster, president of the Green Mountain Care Board, in an interview.
In Vermont, necessary certificates are necessary when a hospital or a health establishment seeks to build a new establishment, to renovate an existing hospital or to buy expensive equipment. If a project reaches a certain threshold in dollars, hospitals or other health establishments must apply to Green Mountain Care Board for authorization.
Currently, for the construction or renovation of the hospital, a certificate of need is required for all projects that cost more than $ 3.8 million. Approval is also necessary for non -hospital construction or renovation of more than $ 1.9 million.
And certificates are also necessary for unique medical equipment or leases that cost more than $ 1.9 million for hospitals, or 1.3 million dollars for non-hospital.
These limits increase each year by an inflationary factor. But the cost of construction and medical equipment has largely exceeded these inflationary increases – something that the invoice would address.
If adopted, the proposed legislation would considerably increase these cost thresholds. Construction and renovation projects, both for hospitals and non-hospital, would only require a certificate of need if the costs exceed more than $ 10 million. And the acquisition of new medical equipment, both by hospitals and non-hospital, would require certificates of need that if the cost exceeded $ 5 million.
With little opposition, the bill supported health care entities which often disagree with each other: defenders, regulators and hospitals.
The certificate of necessity of processes eats “resources, both in money and in time, both for the Green Mountain Care Board and for hospitals,” said Devon Green, lobbyist of the Vermont Association of HospitalS and Health Systems, in an interview.
The reform of the process, as planned by H.96, “would reduce costs and the charge for the board of directors and for health care providers,” said Foster, from Green Mountain Care Board. “And this would increase competition, while offering supervision” on more complex projects.
Obtaining a certificate of need can take months, or even, in the case of a recent construction project, over a year. And the process obliges candidates to provide documentation trains on advantages, costs, projected use of their project and more. Other people, organizations or health entities can also weigh, and members of the board of directors may pose several series of questions and attach conditions to their approval of the project of a applicant.
“Regarding the current certificate of the need for need right now, I think there is a general feeling, this can be heavy administrative,” said Green.
This is the case at the Rutland Regional Medical Center. The consolidation of the delivery unit with the unit of women and children should cost between $ 5.5 million and $ 6 million – enough to demand a certificate of need under the current law, but not under the proposed reforms.
As there are currently, “I would bet that the Con allies process would delay our start of this consolidation of two units of at least a year, if not more,” said Reynolds, hospital vice-president last month.
But if it was signed, he said, H. 96 “gives us the breathing room to carry out these types of projects.”