Monthly Archives: December 2015

Will Pediatric Care Be Maintained in our Community?

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In Another Doc Gorn we saw that Dr. Laura Bellstrom closed her pediatric practice in St. Albans, Vermont. She’s number four in a county that had 11 pediatricians at the beginning of the year.

Will pediatric care be maintained?

Yes, it will. NMC and local physicians have been working to ensure that the greater Franklin County community will continue to be well-served by dedicated, caring Pediatricians and Family Practice Specialists. We had hoped to make an announcement of our efforts after all of the contracts were signed, but a recent press release from the Vermont Pediatric Association has created confusion and additional concern in some patients, so I need to take this opportunity to explain how we are proceeding.

The latest round of cuts to the Medicaid reimbursement to physicians has made it even more challenging for private practice physicians to stay in business and has increased the financial losses hospitals carry for the physicians they employ. This hits particularly hard in areas such as ours which have a high percentage of residents on Vermont’s expanded Medicaid program. For Pediatrics, it is a dramatic impact. I believe this has been a driving force in the decisions of four local Pediatricians to leave practice in our area and move out of state, close practice, or seek employment in Chittenden County.

Fortunately, a strong core of Pediatricians and Family Practice specialists continues to care for our community as they have for decades. Pediatrics is a vital preventive, primary care service. With the changes in the healthcare system threatening the sustainability of private practices, NMC has had to get involved to help maintain access to this necessary care.

For weeks, we have been in discussions with the physicians of Mousetrap Pediatrics (Dr. Chip Chiappinelli, Dr. Deanne Haag, Dr. Roya Mansoorani, Dr. Stacy Strouse, and Dr. Heidi Zvolensky) regarding employing them as “Northwestern Pediatrics.” They are currently reviewing the final contracts and have a letter drafted to send to their patients explaining the transition. We have worked closely with them to ensure the transition is as seamless as possible for their patients. We are currently working through the details of medical records transition, billing transition, etc. The great news is, we expect that these trusted physicians will continue to care for their patients. The office locations in St. Albans, Enosburg, Swanton, and MVU will stay the same. Their telephone numbers will stay the same. Nearly all of the familiar faces in the offices will stay the same. This will be a strong step in ensuring access to exceptional Pediatric care in our community continues.

At the same time, we are working with our Medical Staff to recruit additional physicians and advanced practice providers to our community. I am thrilled to announce that one of our strong pediatrician candidates has recently signed a letter of intent to join our staff in 2016. We also have additional strong candidates reviewing the opportunity and we are working to see if one of the physicians might reconsider with the stability of employment at NMC now a possibility.

At 1.9%, our projected operating margin to keep NMC healthy for Fiscal Year 2016 is lower than it has been in years. It is razor thin.

While this is promising news for our community, it is at the same time concerning for our hospital. We offer more “stability” than private practice, but we are not immune to the negative impact of reduced reimbursement. At 1.9%, our projected operating margin to keep NMC healthy for Fiscal Year 2016 is lower than it has been in years. It is razor thin. Taking on additional losses due to reduced reimbursement threatens that margin and our stability. We made this point to the Green Mountain Care Board, the State’s regulators of healthcare, at our budget hearing. Earlier in December, we made this point to our local Legislators, who act on the Medicaid budget. As we reform Vermont’s healthcare system, we must make it less costly through prevention of illness, elimination of waste and duplication, and prudent investment — not through underpayment of the physicians and advanced practice providers caring for the people of our communities.

I look forward to finishing our work with the Pediatricians and our Medical Staff to preserve and expand access to care in our community for children. I apologize to the patients of Mousetrap that this communication was necessary in advance of the letter from your physician; we just could not let parents who were hearing rumors continue to worry as we worked. If you have any questions regarding access to care for children in our community, please call NMC’s Community Relations Office at 802.524.1280. We will do our best to answer your questions and ensure you have the access to care you and your family need.

