Copley: Excess success?

Copley CEO Art Mathisen said the hospital’s Mansfield Orthopaedics division “has helped us be financially viable,” and as the head of a small hospital, he has to keep an eye on the bottom line as much as all the doctors, nurses and specialists keep their eyes on their patients and the community.

And part of watching Copley’s finances means playing well with the statewide panel that keeps watch on the entire state’s health-care finances.

“Bottom line is, we have to work with the Green Mountain Care Board. They’re our regulators and we have to have a relationship with them,” Mathisen said.

Copley came under scrutiny last year as the care board questioned whether the hospital violated its agreements for a new surgical suite by performing too many surgeries, particularly by its orthopedic division. It is weighing whether to penalize Copley for the success by adjusting the hospital’s rates.

Mansfield Orthopaedics, which also has a branch in Waterbury, has such a good reputation that Copley is drawing patients from the Chittenden County area, patients who would otherwise go to the University of Vermont Medical Center. Mathisen said he was asked at a Green Mountain Care Board meeting last year, “Why are they coming to you?”

“Patients were coming to us for care because we are a hospital of choice,” Mathisen said. “I don’t know what else to say to a room of 50 people.”

Al Gobeille, secretary of the Vermont Agency of Human Services — and former chair of the Green Mountain Care Board — spoke at Monday’s annual meeting.

Gobeille said Vermont has plenty to be proud of, including the best primary care, per capita, in the country. But with that, he said, comes extra pressure to do even better. And that can sting when you think you’re already doing really well.

Doctors and nurses tend to a wide spectrum of aches, pains and ailments, but hurt feelings are another thing.

“Human beings do not respond to negativity very well,” Gobeille said; after success come questions like, “Can’t you do more? Can’t you do it with less money? Can’t you do it on the edge of a spoon?”

John Macy, one of the surgeons at Mansfield Orthopaedics, added, from the back of the room, “We’re also told that productivity is a bad thing.”

Competitive but local

Copley may have a popular orthopedics division, but it is still a community hospital serving a relatively rural area with widely varying socioeconomic strata. So, it has to cover all the medical bases.

Rich Westman, Lamoille County’s only state senator, sits on Copley’s board of directors. He delivered a summation of last year’s financial picture. The audited information is for all Copley Health Systems, which includes Copley Hospital, Copley Woodlands, Copley Terrace and the Health Center Building.

There was a system-wide net gain of $2.9 million, which includes about $3 million in fundraising for the new surgical center.

Copley by the numbers last year:

• 2,833 admissions.

• 3,518 surgical cases and procedures.

• 27,030 clinic visits.

• 12,461 emergency room visits.

• 31,547 imaging procedures.

• 338,241 laboratory tests.

• 14,150 rehabilitation therapy hours.

As a relatively small hospital, Copley has to work hard to attract high-quality physicians who are being recruited by large hospitals all over New England and beyond.

And, since this is rural Vermont, you have to like winter along with the rest of Vermont’s seasons, Mathisen said. He said Copley has a finalist for a general surgeon, and hospital staff members are crossing their fingers she doesn’t pick a different Vermont hospital. Surgeons make big money in Vermont, and they have the luxury of choosing where they want to work.

Last year, the Green Mountain Care Board released salary information for all Vermont doctors making more than $400,000, a list that includes five Copley physicians — all of them surgeons at Mansfield Orthopaedics, earning between $514,000 and $675,000 a year. Macy, for instance, pulled in $670,000 between October 2015 and September 2016.

Regional hospitals such as the UVM Medical Center and Dartmouth-Hitchcock Medical Center have feeder programs — the higher education institutes to which they are connected. Smaller hospitals and even smaller federally qualified health centers don’t have that luxury.

Mathisen said Copley does try to recruit from Vermont Technical College, Castleton University and Community College of Vermont, but for nursing jobs, not surgeons or physicians.

Donald Dupuis, Copley’s co-chief medical officer — he’s not on that over-$400,000 salary list — said after Monday’s meeting that a lack of medical students isn’t a bad thing for a small hospital. Those trainees suck up a lot of resources, and Copley needs to be competitive and efficient.

And the hospital needs to serve the community.

Valerie Valcour asked Gobeille about the state of Accountable Communities for Health, a statewide initiative to take a community-based approach to improve overall health and preventive measure to avoid more frequent trips to the hospital for palliative care.

Gobeille’s answer: not good enough.

He said Vermonters spend 80 cents of every health care dollar on treating chronic conditions, and not enough on housing, healthy food and wellness programs throughout the community.

Gobeille’s rhetorical question Monday: “Are we treating the whole person, or the reason they walked in the door?”