by Hamilton E. Davis
Friday, Dec. 1, marked the first anniversary of Dr. Sunil Eappen’s stewardship of the University of Vermont Health Network, including, not incidentally, the presidency of the UVM Medical Center Hospital in Burlington. By happenstance, that anniversary fell in the middle of the most challenging and perilous year for UVM’s hospital system since it entered the modern era in the early 1970s.
The risk arises from the seven-year effort by the Green Mountain Care Board to squeeze the UVM Network financially to the point where its ability to function as the lynchpin of the state’s hospital system is badly compromised. The most obvious effect of that is a catastrophic increase in the wait times for patients to get needed care across a variety of disciplines. It can take four to six months or more just to get an appointment.
The extent of the Board’s campaign against the UVM system has markedly increased in the tenure of its new chairperson, Owen Foster, who took command on Oct. 1 of last year. In the budget hearing for UVMMC earlier this fall, the Board grilled UVM’s budget team for nine hours in public, and another three in executive session. Anyone who wonders how that went can check out the Board’s formal budget order, which was a torrent of abuse:
First, as a result of responses that were incomplete, did not address the questions asked, or did not provide the required information, UVMMC failed to provide GMCB with information critical to support UVMMC’s budget submission, including its requested change in charge. Several examples of this are highlighted in this Order.
Second, in critical respects, UVMMC’s representations to support aspects of its budget submission were not credible, as further described throughout this Order. Given time and resource constraints, the Board is unable to comprehensively evaluate and ensure each representation by a hospital is accurate and reliable. Nor should such an effort be necessary as GMCB expects and relies on regulated entities to provide candid, accurate, and straight responses to Board questions and requests for information.
When regulated entities make one-sided and self-serving adjustments while failing to make necessary corresponding adjustments, it degrades the credibility of the hospital’s entire submission. GMCB review of UVMHN’s budget submission and responses found a number of instances where UVMHN’s assertions were not sufficiently supported and/or were simply not credible. UVMMC’s efforts to request a large rate increase were undercut by failures to provide the Board with critical information, use of data as both a sword and shield and unreliable responses to Board questions.
That kind of hostility translates into real money. In the period 2018 to 2023, the Green Mountain Care Board shorted the UVM Medical Center by a total of about 100 million dollars. In its budget for the Fiscal Year 2024, UVMMC got cut by something a little over $130 million. A single example of the effect: the hospital needs four cardio-thoracic surgeons to adequately attend to the million or so patients it serves in Vermont and northeastern New York. It currently has two, which means that it has to bring in two such surgeons from away to meet the need—at a ferocious cost. The reason why cardiology, along with a number of units, can’t keep up with demand is that they don’t have enough money to pay market wages for that service.
I’ve used some mushy words here about the dollar amounts involved because the UVM Network senior management won’t take my questions about them. The one who knows the numbers inside and out is Rick Vincent, the Chief Financial Officer. Vincent is a national class numbers guy, but neither he nor anyone of his senior management colleagues qualifies as adequate at communication.
So, the public at large never gets a clear picture of what’s going on at the single most expensive and socially and politically important institution in the state.
The signal vulnerability to assaults like the one suggested above is just the centerpiece of a nine-year anti-UVMMC that has cast the Network flagship as too big, too dominant, too expensive—a bully that is “gobbling up” all the small independent docs and hospitals and badly damaging the whole Vermont system. Every syllable of that indictment is false, but the anti-UVM campaign has been remarkably successful.
Moreover, senior management team of the UVM Network has raised scarcely a peep in its own defense. The one indication there was at least a pulse in its external affairs apparatus came during the budget hearings earlier this fall. A small group of its Board leaders wrote a moderately worded letter to legislative leaders and the GMCB protesting the stance of the regulators.
The real question facing the Network, however, is what its new CEO, Sunny Eappen will do. He has been at his new post for a full year. During that period, he has talked to people at all sorts of forums, and he has been impressive. People who have heard him say he is highly intelligent, knowledgeable about the forces engulfing modern medicine, and apparently sincere in his determination to lead the Network past its current travails.
None of that has deflected the effort to cripple the Network financially. A cynic might object that platitudes about how the Network is doing its best are not up to the task. Certainly, there has been no diminution of the vitriol lapping at the hospital’s doors.
The real test, though, lies immediately ahead. There is a concerted effort underway beneath the surface to find a path toward saving the academic medical center, and at the same time finally to get beyond the stasis of the last several years and put Vermont back at the forefront of modern health care reform in the U.S.
He appears to be trying to figure that out himself. Over the last couple of months, he has been talking privately to various opinion leaders in the state, away from the campus and apart from his senior communication leaders. There has been no reporting about the substance of those conversations, but the whole process is certain to become visible when the 2024 session of the Legislature opens in early January.
What is clear is that Sunny holds in his hands the future of the Network in responding to the depredations of an irresponsible regulator. Not a single member of the Green Mountain Care Board, nor any of its staff have the faintest idea how to steer modern medicine into the new millennium.
So, will Eappen provide bold leadership in defending his organization in its role as the keystone of the hospital system in the state, or will he meekly surrender to the attacks? The answer will be critical not just to the Network itself, and not just to the heavily populated northwestern quadrant of the state, but to the delivery system from one end of the state to the other.
N.B. I’ll post tomorrow what is known so far about the proposed path. At a minimum, by midwinter, the public should have a complete picture of the health of and outlook for their health care delivery system.