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UVM Medical Center Eyes $8.6 Million Primary Care Project

UVM Medical Center. File photo by Mike Dougherty/VTDigger

[U]niversity of Vermont Medical Center is planning an $8.6 million expansion of its primary care services in Chittenden County, new state documents show.

Amid a statewide shortage of adult primary care services, hospital administrators have proposed a new facility in Essex that could handle up to 10,500 additional patient visits annually. It would be twice the size of the hospital's current Essex practice and would add seven new staff.

The practice also would include an in-house psychiatrist and a drug and alcohol counselor as part of a statewide and nationwide effort to integrate such services with medical care.

"It's kind of one-stop shopping," said Dr. Jennifer Gilwee, division chief of general internal medicine and geriatrics. "It just makes it easier to access and takes the stigma away that has followed those kinds of conditions."

UVM Medical Center says its current Essex clinic, at 87 Main St., primarily serves patients from Essex, Essex Junction, Jericho, Colchester and South Burlington. There are about 14,500 patient visits annually, but that number has been stagnant because the practice can't accept new patients "in large part due to the physical constraints of the current space."

Hospital administrators say they have a land-purchase option and "all necessary local permits" to build a new, 12,500-square-foot Essex Adult Primary Care facility at the corner of Route 15 and Essex Way. But the hospital still needs water, wastewater and stormwater permits, and administrators also have applied for a certificate of need from the Green Mountain Care Board.

The care board application says the new facility could accommodate up to 25,000 patient visits per year as currently designed and "can be expanded to handle up to 35,000 patient visits per year" if exam rooms are added.

Among the additional staff planned for the clinic are a physician, an advanced practice provider and two registered nurses.

Increasing access to preventative primary care is a key tenet of Vermont's all-payer model of health care payment reform. It's also a legislative priority for advocates who say primary care saves money and boosts Vermonters' health by catching medical conditions before they become more serious.

But there aren't enough primary care providers to meet the state's need, officials say.

While Chittenden County has a higher concentration of primary care providers than other areas, there is a shortage of internal medicine/adult primary care practitioners in "all counties," said Elizabeth Cote, director of the Office of Primary Care and Area Health Education Centers Program at UVM's Larner College of Medicine.

Cote said her office soon will release an updated primary care workforce report. Preliminarily, she said the data show that "the need for primary care practitioners who care for adults continues and is further demonstrated by the percentage of practitioners who limited or closed their practice to new patients."

In some areas, Cote said, the lack of primary care physicians has been "counterbalanced to some degree" by an increasing number of advanced practice registered nurses and certified physician assistants.

UVM Medical Center has 10 primary care practices, four of which – including Essex – are dedicated to adult care. But Gilwee said she is seeing a shortage of primary care doctors, in part due to an aging population.

An aging workforce is another issue.

"When we look at our primary care workforce, in particular at internal medicine, I have a lot of very dedicated doctors who have been working here for a long time and would like to retire at some point in the future," Gilwee said. "So we anticipate that, as time goes on, our needs will be even greater."

In addition to adding patient volume via the proposed Essex expansion, UVM Medical administrators also want to add new resources. That's supposed to happen via the patient-centered medical home model, which emphasizes a "multidisciplinary care team" that works together to meet a patient's needs.

"For some patients, they really require additional help," Gilwee said. "And that can be in the form of a social worker. They may need a nurse care manager if they have a lot of complex needs. They may need a nutritionist if it's about special dietary (needs)."

In Essex, patient-centered medical home approach will mean a continuing care assistant, a psychiatrist and a drug and alcohol counselor added to the primary care office if the expansion project is approved. The latter two positions would be provided by the hospital's Community Health Team program.

Bringing such services together is not a new concept, "but this will be the first time that we really get it all under one roof," Gilwee said. "They'll be the gold standard that we want to have all the other clinics get to."

There are benefits for patients beyond the convenience factor, she added. A primary care patient who is experiencing depression, for instance, could get much faster access to psychiatric care.

"Onsite counselors really increase the likelihood that patients will actually seek the mental health care that they need," Gilwee said.

The proposed Essex practice also would include "virtual exam" services for patients to access care without coming to the office. Options would include telemedicine via video hookup, or exchanging messages with providers via the hospital's MyHealth Online portal.

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