[T]he Green Mountain Care Board voted 3 to 2 to let the state’s largest hospital system use $12 million in excess revenue to partner with community organizations.
The board made the decision Thursday after a two-hour discussion, with most of that time in deadlock. The debate stopped when Al Gobeille, the chair of the board, voted to break the tie.
The other two yes votes came from Con Hogan, a retired human services administrator, and Dr. Allan Ramsay, a family doctor. Betty Rambur, a nurse practitioner, and Jessica Holmes, an economist, voted no.
The board approved the majority of the University of Vermont Health Network’s proposal: to use $12 million in excess revenue it took in during fiscal year 2015 to fund community organizations including Howard Center, Washington County Mental Health Services and the Champlain Housing Trust.
Regulators rejected the hospital system’s related proposal to spend $3 million setting up an accountable care organization for the all-payer model that is intended to be Vermont’s future health care system. The board’s staff has been negotiating an agreement for that model with the federal government in partnership with the Shumlin administration.
“I can’t make a moral, ethical argument for that $3 million ACO development,” Ramsay said.
The decision leaves about $17.1 million in excess revenue that the Green Mountain Care Board has the authority to regulate. Although the hospital system took in $35.4 million more than it was supposed to during fiscal 2015, regulatory rules mean only $29.1 million falls into an enforceable threshold.
The argument centered on Hogan and Ramsay’s position that $17.1 million should be returned to commercial insurers and potentially their customers. Rambur and Holmes argued that the full $29.1 million should be returned to customers.
Gobeille cast his vote reluctantly after getting a push from Hogan and Rambur. Gobeille told them he had hoped to come to a compromise among members of the board. He said of the divide: “That’s not a split vote. That’s the Grand Canyon.”
Hogan told Gobeille that unity among board members was not as important as his leadership. “If we lose we lose, if we win we win, but we move on, and we continue to do our business,” Hogan said.
With regard to the UVM Health Network’s proposal itself, Hogan said the hospitals “break the mold in a significant way. We didn’t have any rules, if you will, when we started. We should have some rules, but it’s not time to make the rules before we make the decision on this.”
Holmes disagreed. “Whose surplus is this?” she asked. “And sometimes, at the end of the day, I feel like these excess revenues should go into rate reduction for commercial payers.” She said commercial insurers are paying more than government programs in order to subsidize low government reimbursements.
Before the vote, the board approved the Rutland Regional Medical Center’s proposal to use excess revenue to lower how much it charges commercial insurers by 3.7 percent, or about $5.6 million a year.
Because of the inconsistency in approaches, the board said it would create a policy to guide hospitals in spending excess revenue.
Rambur turned to philosophy. “If I really didn’t know who I was in this society, I think that the people paying the bill should have the money back,” she said. “You said it’s the payers’ money. I would say it’s the people who paid the payers’ money, and that’s a big difference.”
Ramsay cited his works seeing uninsured patients at a free clinic. “I spend so much time in my current practice dealing with the social determinants of health,” such as housing, poverty and employment, he said.
“As a physician, I know it’s hard to know whether those (community health investments) are the absolute best things to do for the network, but as a physician I can’t deny that those are really important investments of this money that will help,” Ramsay said.
Rambur replied: “As a nurse, I too feel that very painfully. My question, though, is that something that should be funded through the commercial ratepayers. It’s almost like a hidden, a hidden subsidy.”
Ramsay said: “It’s probably not how it should be done, but unless we have the strength, the moral and social imperative … I’ll take the money any way I can get it.”
Gobeille, who eventually voted with Ramsay, said lawmakers should be funding those community organizations. “There is a place where they’re supposed to do that,” he said.
Ramsay interrupted: “And it’s called courage.”
