Last October, state regulators delivered budget orders that required Central Vermont Medical Center to reduce its Net Patient Revenue (NPR) by $16.2 million. NPR is not profit; it represents the revenue we receive for providing patient services before expenses. As a nonprofit organization, when we reduce revenue, we must reduce expenses to balance our budget.
These include the consolidation of some primary care and rehabilitation locations, including in the Mad River Valley (MRV). These changes are on top of multiple years of administrative cost reductions we have put in place to better control health care costs. We are committed to implementing these consolidations thoughtfully, with a goal of minimizing disruption to our patients.
CVMC’s Mad River Family Medicine Practice is housed in the Mad River Valley Health Center. This practice is the smallest practice across all CVMC and UVMMC primary care locations both in the number of patients seen in the site, approximately 2,700, and in clinic square footage. Given the constraints of the health center building, there is limited opportunity for growth.
The MRVHC board offered the second floor of the building, but it is highly inefficient to operate one practice, particularly one this size, on multiple floors. It requires too many redundancies, including supplies, storage, materials management, etc. More importantly, the building only has one elevator which, if it were to go down, could impact patient and staff safety.
Additionally, this site has the greatest financial loss per patient visit. For example, we lose 41% more dollars per visit to see a patient in Waitsfield than we do at our Waterbury location, approximately 12 miles away. It’s important to note that nearly 30% of the patients seen at the Waitsfield practice live outside The Valley and pass another CVMC or UVMMC primary care site to travel to this location. As part of this consolidation, if those patients would like to see a provider closer to where they live, we will make that happen.
In recent weeks, two interested parties approached CVMC to explore the possibility of taking over the practice’s operations. We provided these interested parties with the requested information to inform their decision. Ultimately, both parties independently decided not to proceed.
We understand that patients in The Valley will need to travel farther for their care. To address this, we are committed to expanding telemedicine visits and continuing to provide mail-order pharmacy options for outpatients. It is important to note that our current waiting list for Mad River is 144 patients, despite numbers reported through other sources.
That number is based on our electronic health records system (Epic) although other numbers have been suggested for the waiting list.
We are happy to confirm that John Wilson, MD, and Meghan Rico, PA-C, will continue to care for patients at our Waterbury location once the move is complete. During this transition we will work to eliminate the waiting list and further expand access for new patients.
We will work with all patients to find the appropriate provider and location of care, regardless of whether their current provider remains with CVMC.
We estimate continuing operation of the Waitsfield site until June of this year. There have been questions about the lease for this practice. The terms of the lease automatically renew. Termination of the lease requires a 60-day notice; therefore, we would have needed to provide that notice on August 2, 2024. For context, CVMC’s hearings for our fiscal year 2025 budget occurred on August 30. The budget order for this fiscal year was received on October 1. Given the timing of the state’s orders, adequate notice to terminate the lease was not possible. In our discussions with members of the MRVHC Board, we shared that we are committed to honoring the terms of the lease.
We understand that the consolidation of primary care sites has impacts on our patients. Unfortunately, we can no longer provide all the same services that we have in the past, in exactly the same way. When this consolidation of our primary care practices is completed, CVMC will still operate primary care practices in five central Vermont communities.
This is a challenging time for health care in our state. Despite these challenges, please know that we remain committed to the critical role we play in caring for the people of Central Vermont and beyond, while ensuring that our organization is financially sustainable for the long term.
Noonan is the president and COO of CVMC.
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