Urgent care coming to Vermont despite opposition from state officials

By Bruce Parker | Vermont Watchdog

Vermonters with non-life-threatening illnesses will soon have an affordable alternative to seeking treatment in hospital emergency rooms.

“We’re going to take something that’s currently costing a thousand dollars and do it for a hundred. We’re going to take something that makes you sit for six hours in an emergency room, and we’re going to have you in and out in an hour,” Michael Porembski, president of ClearChoiceMD, told Vermont Watchdog.

Porembski’s company, which treats a range of ailments from bronchitis and influenza to cuts and fractures, is set to open its first urgent care facility in Barre on June 11. The organization has plans to expand to St. Albans, Burlington, Rutland and Brattleboro by the end of the year.

Porembski said skyrocketing health care costs and crowded emergency rooms have created demand for the walk-in treatment centers.

“I don’t think there’s a person in the state of Vermont, or in most of the United States of America, that says urgent care centers aren’t needed. Go walk into any emergency room and, first, you have a six-hour wait and, second, you have a $1,200 bill for a simple sore throat.”

However, the company received a not-so-warm welcome from state officials, starting with the Green Mountain Care board, the group charged with overseeing the state’s new single-payer system.

“Being good citizens and good neighbors, we wanted to introduce ourselves to the Green Mountain Care board,” Porembski said. “We were met with a stone-cold ‘don’t-come-into-Vermont,’ ‘you’re-not-going-to-be-able-to,’ ‘we’re-going-to-close-you-down’ kind of attitude.”

Initially, the Green Mountain Care board wanted ClearChoiceMD to undergo a certificate-of-need review, an assessment in which health officials decide if the state needs a new health care facility or program. The board backed off, however, after company leaders sent a non-jurisdiction letter saying ClearChoiceMD, being a physicians office, wasn’t required to apply for a Certificate of Need.

Although the company cleared that hurdle, the Legislature passed legislation requiring urgent care centers to accept patients regardless of their insurance status or type of health coverage.

State Rep. Michael Fisher, D-Lincoln, the author of the amendment, told Vermont Watchdog his aim was to stop urgent care centers from discriminating against patients.

“For an urgent care center, they can’t discriminate based on insurance status. So they can’t say you’re uninsured so I won’t serve you. Or you don’t have Medicaid so I won’t serve you,” he said.

Darcie Johnston, head of Vermonters for Health Care Freedom, said state officials are unfairly targeting private health care practices.

“They don’t want them in business because it screws up their single-payer model,” she said. “They don’t want choice, they don’t want competition and they don’t want health care services that consumers can get that are lower priced than a hospital.”

According to Johnston, the new legislation, depending on how it gets interpreted, could require ClearChoiceMD to treat some patients for free. Fisher denied that.

“I haven’t said that you have to treat anybody who can’t pay. … That’s something the federal government has done to the hospitals and emergency rooms, but it’s not something that we entertain doing or that we did do to the urgent care centers. It just says you can’t discriminate based on insurance status.”

When asked if physicians and dentists should have to follow the same regulation placed on urgent care centers, Fisher said, “No, it’s an entirely different animal in today’s world of third-party payers. It’s an entirely different animal for a practice that takes a panel of patients.”

“Nobody is entertaining a change in the private nature of physician practice,” he added. “A physician can choose to work with a patient or choose not to work with a patient.”

Johnston said single-payer will ultimately have authority over private practice physicians, including authority for setting prices and determining who gets treatment. Moreover, she told Vermont Watchdog that Fisher wants the certificate-of-need process to apply to private medical practices now.

“Mike Fisher is intent on a top-to-bottom review of the certificate-of-need statute and would like to eliminate all loopholes and require every medical practice to go through the certificate-of-need process, which would include dentists, physicians offices, chiropractic — anybody having to do with any kind of medical care.”

When Vermont Watchdog asked Fisher if the state should require private medical practices to apply for a Certificate of Need, he said, “I think there is an argument for it. The certificate-of-need process is a way for us to prevent over-building and increasing system costs.”

Porembski said ClearChoiceMD will do what’s necessary to deliver high-quality, low-cost treatment in Vermont.

“We don’t have a problem with the Green Mountain Care board, and we don’t have a problem with Mr. Fisher. We would just like the playing field to be level, and clearly it’s not right now. That’s okay, we’re still going to be here.”

Contact Bruce Parker at bparker@watchdog.org