by Hamilton E. Davis
The track of Vermont’s health care reform movement is long, five decades and counting, and wildly variable over that span, but nothing so far can match the breathtaking hubris of the scam cobbled together earlier this month by the Green Mountain Care Board and the senior management of the University of Vermont Health Network.
It is important to know that the current iteration of reform is undergirded by a web of legislative and regulatory statutory structures. The single most important is Act 48, enacted in 2011: it established the Green Mountain Care Board as the regulator of both the costs and reform of the state’s 14 hospitals. In addition, the Governor and the Secretary of the Agency of Human Services have to sign onto the federal waivers necessary to engage the flow of funds for Medicare and Medicaid, which combined pay about half of Vermont’s health care bill. There have been several follow-on bills affecting details of the reform effort.
As I described in my earlier post, the Workgroup and its manager, the Liaison, basically bulldozed the legal structure right out of existence for the next 16 months. The regulation of the UVM Health Network will be carried out by the new structure, made up not of UVM’s managers, but by two members of its Board. And the voice of the five-member Green Mountain Care Board will become just two for the regulation of 60 percent of the state’s spending on hospital care. No one has said who those members will be, but it seems obvious to reform watchers that it will be the chair, Owen Foster, and the intellectual leader of the GMCB, Jessica Holmes.
In fact, Holmes testified last week before a legislative committee and told the members there is no way Vermont can afford to pay for the hospital system as it is now configured. Which is true, and has been true for a decade, but the ones who are supposed to solve that problem are the members of the Green Mountain Care Board. Anyway, the Board has now gone into full secrecy mode: the agenda for its meeting today is a discussion of the proposed new federal program to shift regulation to Global Budgets for hospitals. The so-called AHEAD program would run well out into the 2030s. Beyond voting to approve the minutes, the entire discussion will be in an executive session and private.
The Governor, the Secretary of the Agency of Human Services, the entire Legislature, the people who actually run the UVM Health Network the business community, the Press, and the general public will not be allowed to know anything that goes on with 60 percent of their hospital financing for the next 19 months, until Labor Day of 2026.
So, what will that look like?
The hospitals will still be required to submit their proposed Fiscal Year 2026 budgets by this July 1. I assume the GMCB will treat the 11 non-UVM facilities in the normal fashion, with a fully public discussion of the issues involved in each unit. There could be just four members, since Member Robin Lunge has now left the Board. Of course, Governor Scott could name a replacement for Lunge, but he hasn’t done so yet. Beyond the basics, the GMCB has shown almost no interest in the independent hospitals. The indies spend around a billion dollars a year, less than the UVM Network, but serious money in Vermont nonetheless. The work of seven national consultants has shown clearly that the costs of the Indies are excessive, and more importantly, their quality performance ranges from mediocre to abysmal. The Green Mountain Board members don’t even mention that evidence, ever. It is the third rail for them.
The machinery for regulating the UVM Network, however, seems obviously extralegal, or blatantly illegal, however you want to think about it. The legal term Ultra Vires, meaning “beyond law” seems to get at it. In the event, here is what it looks like:
The Green Mountain Care Board no longer has anything to do with the UVM Network—the Workgroup is in charge. The cone of silence covers the two Board reps on the Workgroup, but they are almost certainly to be Owen Foster, the chair of the GMCB, and Member Jessica Holmes. That leaves Thom Walsh, David Thurman, and the Lunge seat holder with nothing to do as Green Mountain Care Board members with the north of two billion-dollar UVM Network.
Even crazier, the senior management at the UVM Network will be on the bench for 16 months. The reality is that these people are the only ones in the state who actually know how to run a tertiary care hospital, because they have been doing it their whole careers. Vermonters are paying Sunny Eappen, the Network CEO, $1.3 million per year. His Chief Operating Officer, his Chief Financial Officer, his Chief Counsel, and some of his lead docs get paid $700,000 to $900,000 per year, and they will keep getting paid to twiddle their thumbs while people like Jessica Holmes, who has zero health care management experience, and Owen Foster, who has even less, decide what they should do day after day.
The only body with actual power to deal with this mess is the Vermont Legislature. Will they? Anything is possible, but our lawmakers are in full get-out-of-town adjournment mode, so it’s unlikely. Which is sad.
Over 50 years, tiny Vermont built a national class Academic Medical Center, and in the Phil Scott era it is steadily sliding into mediocrity.
We’ll look next at two of Vermont’s most important players, who are going all out to turn the whole toxic process around.