Perhaps the most asked question in the aftermath of the University of Vermont Health Network announcing plans to close two local health clinics – a primary care clinic and a rehab center – is the question of who can impact those decisions and by whose authority those decisions were made. A lot of questions are being raised specifically about the Green Mountain Care Board (GMCB), the regulatory board that ordered the hospital network to limit its budget growth and reduce how much it charges private insurance companies for patient services.
The hospital network appealed the orders of the GMCB in late October, before announcing a slate of planned closures intended to fill a $122 million budget deficit.
The Mad River Valley Health Center board of directors which manages the building that houses the primary clinic is still seeking the financial specifics to understand why this clinic was targeted for closure and local leaders are still seeking that same information.
CUTS TO SERVICES
Mad River Valley Health Center (MRVHC) board president Don Murray said the board met with hospital administrators last week, who told the board that even with a successful appeal of the GMCB orders, which could take up to eight months, the network would still likely be making the same cuts to local services.
Board members met with CVMC president and chief operating officer Anna Noonan and UVMHN vice president for primary care services Lisa Goodrich.
Murray said that Noonan told MRVHC board members that CVMC has struggled financially for years and, “even without the GMCB’s recent decision, she claims that they would need to be making changes like the ones they have made at some point in time anyway.”
Local legislators are also hitting a wall in terms of getting clear answers.
PROJECTED COST SAVINGS
Washington 2 state representative-elect Candice White said she was told by a GMCB member that primary care facilities do not always lose money – that it depends how they’re run.
“So again, the Mad River Valley Health Clinic needs to see the financials from CVMC to better understand their situation and to chart a path forward,” she added. “We all know that cutting primary care facilities is not in the best interest of Vermont.”
CVMC media spokesperson Jay Ericson has declined to share financial information about the projected cost savings with closures, citing privacy policies, although that is the information that local leaders are most interested in obtaining.
The GMCB does not typically have access to detailed budgets for individual clinics, according to GMCB information management officer Kristen LaJeunesse. “Our oversight is generally at a broader hospital-wide level,” she said.
GRANULAR FINANCIALS
But, in theory, the GMCB could request more granular financial information about the Waitsfield clinics from the hospital network. On November 26, regarding the network’s plan to shutter inpatient psychiatry services at CVMC within months, the GMCB asked CVMC and the hospital network to explain why other courses of action were not pursued, and to provide information about profits, expenses, staffing, and numbers of patients treated daily in the unit in recent years.
If the care board can request that information from the health network for that closure, it is unclear why it cannot request similar detailed information about the finances of the local health clinic.
The GMCB is an independent regulatory board with five members nominated by committee and appointed by the governor for six-year terms. Members include attorneys Owen Foster and Susan J. Barrett; CVMC clinician David Murman; Middlebury College faculty Jessica Holmes; Dartmouth College faculty Thom Walsh; and public policy expert Robin Lunge.
UNFOLDING
The board was created by the Vermont Legislature in 2011 under Act 48, Vermont’s health reform legislation, with the goal of making improvements to access, affordability, and quality of health care for Vermonters while keeping the overall health care system financially sustainable. To do so, the board has authority to regulate hospital budgets and commercial health insurance rates. It also collects and monitors various kinds of data from hospitals and insurance providers.
The GMCB answers to the governor, who can choose to re-appoint members at the end of their terms, and to the courts, if decisions made by the board are brought to a judge.
Such a scenario is currently unfolding.
In late October, before the hospital network announced plans to cut services, it filed appeals to overturn two orders from the GMCB – one that caps how much revenue UVMMC can bring in from caring for patients and another that reduces how much it can charge commercial insurance companies for those services.
An order for that decrease followed findings from the GMCB that last year, UVMMC inaccurately budgeted revenue and expenses, failing to account for tens of millions of dollars in federal funds, which the GMCB said resulted in unnecessary financial strain on Vermonters. The board also found that UVMMC did not receive repayment of tens of millions of dollars that it paid to support New York hospitals, was penalized by the federal government due to UVMMC’s quality and safety results, had excessively high commercial prices and failed to adequately control its expense growth, “yet rewarded its executives with significant compensation at a time when Vermonters struggle with health care costs,” according to a GMCB statement.
In the appeal filed in Vermont Superior Court, UVMMC argued that the GMCB did not give its administrators a chance to fully explain why it was seeking budgetary and insurance rate hikes, making its decision-making process illegal.
Vermont State Senator Andrew Perchlik said of the GMCB, “I think the overall structure and mission is a good one and while we can improve it, we shouldn't get rid of it, unless we have a better way of trying to control costs. I think the GMCB is moving in the right direction and that includes holding the hospitals’ feet to the fire.”
