[T]hough the Green Mountain Care Board has broad authority over health care matters in Vermont, none of its members are required have any medical experience.
And that will remain the case for the time being: A legislative effort to change the regulatory board’s membership requirements failed as the 2018 session adjourned.
But the matter is expected to come up again. That’s partly because there remains strong backing for mandating medical experience on the care board, and also because legislators may simply have run out of time to consider the matter this year.
“There was not a deep philosophical opposition to the concept,” said Rep. Anne Donahue, R-Northfield and vice chair of the House Health Care Committee. “But we thought it needed more time.”
The Legislature formed the Green Mountain Care Board in 2011 to boost the quality of health care in Vermont while also containing costs. The board’s duties include regulation of hospital budgets, insurance rates and accountable care organizations, and the board must sign off on significant health care investments.
The care board also is involved in payment reform, workforce, technology and prescription drug issues.
The board’s five members are appointed by the governor based on suggestions from a nominating committee. That committee is supposed to consider several factors, including a candidate’s commitment to health care reform principles; knowledge of health care issues; ability to be impartial and “free from undue influence”; and “possession of desirable personal characteristics.”
But no board member is required to have spent any time in the health care industry. And no current board member is a health care professional.
Were it not for last-minute revisions, H.912 would have changed that eventually.
The wide-ranging bill, which Gov. Phil Scott signed on May 22, makes a number of care board-related changes including updating the certificate of need process for health care projects; tweaking the board’s “bill back” funding formula; and modifying the state’s Health Resource Allocation Plan.
When the Senate approved the bill in early May, it also included language saying at least one care board member should be a person licensed to practice medicine, a physician’s assistant, a registered nurse or an advanced practice registered nurse.
The provision was designed so that no current board member would be booted. Current members also could seek new terms without being penalized for lack of medical experience.
But in the last week of the legislative session, the membership language was deleted in the House based on an amendment offered by Donahue.
In an interview this week, Donahue said she agrees with the general concept of ensuring medical expertise on the care board.
“It just seems like having that voice of a health practitioner is important,” she said. “Ideally, you would always have at least one member that has firsthand experience with the subject.”
But Donahue said the Senate’s legislative language “actually was kind of narrow — that it had to be a particular health care practitioner” on the care board.
She also cited other “complicating factors,” including questions about how care board vacancies would be handled.
“We just realized that this was not something that could be done while we’ve got a day or two left (in the session),” Donahue said. “It needed more time and effort.”
Kevin Mullin, the care board’s current chairman, applauded the House’s deletion of the membership language because it “severely limited which (health care) providers would be able to serve.”
He referenced an amendment made on the Senate floor that allowed a prospective care board member to be affiliated with an accountable care organization but not with a hospital.
Mullin said he expects further discussion about whether there should be a mandatory medical presence on the care board. He didn’t explicitly endorse the idea, but he also said he sees its merits.
“I think, if you get the right (medical) provider, it would be a big plus for the board,” Mullin said. “But it has to be somebody that’s committed to doing the work, and not just doing it for the sake of doing it.”
Several health care groups including the Vermont Medical Society have lobbied for inclusion of a medical professional on the care board. That lobbying continued during the 2018 session, when the medical society told the House Health Care Committee that medical experience “can be invaluable when grappling with critical health care reform issues.”
“The board benefitted from a physician member at its inception, and most recently a primary care doctor and nurse provided the clinician perspective,” the society’s letter said. “That clinician perspective is unique, and having someone who’s been in the exam room with patients and managed patient care and seen how health care works on the ground is a necessary and valuable perspective.”
