by Hamilton E. Davis

         Last fall, the senior management of the UVM Health Network sued the Green Mountain Care Board on the grounds that the state’s regulator had not allowed UVM to make the case for its 2025 budget. The Board had allowed the Network’s flagship Academic Medical Center in Burlington to take in significantly more patient revenue, but refused to allow the hospital to charge Vermont Blue Cross and other insurance companies enough to actually get that revenue. The shortfall to UVM was about $122 million; At least that was one number that got tossed around.

   The decision to appeal to the courts was a head-snapping U-turn for the company, not just because hospital resistance to the regulator was rare in the 30-history of reform, but because it was so out of character for Sunny Eappen, the Network CEO, who had ascended to the top job two and a half years ago. Eappen tended to praise the GMCB extravagantly and then simply accept whatever he was dealt by the Board; in fact, at one point he suggested the Board could have pressed the hospital even harder to cut costs…

   Still, the UVM case looked strong. The hospital retained Shap Smith, a former Speaker of the Vermont House of Representatives and one of the state’s premier litigators, to manage its case; and when Smith filed his first brief, many of the state’s health policy mavens were impressed. Bill Gilbert, the lawyer who anchored former Governor Dick Snelling staff, and has studied health policy ever since, said he didn’t see how Shap could lose.

That was then.

On March 25, Sunny Eappen pulled the plug on resistance to overreaching regulation, and in effect turned the management of the Academic Medical Center over to a congeries of consultants, advocates, and bureaucrats who, taken as a whole, have no ability to carry out such a scheme. UVM apparently voluntarily withdrew the suit. Eappen’s proposal basically replaced the Green Mountain Care Board with a “Working Group” made up of two members of the current five-member GMCB, one member from the UVM Health Network board, and a second from the UVM Medical Center Hospital Board, and a fifth person, free-floating “liaison” to manage the group.

The powers of the Working Group are so extensive as to render the actual management team of the flagship Medical Center Hospital of Vermont irrelevant. The two UVM members of the Working Group do not include Sunny Eappen, who gets paid $1.3 million per year, or any of the high six-figure salaried senior managers who report to him—the Chief Operating Officer, Chief Counsel, Chief Financial Officer, or key doctors. The members are drawn from the UVM hospital and network Boards, who are unpaid folks drawn from the community, and who may or may not have any serious health policy credentials.

In any event, the Working Group will take command of the UVM system for 16 months, then dissolve. There are a half dozen or more specific issues wrapped up in the whole issue. A Vermont Journal will lay those out over the next few weeks. They will be available in the normal channels to my tiny corps of brilliant readers, and in my national Substack platform: Policy meets Politics.

The agreement between the Green Mountain Care and the UVM Health Network will undermine and potentially destroy the medical integrity and financial health of the Vermont hospital system. The process will take 16 months. It is simply astonishing that such a threat is not the most impactful dimension of the news. The truly jaw-dropping fact is that the whole unprecedented mess will be carried out in total secret. Really, the press, the legislature, the whole health care industry at large and the general public will be enjoined from hearing a word about it. Enjoined in formal legal language. Consider:

The Green Mountain Care Board meeting in mid-April where members discussed the UVM initiative was held in executive session. Nothing substantive was ever disclosed about the content of the debate. And then, buried deep in the seven-page document produced by UVM is the following:

Section 8E: “The workgroup will agree to a policy of confidentiality to the extent consistent with Vermont public meetings and access to public records laws; and (8F) The independent Liaison and other professionals will have no media connections unless specifically authorized by the workgroup”; and 8G “the work group and independent Liaison will exist for 16 months…After that, the Parties will return to the generally applicable processes set forth in statute and rule for sharing information.”

In six decades of following government policy, I have never seen anything quite as grotesque as that. It turns constitutional press protections into a joke, and it makes a mockery of all the pious commentary at every level about transparency in government.

And there hasn’t been a peep about it from the Scott Administration, including the Agency of Human Services, the Legislature, the Health Care Advocate, or the Auditor.

And most amazing of all—the Press itself.