— Jill Berry Bowen

Jill Berry Bowen is the Chief Executive Officer of Northwestern Medical Center in St. Albans, Vermont. NMC is a 70-bed, private, not-for-profit, accredited community hospital. Dick Harper served on the NMC Board of Incorporators for a decade. This op-ed also appeared in the St. Albans Messenger.

 

Another Doc Gorn

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Medicaid cut payments by 20% back on the first of January this year.

I'm from the Government
Dr. Laura Bellstrom closed her pediatric practice in St. Albans, Vermont, last week. She’s number four in a county that had 11 pediatricians at the beginning of the year. We have seven now. I know half a dozen of her now-former patients from North Puffin alone.

Yeppers, between ObamaDon’tCare and “expanded” Medicaid, we’ll cover everybody, absolutely.

Oh. wait.

The Guardian reported on the little costs that rack up thanks to what the Unaffordable Care Act doesn’t cover. Family members now have to pay for their own coverage. The co-pay for an asthma inhaler cost $7 before Unaffordable Care Act. “Then it went to $30. Then $60. Now it’s $100, every month.” A friend is fighting the mental fog of Lyme disease. Her insurance won’t pay for a treatment that will get her off Doxycycline therapy.

Kaiser reported that the “family glitch” in the Unaffordable Care Act means many mostly middle-income Americans remain uninsured because they can’t afford their insurance at work but make too much to qualify for the income tax prebate “subsidies.”

Several million did get coverage through the Medicaid program in states that opted to expand it. Now, since Medicaid ain’t paying its bills, look at what happens.

For the record.
Voting for the Unaffordable Care Act in the House: Florida Democrats Corrine Brown, Kathy Castor, Alan Grayson, Alcee Hastings, Ron Klein, Kendrick Meek, Debbie Wasserman Schultz, Robert Wexler plus Vermont’s sole representative, Democrat Peter Welch.
Voting for the Unaffordable Care Act in the Senate: Florida Democrat Bill Nelson plus both of Vermont’s senators, Democrat Patrick Leahy and “Independent” Bernard Sanders.

Dr. Laura Bellstrom. Gone. Three other pediatricians. Gone.

6,000 kids in northwestern Vermont lost their docs this year.

Six thousand.

Pediatricians are in the spotlight now, but similar problems face primary care providers for adults, said, Vermont Health Access commissioner Steven Costantino.

Shrinking provider networks under the Unaffordable Care Act mean you not only can’t keep your doctor, you may not find a doctor.

The solution hasn’t changed since the Unaffordable Care Act passed in 2009.

1. Do not raise taxes to pay for care. Do not raise government “fees” to pay for care. (Politicians are suggesting both. Again)
2. Throw da bums out.
3. Do not raise premiums to pay for care. (Politicians are suggesting that, too. Again)
4. Throw da bums out.
5. Reform the health care system. It’s still broken.
6. Did I mention, Throw da bums out?

Merry Christmas.

 

The North Puffin Poo Chronicles

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My Saturday was going really well until I realized it’s Monday.

Halloween is far enough past that it is (probably) safe to relate the tale of the “outhouse races” up here in farming country. Oh, we’ve had indoor plumbing as long as anyone (you may recall my Day of Poop two summers ago) so we all pretend that only our cows go in the barn. My friends Jim and Fred Baillargeon have a 200-head dairy farm up near the border in North Puffin. They have a two-holer about 40 steps off the back porch, not too far from the the calf sheds and on the other side of the manure digester.

Great sport as the temperature drops on Mischief Night is not cow tipping but outhouse tipping.

Two-Holer OuthouseOuthouse tipping has some rules. The most important is to tip the outhouse onto its door. See, that way the tippee has no way out other than through the small hole in what has become the sidewall of a very low room. And the pit is now a viable moat to cross.

The tippee is usually annoyed.

Extra points for a two-holer. Year-long bragging rights for a doubly occupied two-holer.

