[B]URLINGTON – As University of Vermont Medical Center administrators presented a $1.3 billion budget to state regulators on Wednesday, the hospital’s unionized nurses protested outside.
But it doesn’t appear that the nurses’ months-long contract dispute will have any substantial effect on the Green Mountain Care Board’s consideration of the fiscal 2019 spending plan for the state’s biggest hospital.
Hospital President Eileen Whalen began her presentation with an acknowledgement of the fact that the care board has pledged to not delay approval of UVM Medical’s budget despite ongoing labor unrest.
“We deeply value each member of our team at the medical center. Our people, we know, are our strength,” Whalen told the care board. “I want to thank you for giving us the space to negotiate this union contract and really respect the collective bargaining process.”
That didn’t stop the nurses from making their case and taking issue with care board Chair Kevin Mullin’s promise earlier this week to proceed with “business as usual.”
“I don’t know what business as usual looks like for hospital administrators,” said Maggie Belensz, a registered nurse in UVM’s neurology unit. “But our business as usual is a crisis.”
The care board is in the middle of its fiscal 2019 budget deliberations for 14 Vermont hospitals. The fiscal year for hospitals begins Oct. 1, and the board will make budget decisions next month.
Individual hospital information is available on the board’s hospital budget review website.
As part of a series of care board public hearings, UVM Medical Center administrators presented a proposed budget that includes a $39.2 million operating surplus. That represents an operating margin of 2.8 percent on approximately $1.38 billion in revenues and $1.34 billion in expenses.
Chief Financial Officer Rick Vincent noted that the 2019 operating margin is “down from where we’ve been historically.” By comparison, the hospital is projecting a $53.55 million operating surplus and a 3.9 percent positive margin in the current fiscal year, and those numbers were even higher in fiscal 2017.
Vincent said the expected dip in 2019 primarily is due to big expenses in connection with implementation of a new, $151 million electronic medical records system and completion of a $189 million, 128-bed inpatient facility called the Miller Building.
UVM Medical administrators plan to partially offset increasing expenses with a 4 percent increase in rates charged to insurers. That’s expected to bring $25.3 million in additional revenue.
“We feel that’s a reasonable place to be at in terms of our 2019 budget,” Vincent said.
The hospital’s net patient revenue – a key measurement used by the care board – is expected to grow by 1.7 percent in fiscal 2019 compared with UVM Medical’s 2018 budget. That’s significantly less than a 3.2 percent growth target set by the care board earlier this year.
Nevertheless, the care board could decide to reduce UVM’s proposed rate increase and/or the hospital’s requested growth rate for net patient revenues. Board members questioned hospital administrators about their financial needs and projections, as did representatives from the Office of the Health Care Advocate.
UVM Medical Chief Executive Officer John Brumsted made it clear that he does not expect the care board to make budget decisions based on the nurses’ union dispute or its potential outcome. The board approves hospital budgets “at a very high level,” Brumsted said, leaving it to medical center administrators to figure out details.
“Once the budget’s approved, our management team has to respond to all sorts of different changes as we go from a plan to what’s actually happening,” Brumsted said in an interview.
Mullin seemed to underscore that sentiment by asking Brumsted and Whalen whether they thought the hospital could gain “any type of competitive advantage” in the union dispute by the board’s approval of a 2019 budget. Both administrators said no.
Nevertheless, some issues that have been central to the labor battle did play a role in Wednesday’s hearing.
For example, the nurses’ union – the Vermont Federation of Nurses and Health Professionals – has balked at the hospital’s executive compensation. Recent federal filings showed that Brumsted, who is president of both the medical center and UVM Health Network, took home more than $2.1 million in compensation in 2016.
But in his presentation to the care board on Wednesday, Brumsted detailed a compensation process involving health network trustee review and a consultant’s comparison to “over 120 similar organizations.”
For his own salary, “there’s no negotiation involved in that,” Brumsted said. “It’s what the board compensation committee deems appropriate based on those benchmarks.”
Hospital staffing also came up, with care board member Robin Lunge asking how the hospital is dealing with increasingly acute patient needs. Whalen said hospital leaders are “addressing staffing concerns” in bargaining with the nurses, pointing to a pledge that supervisory nurses won’t have patients assigned to them.
“What we have committed to is to free up charge nurses on every single unit” so they can help with higher acuity patients, Whalen said.
Hospital spokesperson Michael Carrese said UVM Medical Center currently has 113 open positions for registered nurses and licensed practical nurses. But Carrese said the inpatient nurse vacancy rate is “comparable to similar organizations,” and he said the hospital’s “nursing turnover rate is in line with other academic medical centers across the country.”
Carrese also said the volume of nursing applications “has increased within the last two quarters.”
Union members, however, argue that the the hospital hasn’t gone far enough to address nursing recruitment and retention. They say staffing shortfalls have led to safety concerns and long wait times.
“Their numbers really don’t seem to support what they’re saying,” said Deb Snell, a UVM nurse and president of AFT Vermont, referring to the hospital administration’s proposed budget. “They’re talking about workforce development and not really talking about how they’re going to do it.”
On Wednesday, nurses and their supporters marched around Burlington City Hall, where the care board hearing was held. They chanted slogans within earshot of the meeting inside, then filed into the auditorium to participate in the public comment portion of the hearing.
Belensz told the board that, when she started at UVM Medical Center three years ago, nurses were routinely called off because they weren’t needed.
“Now, I get at least a call a day offering double time to come into work,” Belensz said. “We’re tired, and people are going to stop coming in.”
Mike Dougherty contributed to this report.