by Hamilton E. Davis
The Green Mountain Care Board is imploding, almost certainly ending Vermont’s decades-long effort to regulate and reshape its doctor/hospital system.
In the span of just a few weeks this fall, the Board ordered the UVM Health Network, which delivers 60 percent of all the hospital care in Vermont, to operate under a money-losing budget it could not possibly survive. The amount below breakeven was $122 million.
In November, the Network senior management, in a doormat mode for two years, challenged the budget order and threw the whole mess into the Vermont court system, where it will take at least a year to resolve, if not longer. A consequence is that no one in government or the industry has reliable figures for the fiscal year we are now two months into, not to mention the need for hospitals to begin building their Fiscal year 26 budgets in February.
Meanwhile, the consultant hired by the Board to actually design a viable hospital system, a project far beyond the Board’s staff, turned in a report that was so filled with errors and dumbness, that its credibility vanished on sight. The Secretary of the Agency of Human Services, Jenney Samuelson, immediately issued a statement reassuring Vermonters that the report’s recommendations, including closing four of the 11 small community hospitals, would never be executed. Mike Del Trecco, the boss of the Vermont hospital trade group, demanded an apology…
Just days later, the UVM Health Network announced that it would cut a number of money-losing services, including kidney transplant and dialysis, close a 50-bed safety net where other hospitals could send difficult patients during the Covid crisis, close a psychiatric unit in central Vermont, and shutter OneCare Vermont, the structure designed mainly to shift reimbursement in the payment system from fee-for-service to capitation, the key to sustainable cost containment.
The Board never evinced any interest in shifting away from fee-for-service, but the collateral is likely to be devastating. OneCare Vermont has been the vehicle for providing a lifeline for the state’s primary care providers, contributing about $20 million a year to the state’s 700 or so primary care docs. That number dropped in the last couple of years, but it was a vital financial lifeline that took money from surgery-rich hospitals to primary care docs, especially those with Medicaid-heavy patient panels. No OneCare, no lifeline.
Facing a catastrophe, Owen Foster, the chair of the Green Mountain Care Board, and his team put out a statement that the UVM Network had never warned the Board that it might make severe service cuts. The Network replied that it had fact warned Foster personally, in person and in writing. If Foster can be shown in a legal proceeding to have lied about having been blindsided, it could put his job at risk.
The extraordinary Meeting Today
The severity of the mess facing the healthcare delivery system galvanized the Vermont Legislature, which scheduled for this morning a rare meeting of the Health Reform Oversight Committee, the chairpeople of the six committees in the House and Senate that deal with healthcare—House Health Care and Senate Health and Welfare, House and Senate Appropriations, the tax-writing House Ways and Mean, and Senate Finance committees. These folks will have to decide in 2025 what might be done to solve the problem, how much the state should spend to execute a plan, and how to raise the money.
This group will spend four hours grilling the three most important players in the delivery system: Owen Foster, the chair of the Green Mountain Care Board; Jenney Samuelson, the Secretary of AHS, who works for Gov. Phil Scott, but who under federal law is a signatory for Vermont in any agreement with federal health care officials; and Dr. Steve Leffler, who runs the 500-bed UVM Medical Center in Burlington, and is the spokesman for the UVM Health Network.
You can never rule out a lightning strike, of course, but there is little likelihood that today’s HROC session will conclude with a clear path forward for the reform project. At a minimum, however, the lawmakers should be able to clear away the jungle of magical thinking that has enveloped the system.
Moreover, four hours on the grill for Foster of the GMCB, Samuelson of the Scotties, and Steve Leffler of the UVM Network should illuminate, or at least provide some insight into the factors that have led these leaders into the weeds. There is enough complexity and even weirdness in the reform space to test even the best policy analysts, but there has also been plenty of palpable political irresponsibility and outright incompetence. The temperature on the grill could get really high.