See, most folks retain an outhouse because that chance to be alone with ones thoughts and a good book is almost the best part of a day on the farm. When Jim and Fred both have to go, though, it was either a race or a building project. They chose to build.

Unfortunately, Jim and Fred both had to go around midnight on Mischief Night. They knew better but sometimes the urge is just too great. The high school football team had hosted a fundraising dinner that very evening in an effort to keep the pranksters tied up for a good cause. Nobody thought twice when the menu had Boston Baked Beans. Lots of beans. A troop of commandos went over to the farm and lay in wait in the calf shed for the inevitable. I don’t know Jim and Fred didn’t hear the giggling over the calves bawling but they both went quietly to their fate.

The boys didn’t know that Jim had loaded his bird gun with rock salt and Fred had a pair of million candlepower torches. The boys gave them a minute to get settled and ran out.

“Everybody push!”

Outhouses are strong little buildings and weighted at the bottom. This tipping op turned out to be harder than expected. Finally, it started rocking and went over. The left tackle’s foot slipped and he almost fell in the hole when Fred lit ’em up. Jim took careful aim and…

Let’s just say the latrine wasn’t the only slippery place on the farm.

Fortunately North Puffin poop don’t stink.

Speaking of cows, Green Mountain Power met with dairy farmers, selectboard members, and the actual public last week. The Quebec energy company Gaz Metro owns Vermont Gas, Green Mountain Power, and Central Vermont Public Service. Fred and Jim were there. As far as I know, the football team wasn’t.

They discussed constructing a manure digester near the St. Albans Bay. St. Albans Town has about 10,000 cows. That’s a fair dinkum lot of manure.

GMP is Vermont’s heaviest investor in alternate energy and, since they need to make a profit with it, they aren’t just flinging poo at the wall.

The front end of a digester is in essence a cow-power septic tank. A large concrete holding tank collects the manure. The tank sits at 101°F for 21 days while methane gas rises naturally to the top. A collection system syphons off the biogas fuel which feeds a natural gas engine, which in turn spins an electric generator to create electricity. The electricity goes onto the GMP grid.

Nothing goes to waste. The tank empties into a separator to divide out the liquids from the solids. The liquids get spread or, better, injected as fertilizer. The solids can be composted into soil amendments or can be used as bedding for the cows.

I think my friend Bill Rowell built the first digester in Franklin County (Foster Brothers Farm in Middlebury has had an active digester since 1982, the first in Vermont).

“The digester process greatly reduces pathogens, fly and insect larvae, weed seeds, and odor,” Mr. Rowell said of his million gallon plant. Particularly odor.

GMP has at least 13 farms in the program; this would be the fifth digester on farms in Franklin County. The others are in Bakersfield, Berkshire, St. Albans Town, and Sheldon.

Farm digester projects in Vermont tap a utility-funded grant program created by the settlement when Entergy Nuclear bought the Vermont Yankee nuclear power plant. The Renewable Development Fund started in 2004; it provides technical assistance funds for digester projects. Cow Power program customers can also opt in to pay a premium of $.04/kWh on renewably-produced power. Green Mountain Power pays farms that same premium for each kilowatt hour they deliver to the grid. By the end of 2012, energy produced by the farms exceeded demand by 35%.

Headline: Nuke Money Pays for Poo!

So our poop not only don’t smell, it glows in the dark!

 

Roads! We Need More Roads!

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This bright idea is making the rounds among the True Believers on social media these days:


Millions are unemployed and our roads and bridges are falling apart!

Will all these political proposals really create jobs? If so, why not just keep adding new programs until we achieve full employment? Heck, according to USDOT, we get 47,000 new jobs per $1 billion spent building roads. Let’s guess that it costs about $5 million to build the average mile of road (not so far off overall), so that works out to 235 jobs per mile.

The US labor force stats show 7.9 million unemployed.

Bernie’s right. All we need is to build about 34,000 miles of road and there won’t be a single, solitary unemployed person anywhere in the country!

My work here is done.