VT Health Resource Allocation Plan (HRAP)

503 Pages·2005·2.65 MB·English

State of Vermont
Health Resource Allocation Plan

August 2005
Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
Vermont . . .

Department of Banking, Insurance
Securities and Health Care Administration
Division of Health Care Administration

August 1, 2005

Dear Governor:

I am pleased to submit to you herewith, for your consideration and approval, a Health Resource
Allocation Plan (HRAP): a four-year plan that identifies Vermont’s needs in health care services,
programs and facilities; the resources available to meet those needs; and the priorities for
addressing those needs on a statewide basis. This HRAP differs slightly from the proposed
HRAP I submitted to you on July 1, 2005.

This HRAP is being submitted to you pursuant to Act 53 (2003), in which the Department of
Banking, Insurance, Securities and Health Care Administration (BISHCA), in consultation with
the Secretary of the Agency of Human Services, was charged with developing a Health Resource
Allocation Plan for your consideration and approval. Act 53 was passed to strengthen the state
planning process for health care services and to address concerns about health care access,
quality and costs.
Act 53 specifies that the HRAP must include hospital, nursing home and other inpatient services;
home health and mental health services; treatment and prevention services for alcohol and other
drug abuse; emergency care; ambulatory care services, including primary care resources,
federally qualified health centers, and free clinics; major medical equipment; and health
screening and early intervention services. In developing the HRAP, these services were
considered in relation to: the continuum of care from prevention through end-of-life; a specific
regulatory framework (the state Certificate of Need program); and the six Institute of Medicine
Aims for health improvement which state that services be safe, effective, patient-centered,
timely, efficient and equitable.
To develop an HRAP that both met Act 53 specifications and accurately reflected Vermont’s
needs, I appointed an advisory committee of consumers, providers and health care professionals
to participate in the process. BISHCA staff spent several months studying state resources and
met monthly with the advisory committee to evaluate resources and priorities and develop
recommendations. Additionally, healthcare experts presented data and recommendations to the
Committee and public input was sought through public hearings in April and May. The advisory
committee also worked to ensure that the HRAP was congruent with the State Health Plan and
the fifteen individual Community Needs Assessments conducted by the hospitals in Vermont.

The priorities and recommendations reach broadly across the Vermont health care system. This
is the first time this scope of data has been gathered and presented in one place, helping to
crystallize and quantify the information about our health care delivery system today. Seven key
factors emerge as priorities that we must address in Vermont:

Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
1) Demographics – The emergence of the baby boomers into middle age has resulted in a
distribution of the population that continually pressures resources;

2) Chronic illness – Chronic illness, the leading cause of illness, disability, and death and the
chief area for health care expenditures in Vermont and nationally, compels us to redirect our
health care resources to focus on the six aims for improvement articulated by the Institute of
Medicine; care should be safe, timely, effective, efficient, patient centered, and equitable;

3) Prevention – Improved prevention and health promotion activities are key areas of concern for
addressing health care resources;

4) Workforce – Establishing and developing a workforce that can support the growing aged
population in numerous healthcare services is a high priority;

5) Health Care Information Redesign – Information technology provides an opportunity to help
re-design and improve the processes and outcomes of health care services;

6) Population-based analysis – This science pioneered by Dr. John Wennberg, MD will allow
evaluation of health care current and projected use and need and allocation of health care
resources accordingly;

7) Integration of care – The efficiency and effectiveness of health care can be improved by the
continued integration of primary, specialty, physical and mental health care.

Establishing the recommendations to support these priorities will require the Commissioner to
develop additional benchmarks, guidelines, and regulations particularly for administering the
Certificate of Need law. Next Steps identifies several key first actions steps and plans for
addressing these items. For example, the recommendation to use the science of population-based
analysis to examine utilization trends and patterns will require guidelines to establish valid
findings with consistency and objective information. This approach can also be adopted for
other recommendations that will allow Certificate of Need applications to be reviewed with
similar standards and scope of review.

The HRAP owes its existence to the generous contributions of time, energy and intellect
provided by the advisory committee (member list follows), as well as numerous others who have
been involved in the process. Many thanks to those individuals, and to all of you who will
participate in the future updating and refining of a Health Resource Allocation Plan that will be
used as a tool for future planning for all of Vermont.

Sincerely,

John P. Crowley
Commissioner, Department of Banking, Insurance
Securities & Health Care Administration

Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
Health Resource Allocation Plan Advisory Committee

Patricia Burnham John Nopper
Consultant River View Farm
Transitions Associates Putney, VT
Lower Waterford, VT
John O’Kane
Catherine Hamilton Manager, Community & Government
Vice President, Planning Relations
BCBSVT IBM Corp
Montpelier, VT Essex Junction, VT

Churchill Hindes Greg Peters
CEO Managing Partner
VNA Chittenden & Grand Isle Counties Lake Champlain Capital Management,
Colchester, VT LLC
Burlington, VT
David Little
Medical Director Betty Rambur
UVM AHEC Program Dean, Professor
Burlington, VT UVM College of Nursing & Health
Sciences
Stephen Marion Burlington, VT
Vice President, Regional Planning
Dartmouth-Hitchcock Alliance David Reynolds
Lebanon, NH Executive Director
Northern Counties Health Care
Michael McCormack, CPA St. Johnsbury, VT
McCormack, Guyette & Associates
Rutland, VT Harvey Yorke
President and CEO
Madeleine Mongan Southwestern Vermont Health Care
Vice President, Policy Bennington, VT
Vermont Medical Society
Montpelier, VT
Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
Health Resource Allocation Plan

Table of Contents

Page
Section One
Overview i
Executive Summary iii
HRAP Priorities vii
HRAP Recommendations xi
HRAP Next Steps xxvii
User’s Guide xxxix
Statement of Principles xxxi
Health Care Expenditures Summary xxxv
Vermont State Health Plan Summary xxxvii
Community Needs Assessments Summary xli
Section Two xlv
List of Acronyms xlvii
Glossary of Terms liii
Section Three 1
Chapter 1: Inpatient, Emergency & Hospital-Based Services 3
Inpatient Services 3
Hospital-Based Outpatient Services 23
Hospital-Based Mental Health/Substance Abuse Services 39
Emergency Medical Services 53
Major Medical Equipment 65
Access to Hospital Services 77
Vermont Hospital Monograph Series Hospital Service Area 87
Analysis
Chapter 2: Ambulatory Care Services 89
Primary Care Services 93
Specialty Care Services 129
Oral Health Services 143
Ambulatory Mental Health/Substance Abuse Services 155
Maps for Primary Care and Underserved Areas 175
Chapter 3: Community-Based Services 185
Long-Term Care Services 185
Community-Based Mental Health/Substance Abuse Services 205
Chapter 4: Other Medical Services 219
Chapter 5: Healthcare Workforce 233
Chapter 6: Healthcare Information Technology 289
Section Four 327
Certificate of Need (CON) Standards 329
Section Five 347
Appendices 349
Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
Health Resource Allocation Plan

Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
Health Resource Allocation Plan i
Section One: Overview

SECTION ONE: OVERVIEW

Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]
Health Resource Allocation Plan ii
Section One: Overview

Department of Banking, Insurance, Securities, and Health Care Administration
89 Main Street, Drawer 20, Montpelier, VT 05620-3601
Tel: [phone] Fax: [phone]