• Matt Mignanelli

The University of Vermont Medical Center may soon be able to perform thousands more surgeries each year — welcome news in a state where people with failing joints and other painful ailments often wait months for relief. All it will take is $130 million and a green light from state regulators.

The Burlington hospital is asking the Green Mountain Care Board for permission to build a state-of-the-art outpatient surgery center that could accommodate up to a dozen new operating rooms. Hospital leaders say the move would allow them to shift outpatient procedures away from the outdated Fanny Allen campus and begin to chip away at persistent backlogs.

The prospect of Vermont's largest health care system grabbing an even bigger share of the market has worried some cash-strapped rural hospitals, which rely on revenue from outpatient surgeries to stay afloat. But UVM Medical Center execs say there's enough business to go around. They project that by 2030, the hospital will need to perform upwards of 23,000 surgeries every year — 4,000 more than it can currently handle.

Without extra capacity, those patients will either "wait too long, travel out of state or potentially not receive care at all," said Sunny Eappen, the UVM Health Network's president and CEO, at a hearing before the care board last week.

"We're proposing this project for one reason: It meets an urgent patient need," Eappen said. "And that need is only going to grow with every year we don't take action."

The plan comes amid a broader shift in America's health care system toward providing care in nonhospital settings. Medical advancements have produced less-invasive procedures that allow patients to safely recover at home, where they're more comfortable. That frees up hospital beds for sicker patients who need around-the-clock care.

Outpatient surgeries also limit the amount of staff time spent on each case, one of the reasons they are among a hospital's more lucrative services.

The UVM Health Network pitched the surgical center in fall 2021 and received approval from the regulatory panel to begin a $5 million planning process. A budget deficit delayed the project, but the hospital says it now has enough in its capital reserves to break ground. First, though, it must clear Vermont's "certificate of need" process, which requires that the state board sign off on any major health care investments.

The five-member board will issue a decision this summer. It's unclear where it might land. Although regulators have taken more aggressive steps to rein in the UVM Health Network's growing costs in recent years, they've also urged the hospital group to fix its bottlenecks.

During last week's hearing, the hospital deployed executives, physicians and even an aggrieved patient to make its case that the status quo falls short.

Many of the hospital's 25 operating rooms aren't big enough to perform some of the complex surgical procedures now commonly provided in outpatient settings. There are not even enough rooms to begin with, said Dr. Mark Plante, chief of the hospital's urology department, who likened the daily task of scheduling to a game of Tetris.

The hospital called on Susan Anderson, a 73-year-old Colchester resident who recently needed a dual hip replacement, to explain how this harms patients.

Anderson, executive vice president of the Greater Burlington Industrial Corporation, told regulators that by the time she got an appointment to see a specialist at the Burlington hospital last summer, she was in enough pain to require a walker. When she was told it would be at least four months before she could get the first hip replaced, she sought care elsewhere. She eventually landed at the Alice Peck Day Memorial Hospital in New Hampshire, where both procedures were done by year's end.

"It would have made a world of difference if I could have had this surgery here," Anderson said, recalling long, uncomfortable car rides to her New Hampshire appointments. "Once you're in pain, time is critical, and four-month waits are unfathomable."

"We failed you," Dr. Stephen Leffler, the hospital's president, said after her testimony. "And there's many, many other patients that we have that could give the same, devastating story."

A Seven Days investigation in 2021 found many similar instances of patients enduring lengthy delays for care at the Burlington hospital. Since then, the hospital says it has improved its scheduling, increased operating hours and referred some patients to other network hospitals where they can be treated more quickly. But backlogs persist: Among them are more than 300 patients who are waiting at least three months for surgery.

Related The Doctor Won’t See You Now: Patients Wait Months for Treatment at Vermont’s Biggest Hospital

The Doctor Won’t See You Now: Patients Wait Months for Treatment at Vermont’s Biggest Hospital

By Colin Flanders and Chelsea Edgar

Health Care

The proposed center would be located at the hospital's Tilley Drive campus in South Burlington and could open within the next two years. It would start with eight operating rooms and would have enough space to accommodate four more should they become needed. The five ORs at Fanny Allen would be repurposed, Leffler said.

The hospital says it would aim to seek donations for about 10 percent of the $130 million cost and would finance most of the rest. The center would begin paying for itself almost immediately and, by 2030, could generate an annual net profit of at least $10 million, even after accounting for the 75 new hires that would be needed to staff the facility, hospital officials said. The profits would then be used to bolster hospital services that operate at a loss, officials said.

The favorable finances are one reason the health network has moved forward with this project instead of others, Eappen said. His predecessor, John Brumsted, scrapped plans to build a new inpatient mental health unit at another UVM-affiliated hospital in 2022, saying the network couldn't absorb a projected $25 million annual deficit.

But other hospitals say the UVM proposal creates a new financial risk for their operations. In a submission to the care board, Joe Woodin, CEO of Copley Hospital in Morrisville, expressed concern about the prospect of losing patients to the new surgical center. Perhaps because of its proximity to Stowe and other ski areas, Copley does a lot of joint replacements, many of them for Chittenden County residents who travel there for the procedures. He argued that the project would introduce "overcapacity and redundancy" and could threaten his already-struggling hospital's bottom line.

UVM Medical Center made the same argument back in 2016, when the hospital opposed a proposal from a group of private investors to build a stand-alone surgical center in Colchester that would have added just two new operating rooms to Chittenden County. During that contentious certificate-of-need process, which dragged on for two years, a UVM Medical Center official asserted that the Colchester project wasn't needed because the Burlington hospital had "substantial capacity" and could easily accommodate higher demand for surgeries in the future.

Those projections were way off, Leffler, the hospital's president, conceded last week. "We were wrong," he said. "We should not have said that."

Regulators ultimately approved the project but limited the types of surgeries it could offer.

The hospital is now betting on a different set of numbers: Vermont's aging demographic and projected growth in population around northwestern Vermont over the next decade. Should those forecasts also prove wrong, the center could struggle to turn a profit. But Eappen encouraged regulators to consider the alternative: that Vermont's growth will exceed expectations, and its largest hospital would end up unprepared.

"That's a much bigger concern for me," Eappen said, "because I'm betting on Vermont."