Editor’s note: This op-ed is by Allan Ramsay, MD, who is a member of the Green Mountain Care Board.
As a family physician in Vermont for over 30 years, I always knew that confidentiality was fundamental to the doctor-patient relationship. The concept of openness and transparency in daily work was not one I would have considered essential to provide the best care for my patients. Since joining the Green Mountain Care Board, I have learned a great deal about health care policy. I have also learned the importance of being open and transparent in all the things we do as a board.
There are five members of the GMCB. Under Vermont’s open government laws, if three or more of us discuss health care reform, in person or even by email, we must do so in an open meeting that has been noticed to the public. To that end we generally hold two open board meetings each week, announcing the agendas to the public ahead of time so that any interested person or party can attend, listen and comment on the discussion.
All of the important decisions we make, such as setting hospital budget targets, approving insurer rate increases, or payment reform pilot projects, result from processes that are open and that involve public comment and input. As an example, we have recently established a hospital budget trend target of no more than a 3.75 percent increase after a process that included public board meetings and soliciting input from the hospitals on this decision. In addition, if a hospital requests an adjustment based on expenditures that are clearly linked to quality improvement (for example increased investment in primary care services), the GMCB can evaluate these expenditures and respond appropriately.
Lack of transparency permeates our current health care system. Let’s say an uninsured patient wants to save for a screening colonoscopy. Maybe he or she just learned a family member had died of colon cancer and decided this reassurance would be more important than the next vacation. This person could not get an accurate estimate of cost no matter how hard he or she tried. If a precancerous polyp needs to be removed, or several, there would be additional costs. It would be even more complicated if this person decided to check among different hospitals or providers, where the price might vary widely. This is wasteful and unfair, because there is no real transparency in the process.
The rules of openness established for the GMCB by Act 48 are a foundation for how we will assure that all Vermonters have a voice in the process. Those who oppose health care reform efforts do not function with the same set of rules regarding openness and transparency. They are free to attempt to convince Vermonters that changing the health care system will lead to declines in quality and long waiting lines for procedures such as the above-mentioned colonoscopy. During my years of practice in Vermont I had many patients who did not get a necessary test or procedure because they had no insurance or their deductible was too high. There are many Vermonters right now who can’t even wait in line — even if a line existed.
The goal of the Green Mountain Care Board is to improve the quality of care, make sure it is accessible to everyone, and to control the rising cost of care to a level we can afford. Transparency will assure this happens. If we see, through our regulatory processes, that hospitals or other health care providers are controlling costs simply by reducing utilization of services we will respond by holding them accountable for improved outcomes and improved patient experience. If everyone in the health care debate would be willing to be open and transparent, whether about their information sources or their funding, the outcomes of this process would be better for everyone.
