Eileen Whalen is now the president, chief operating officer, and acting chief nursing officer of the University of Vermont Medical Center—or whatever it’s called now.

All of us at Vermont Woman fall all over ourselves in ecstasy when the Manarchy appoints a woman head of anything. Whalen is smart and experienced, with serious street cred: a trauma nurse and master of health administration; high-level experience at Saint Mary’s Regional Health Care System in Nevada, San Francisco General Hospital, and Maryland Institute for Emergency Medical Services Systems; editor of the Journal of Trauma Nursing; coauthor of a tremendous textbook on trauma care; executive vice president of the University of Arizona Medical Center in Tucson; executive director of the University of Washington’s Harborview Medical Center in Seattle.

She left Harborview after her announcement of a well-intended plan to relocate primary care clinics out of the hospital and into neighborhoods provoked a storm of controversy. We saw “storm of controversy” and liked her immediately. Does she know what she’s getting into? Welcome to Vermont!

Same as the Old Boss?

In a recent interview, Whalen said she’s all on board with UVMMC’s “relentless focus on quality and safety”—the company’s new mantra to take our minds off things like overcharging and shortchanging patients. “Infection prevention speaks loudly to the community on how focused we are,” she said. It’s fabulous that UVMMC has the lowest inpatient infection rate in the USA. Is this because we discharge patients too soon after surgery, with little or no follow-up, as an elderly neighbor of mine recently complained?

Quality measurements can be rigged to make profitable practices look good. We’ve seen the company post its misleading “primary” C-section rates, not its total rates. Vermont hospital utilization data is now inaccessible to anyone without a database program—no longer can the layperson see how many patients are getting cardiac procedures, spine surgeries, or C-sections at UVMMC and elsewhere. Don’t they want us to know?

Despite her patient-care advocacy, nowhere in Whalen’s record is there a peep about corporate cost cutting. She said that the University of Vermont’s ever-expanding health network is “absolutely the right thing to do”—even as consolidations, mergers, networks, or whatever the guys call them, increase patient costs nationwide without improving patient care.

Academic medical centers were the lean, mean, fighting machines of health care. Now they’re huge corporations, erecting lavish facilities, spending millions on unproven technologies, creating layers of management with high-end compensation packages, and boasting huge operating margins. They’re NINOs—nonprofits in name only.

Costs at UVMMC have skyrocketed as the network has expanded. At Hinesburg Family Health, a 15-minute visit for a nurse-practitioner to flush wax out of a kid’s ear was billed at over $500 dollars: $305 for the flushing—coded as a “surgical procedure”—plus $197 just for walking through the door.

An abdominal-pelvic ultrasound—another 15-minute procedure commonly performed on women—was double-billed at a whopping $5,681: $3,099 for the abdominal scan and $2,529 for the pelvic (for which the scanner moved down six inches).

Meanwhile, UVMMC boasts $2.3 billion in patient revenue, from a regional population of about 500,000. That’s $4,600 per year for every infant, child, woman, and man in the area—not including insurance fees, charges from other providers, medications, or supplies.

We’ll Get on Our Knees and Pray

One hope for hospital networks was that they’d improve communication for docs, nurses, staff, and patients. That hasn’t happened, despite millions spent on tech systems. A friend writes: “We had several medical issues this year and used Central Vermont Medical Center for all of them (knee surgery, pregnancy and delivery, and baby hospitalization). Some of the doctors we saw billed out of Fletcher Allen, though we never stepped foot in that hospital. When it came time to arrange payments, we put in a lot of time to figure out who was charging what and to make payment plans. We asked CVMC to lump everything together so we could begin making payments on one lump sum.

No one told us this payment plan didn't include the Fletcher Allen stuff; that got sent to collections. When we tried to talk with Fletcher Allen about our bills to see if they could back out of the collections process and set up payment plans, they were extremely unfriendly and refused to work with us. Our credit is now dinged due to a payment system that we feel wasn’t handled very well.” There’s a quality issue.

Another problem in corporate health care is the Relative Value Unit—a quota system forcing clinicians to see as many patients as possible to maximize revenue. Patients and providers hate this. No more quality time: it’s the seven-minute quickie, with the doc tapping the computer, hardly observing the patient’s flushed skin, rapid respiration, and clenched jaw muscles to note how hypertensive she’s become from being treated like that at $30 per minute.

Though hospital budget increases have slowed to around 3 percent per year, that’s still a whopping 300 percent increase over 10 years. Most working Vermonters don’t get wage increases of that kind. We hope Whalen is mindful of the stream of money hemorrhaging from patients’ pockets toward her own.

We Won’t Get Fooled Again

In this culture, income has priority over outcome. Vermonters—the healthiest bunch on the mainland—now pay 13 to 20 percent of their paychecks to the health-care industry. Costs continue to rise: UVMMC is building a new inpatient unit for $187 million and proposing another $53 million for more land and buildings in South Burlington.

The Wall Street Journal published a report—by a man—showing that women in power everywhere would be better for everyone. But the writer mentioned the problem of women leaders in organizations with hierarchies of men having to behave like men—instead of telling the guys to straighten up and fix their junk. In corporations where group-think and conformity of language are enforced—as at UVMMC, where employees are forbidden to use that nickname—we wonder if any critical thinking or resistance is allowed.

Whalen seems a smart, spirited, savvy woman. Maybe she’ll be the one to sharpen the focus on patient-centered care, which cannot happen without patient-centered economics.

We hope she will. We wish her all the power in the world.

Katharine Hikel, MD, a volunteer with the Chittenden County Medical Reserve Corps, lives with her family in Hinesburg.