The Green Mountain Care Board has endorsed an ambitious, expensive and still-evolving plan to boost Vermont’s mental health treatment system.
The care board’s backing came in the context of hospital budget regulation: Four of five board members voted Wednesday to allow the University of Vermont Medical Center to use $21 million in excess revenue to “measurably increase inpatient mental health capacity in Vermont.”
It’s a signal that the board wants the University of Vermont Health Network to move forward with designing a new acute inpatient psychiatric facility that could be located on the campus of Central Vermont Medical Center in Berlin.
“I’m pretty optimistic about UVM’s proposal and the opportunity it brings to maybe alleviate a crisis that we see in the mental health system,” board member Jessica Holmes said.
Board member Tom Pelham was the lone dissenter. He argued that the majority of UVM Medical Center’s excess revenues in fiscal year 2017 should be used to cut the hospital’s rates in order to save health care consumers money starting Oct. 1.
While some of the hospital’s cash also should be set aside for developing a mental health project, “we also have an affordability problem out there that we can address now,” Pelham said.
The care board’s vote came one week after a UVM doctor and top state health care officials unveiled a plan to overhaul the state’s mental health system.
That proposal came as the care board deliberated over Vermont hospitals’ fiscal 2017 budget performance. UVM Medical Center’s net patient revenues exceeded its state-approved budget by $38.3 million last fiscal year, triggering board review and possible regulatory action.
At a meeting last month, board members came up with a unique solution: They proposed a possible 3 percent rate cut — meaning a reduction in the amount the hospital can charge insurers — but also said that penalty could be softened if UVM Medical administrators came up with a plan to address the state’s mental health needs.
Those needs are growing.
One indicator of the problem is the increasing amount of time mental health patients are stuck in hospital emergency rooms due to a lack of available inpatient beds. New figures from the Vermont Association of Hospitals and Health Systems show that mental health patients spent 5,237 days in emergency rooms in 2017, an increase of nearly 30 percent from the year before.
UVM Health Network’s plan to ease that pressure involves building an acute inpatient unit of still-undetermined size in Berlin, then shifting the current state psychiatric hospital — also in Berlin — to a less-intensive “secure residential” site.
The end result, presumably, would be more mental health beds in both treatment categories.
The project would be several years away due to design and permitting requirements. In the meantime, state officials are discussing smaller, shorter-term projects to increase mental health capacity — possibly at the Brattleboro Retreat or at Northwest Regional Correctional Facility in Swanton.
So there are a lot of moving parts and unanswered questions. But Green Mountain Care Board’s endorsement via its hospital oversight authority was a key first step, and the board provided that on Wednesday.
A majority of the board backed Holmes’ motion saying UVM Medical Center will face no rate cut, but the hospital should set aside $21 million “in surplus funds” for the sole purpose of increasing mental health capacity.
Starting this July, UVM Health Network must give the care board quarterly reports on its plans and progress. The network also “must quantify how the plan will significantly increase access to and quality of mental health treatment and lower overall system costs.”
If the network fails to make “sufficient progress” on the plan, the care board could order UVM Medical Center to “use all or a portion of the $21 million to benefit ratepayers through a commercial rate reduction.”
Pelham made a much different suggestion. He wanted $14 million of UVM Medical Center’s net operating income in fiscal 2017 to go toward a 2 percent rate cut for the hospital, effective at the start of the next hospital budget fiscal year.
Another $6.64 million would be held in reserve “for the purpose of the planning, design and construction of new inpatient mental health capacity at Central Vermont Medical Center,” Pelham’s motion said. UVM Medical would be authorized to spend up to 10 percent of that this year to develop a certificate of need application, which the care board will have to review before approving any new mental health facility.
Pelham also argued that 67 percent of any surplus revenue generated by UVM Medical Center in the current fiscal year should be put toward the new psychiatric facility, with the remainder to be used for another rate cut.
“I think that we have two crises here,” Pelham said. “One is a crisis of (health care) affordability. And the other is a shortage of inpatient mental health beds.”
The affordability issue, Pelham said, requires attention. He cited multiple studies including a February report from the state Health Care Advocate showing that, by three different measures, a widespread lack of affordability “is both quantifiable and measurable.”
“Many Vermonters cannot afford health insurance premiums or the out-of-pocket charges when they get sick,” that report concluded. “Vermont Health Connect insurance costs have grown faster than wages and the cost of living in the state.”
Pelham also said that UVM Health Network’s psychiatric proposal is still missing key details.
“We’re in a situation where nothing is shovel-ready, even if approved today,” Pelham said. “There is no site plan. There are no environmental permits. There are no traffic studies. There is no certificate of need application. There are no architectural drawings. And any cost-sharing agreement with the state has not been developed.”
No board member supported Pelham’s proposal.
Holmes countered that UVM’s plan may be “short on details, but it is long on vision and far-reaching in potential impact.” While construction and completion is several years away, “I think, given the crisis that we have now, we need to start now.”
Board Chair Kevin Mullin said that, several weeks ago, he had been in favor of imposing a rate cut on UVM Medical Center. “I think we’ve come a long way (since then), and that speaks volumes to the crisis that we have in our mental health system,” Mullin said.
Dr. John Brumsted, who serves as top administrator of both UVM Medical Center and UVM Health Network, applauded the care board’s vote.
“We appreciate the board’s recognition of the need for additional treatment capacity in the mental health system and the opportunity to contribute to addressing this critical problem,” Brumsted said in a statement issued after Wednesday’s meeting.
“We look forward to working with all concerned parties to develop a fiscally responsible plan that will provide the high quality care our patients need and deserve.”
