The Valley Reporter - MRVHC board meets with CVMC/UVMHN

The Mad River Valley Health Center Board would like to provide an update on the recent decision of CVMC to close clinics in The Valley.

Board members are as upset and disappointed with the decision to close the CVMC clinics as The Valley residents are. We are residents ourselves and many of us are patients at the clinic. To be clear, the board was never notified in advance of this decision and learned of the closure on the same day as the announcement was made public.

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The primary role of the board is to maintain the facility housing health care providers. The board has no control over the decisions made by UVM and/or CVMC regarding the operation of the clinic here. Notwithstanding, we have attempted to keep lines of communication open with CVMC in an attempt to keep our options open and to understand better how and why CVMC arrived at its decision.

Board members recently met with Anna Noonan (president and COO of CVMC) and Lisa Goodrich (UVMHN VP for primary care services). Based upon emails circulated in setting up this meeting, we anticipated that they viewed the decision as one that was already made and would not likely hear any requests for reconsideration. In fact, as we started the meeting, that was their opening statement. They are now focused on planning what comes next.

During that meeting, they said that should their appeal of the Green Mountain Care Board (GMCB) decision be successful, they likely would be making these same cuts. They also noted that any appeal of the GMCB would likely take six to eight months and that they were not overly optimistic of that appeal succeeding. Further, they indicated that what they are really appealing is the process by which the GMCB reached its decision, not just the numbers. In the meantime, they need to move forward with their budget and addressing the cuts they claim that they are being forced to make.

SMALLEST OF ALL 31

They claim the local clinic is the smallest of all the 31 clinics in the UVM Health Network. They also claim that all 31 of their primary health care clinics lose money. That loss is offset by prescriptions, specialized services, referrals, and other income from the network in general. They also claim that consolidating will save more money in the long run and that they’ll be able to provide ‘better’ services through consolidation. Eliminating the rent alone is not their only savings. They claim that by consolidating they will be able to provide service more efficiently. They talked about delivering and dropping off supplies and test samples from the clinic here as an example of other expenses they can avoid and having more centralized support staff will be helpful. As to support staff, they claim that they have many openings throughout their system and that they don’t anticipate having to fire any support staff; that staff might have to work somewhere else.

We talked about the difficulties of traveling to Waterbury (or elsewhere) for many including the older residents as well as those working here and the additional time needed off from work. While they recognize that these are concerns, they maintain that cutting their expenses will enable them to provide better care which should offset these difficulties. They did also say that they are looking into some sort of visiting nurse scenario where they would travel to see patients. (Good luck with that in some places here in The Valley, particularly in the winter time.) They reiterated their hope to increase telemedicine options. They claim all they need for that is a cellphone and that virtually all of the patients here have cellphones.

LACK OF EASY ACCESS

We stressed the fact that lack of easy access to primary care will almost certainly result in higher rates of emergency department use and an overall decline in health status. They claim they will be working with all patients here to accommodate them in either Waterbury or another clinic. We also pointed out that the MRVAS is one of two remaining all-volunteer EMS services in the state that is already struggling to meet the demands of The Valley and that if there is any increase in service demands, the MRVAS might not be able to meet those needs. They said they would look into that further.

We questioned why The Valley clinic was chosen over others. They said that the clinic in Barre has more patients and a larger physical space. Additionally, there is a greater population to support. As to the Northfield clinic, they said the same thing. There are more patients there and they have greater space available. They are tied in with Norwich University and provide all the health care to the student population as well as the local area. When they mentioned lack of space we asked about our building and the fact that we had briefly discussed in the past renting them additional second-floor space. They brushed that one off and said that the second-floor space was not adequate for their needs. That, the board believes, is totally false. When we had mentioned providing them more space in the past, their claim was that they were having difficulties in providing additional health care providers, and that they could not commit to taking on more space without first having the provider.

NEED TO COMMUNICATE BETTER

At this point they are still in discussions with their providers as to who will remain. Their hope is to retain everyone, but they don’t know yet for sure. It sounds like the new doctor that just started at the clinic may not stay. We did point out that they need to communicate better with their patients here, particularly more direct communication. While they may not know who is staying and/or where they will go (which they may not have finalized until February), we stressed the need to at least let patients know of the proposed timeline and to keep them better informed as the process unfolds.

We talked about the need for greater transparency and better communication. They acknowledged that they can do a better job at that and will follow up with patients more. There are other issues of communication needed as well. They talked about how CVMC provides a mail order pharmacy for prescriptions. We told them that few, if any, people here in The Valley are likely even aware of that option. We pointed them to the community well-being survey where a lack of a local pharmacy was one of residents’ biggest concerns. Now a lack of a local health care provider can be added to that list!

We also discussed the unique history of the clinic here in The Valley, how it was originally created and funded by contributions from Valley residents in 1981. And how, when it became apparent that the original building was too small to meet the needs of the clinic, the community again raised over $1M to fund the new building.

It is also interesting to note that while the GMCB decision was made with respect to the UVM Health Network as a whole, most of the cuts seem to be affecting CVMC operations.

STRUGGLED FINANCIALLY

Anna Noonan said CVMC has struggled financially for many years. Partnering with UVM has helped it survive, but even without the GMCB’s recent decision she said they would need to be making changes like the ones they have made anyway.

At this point, the board does not have a clear path as to what can be done next. Some of the ideas we have discussed and are exploring include the following:

Determine if there are any other means to convince CVMC to alter its decision.

Finding an independent practitioner to take over the space. This seems highly unlikely to succeed in today’s health care environment. There is a private practice in Bristol that the Board might be able to reach out to and/or use as an example of how to proceed. The Board members would need to find others with the necessary expertise to help lead any such search.
Trying to partner with some other primary care organization. Gifford Healthcare has its own financial problems and may not be a good fit. Copley Health Systems would be another possibility, but they may not fit the bill either. It has been suggested that Dartmouth-Hitchcock might be an option, but they are overwhelmed already and would not likely ever come this far.
With either of the above options Valley residents would be faced with a difficult choice. They could keep their primary care provider and follow them to Waterbury or hope to find a new provider here that they could get in with. Any ‘new’ practice established here would also face the same problems of finding enough providers to meet the demand.

The board of directors has also reached out to our local representatives for their input and assistance. The consensus seems to be that the more pressure that can be put on UVM and CVMC the better. This would include contacting Sunny Eappen, president and CEO, University of Vermont Health Network, Anna Noonan, Central Vermont Medical Center, Governor Scott, and our state representatives and senators. The more people that reach out, the better.

Members of the Mad River Valley Health Care Center Board are: