[S]hould the Green Mountain Care Board include a member of the medical profession?
The state Senate thinks so. Senators on Friday gave final approval to S.42, which says at least one member of the board should be an individual licensed to practice medicine, a naturopathic physician, a physician assistant, a registered nurse or an advanced practice registered nurse.
Currently, none of the five care board members are health care professionals. And a number of Vermont health care groups want that to change as soon as possible.
“That clinician perspective is unique,” Vermont Medical Society Executive Director Jessa Barnard said in recent testimony submitted to the Legislature. “Having a board member who’s been in the exam room and consistently managed patient care and knows how health care works on the ground is a necessary and valuable perspective.”
The care board was established by the Legislature in 2011 and regulates hospital budgets, insurance rates and major health care investments, among other things. Board members are appointed by the governor after consideration by a nine-member nominating committee.
While there have been medical professionals who’ve served on the board, nothing in the qualifications for board nominees requires that job title. Rather, one of the criteria is “knowledge of or expertise in health care policy, health care delivery or health care financing, and openness to alternative approaches to health care.”
This isn’t the first debate about care board membership. A bill including language that required a medical professional on the board passed the Senate last year, but that language was edited out of the final version in the House.
S.42 picks up where last year’s bill left off. With the care board focusing on both costs and health care quality, “you need people doing the work as a practitioner to bring that quality to the Green Mountain Care Board and bring that perspective,” Sen. Richard Westman, R-Lamoille, said while presenting the bill Thursday on the Senate floor.
If S.42 becomes law, that wouldn’t mean any current board member is out of a job. Westman said the membership requirement “would become effective upon the next Green Mountain Care Board vacancy, and also would not disqualify a current member from seeking another term.”
“It is a balancing act,” Westman said. “We didn’t want to take anyone who’s currently on the board and put them in a position where they couldn’t be reappointed.”
Westman is vice chair of the Senate Health and Welfare Committee, which received a letter signed by 13 groups supporting S.42. The organizations included those that represent Vermont’s medical doctors, dentists, psychiatrists, nurses and visiting nurses, among others.
“Each decision the (care board) makes stands to have considerable impact on every health care clinician and most importantly, every patient in the state,” the letter says. “Health care professionals have been trained to take care of patients, and their clinical experience can be invaluable when grappling with critical health care reform issues and where to attempt to reduce costs and where to invest.”
The committee also heard from Dr. Kathleen McGraw, chief medical officer at Brattleboro Memorial Hospital. Speaking on behalf of the medical society, McGraw told legislators that there is concern “that health care is being regulated without all the appropriate knowledge being intrinsic to the decision-making process.”
If regulators are supposed to consider cost, quality and the patient experience, “they are missing the perspective of the practicing health care professional who routinely considers how to improve quality in the context of the other two variables,” McGraw said.
Care board Chair Kevin Mullin said the panel has not taken a position on S.42.
“I’m not opposed to having a member of the medical community on the board,” Mullin said in an interview. “I think we’ve seen in the past some very successful members of the board … that came from the medical community.”
At the same time, Mullin said he is concerned that a statutory membership mandate could “handcuff” the board appointment process because there are “no guarantees that the nominating committee and the governor are going to have that pool of candidates” to choose from.
Senators expressed no such concerns on Thursday. But Sen. Chris Pearson, P/D-Chittenden, raised conflict of interest issues. He wondered whether a doctor working for University of Vermont Medical Center, for example, could continue in that capacity while serving on the board.
Given the size of the health care industry and the reach of the state’s largest hospital, Pearson said it may not be a good idea “to have somebody employed by, potentially, a big actor in that health care economy regulating their boss.”
Westman said there would be no prohibition against the scenario Pearson described. But he said care board members are required to abide by “strict conflict of interest rules.”
According to statute, that includes a prohibition against board members participating in decisions in which they or a family member have an “economic interest.”
Westman also noted that potential care board members are vetted by the nine-member nominating committee before being considered by the governor. Westman said he expects that “the people that are on the nominating committee are going to be vigilant and make sure that they pick people of integrity.”
Before the final passage of S.42 on Friday, the Senate agreed to add licensed naturopathic physicians to the list of potential health care professionals on the care board. That amendment was offered by Sen. Jeanette White, D-Windham.
In state law, naturopathic medicine is defined as “a system of health care that utilizes education, natural medicines and natural therapies to support and stimulate a patient’s intrinsic self-healing processes.”
S.42 now goes to the House for consideration.
