The board of directors of the Mad River Valley Health Center, Inc. would like to provide a further update on the recent decision of CVMC to close the clinic in The Valley. Members of the board have had further discussions with representatives of the UVM Health Network and Central Vermont Medical Center, namely, Lisa Goodrich (UVMHN VP for Primary Care services), Jay Ericson (director of communications and engagement of CVMC), Jim Alvarez (vice-president of support service) and Anna Noonan (president and COO of CVMC).
At our first meeting before Thanksgiving CVMC and UVM began the meeting by telling us they were there only to explain why they had made their decision to close and were not prepared to discuss alternatives. At our most recent meeting it was made clear that they are not willing to reconsider their decision and are moving forward with planning for the closure.
BIGGEST LOSING CLINIC
CVMC remains unwilling to provide us with any specific financial information, other than to tell us that the Waitsfield clinic is the biggest losing clinic and that is part of why they are closing it. They would only tell us that their costs of running this practice are 46% higher than any other primary care location but declined to tell us what their actual claimed loss is.
CVMC and UVM still do not deny that a lack of access to primary care can lead to higher rates of emergency department use and an overall decline in health status. However, they maintain that primary care will remain available, simply in a new location.
Efforts to move patients elsewhere, ignore the reality that if patients cannot be seen locally, many will likely skip or miss their regular primary care checkups. It’s easy to say that Waterbury is only 12 miles away, but in actual travel time, that can be a 20- or 30-minute drive. Moreover, many of the individuals being cared for in the clinic do not live in Waitsfield but live in Warren, and other towns on the periphery of Waitsfield making the distance more than 12 miles. That says nothing about winter conditions. The section of Route 100 from Waitsfield to Waterbury over Duxbury hills can be one of the worst sections of Route 100.
CVMC had previously mentioned utilizing some type of visiting nurse scenario. Between the costs of that and winter travel issues, the board does not see this as a valid option and CVMC has apparently not considered this any further.
INCREASING TELEMEDICINE
CVMC talked about increasing telemedicine options. They claim that even those patients who might not have internet access would still be able to take advantage of this option as long as they have a cellphone. They claimed that 80% of the patients here use MyChart. That is one of the higher percentages of similar clinics. They maintain that this indicates that patients here are savvy enough to deal with telemedicine and similar services. What that ignores is the fact that The Valley has a great many areas where cellphone service is spotty at best and in some places, nonexistent.
CVMC’s current lease automatically renewed for two years starting on October 1. CVMC says they will honor that lease and will either pay us through the end of the term or discuss some type of discounted buyout when they have a definitive move out date. Clearly, saving money on leasing space here in our clinic is not a financial factor in their decision to close if they will continue to pay that lease even when not using the space.
There is also uncertainty as to the correct number of current patients at the clinic as well as the number on a waiting list to become patients. The board has been told by personnel at the clinic that the waiting list is 650 potential patients, yet CVMC claims the correct number is 317.
As to which providers are staying and which are leaving, CVMC currently has no answers. While they did say that no one has given them their notice to quit, they do not have commitments that they will be staying.
WHAT STEPS CAN BE TAKEN
The board asked why this practice was such a loss leader as they claim and what steps, if any, could be taken to improve that. We specifically asked about the potential of using additional space on the second floor as an option. (Obviously, that could only be done with sufficient advance notice to work with current tenants, but we were more curious about their answers.) CVMC said that they prefer to use one-story buildings as those are more efficient. They claimed that they would have certain duplicate costs associated with having additional exam rooms on the second floor. They also talked about the fact that there is only one small elevator and claimed that they would need to have plans in place to deal with patients should the elevator break down. They said that the first-floor space only has six exam rooms which can effectively only accommodate three primary care providers (PCPs). Thus, they maintain that our building is simply not designed to accommodate more patients. They also talked about the difficulties of hiring staff, not just PCPs, but support staff as the cost of housing in The Valley is so high. They even talked about filling in for staff who call in sick and how if they don’t have someone available to cover from the Waterbury location, that most others are not willing to travel here to work. (We quickly pointed out the irony of that statement; if staff has a hard time traveling here, what about Valley residents who will now have to travel elsewhere for care?) They did acknowledge that other sites are not ideal either, but most have much larger first floor space.
The board briefly asked about whether there were any steps we could take to help them potentially stay here, such as adjustments to rent. They were not interested in pursuing that discussion.
They also told us that 28% of the current patients here drive by other clinics that are closer to them. Their plan is to encourage those patients to start using those other clinics but did state that if the current providers here go to Waterbury and a patient wants to keep their current provider, they will still have that option.
We talked about the fact that the clinic here and the amount of rent paid is a small line item in their overall budget. We argued that the actual dollar savings of closing the clinic had to be minimal, but that the impact of The Valley losing this clinic (and one that residents paid for!) will be devastating. All they could say is that they understand that the decision is a hard one, but one they claim they had to make.
GMCB ORDER ISSUED 10/1/2024
They did also claim that the order from Green Mountain Care Board (GMCB) to reduce their budget was issued on 10/1/2024 which is the first day of CVMC’s fiscal year, leaving them little time to adequately prepare and plan for the $16M in cuts they were ordered to make. They claim they did look at administrative costs first and did cut $1.2M, but that is well short of the $16M they were ordered to cut. They did acknowledge that their plan has been developed on the fly, but claim they had little choice in the matter.
We did talk about the fact that it does not make sense that the GMCB is so focused on patient revenues and that reducing revenues will be at all beneficial. Clearly, if CVMC and UVM are seeing more patients and sicker patients, revenues will be up. And if they are increasing revenues, and not their margins, then they are incurring higher costs to deliver this care. This should not be a problem, but with the current metrics being used by the GMCB there seems little room for movement. Anna Noonan said she has been in touch with the GMCB and that she hopes to meet with them and work on making their relationship less adversarial and more focused on serving Vermonters. While that is a good idea, it sounds like it is too little, too late for our clinic!
PEOPLE MOST LMPACTED
We tried to emphasize that the people that will likely be most impacted, those that cannot travel, those who do not have internet access, those who do not have reliable cell service, and those who do not have a real voice in what is happening here, i.e., the most marginalized in our community, will be the ones that will lose the most. Their care will deteriorate; they will likely have less preventative care and more emergency room visits.
This entire process has been difficult and frustrating for the board. It is hard to have a real discussion about the merits of keeping or closing this clinic when CVMC and UVM show no willingness to have that discussion.
Compounding the frustration is the fact that there seems to be no one that can effect a change. The GMCB tells us that they have no authority to delve into the specifics of what is or is not cut from a hospital’s budget but that they only have the power to set limits on that budget. Our legislators similarly tell us that the Legislature doesn't get to vote on such cuts or hospital budgets. The governor’s office has so far not provided any specific help other than to state that, “The Agency of Human Services will continue to press all health care stakeholders to make accurate and informed decisions.”
The board will continue to push for options and continued discussions.
Health center board members include:
- Don Murray, president – Fayston
- Polly Bednash, vice president – Waitsfield
- Rosemarie White, treasurer – Warren
- Steve Fried, secretary – Waitsfield
- Bill Zekas – Moretown
- Danielle Hampton – Fayston
- Judy Phelon – Warren
- Mike Curtin – Fayston
- Ted LaRock – Warren
