Legislative language agreed to by the House Health Care Committee on Tuesday says the Green Mountain Care Board should “collect and review” a variety of data from both the Brattleboro Retreat and the Vermont Psychiatric Care Hospital.
Neither hospital currently is under care board supervision. But lawmakers also said they’re not looking for the same kind of detailed, budgetary oversight that the board provides for medical hospitals.
“To me, it’s much more about integration of health care, and not continuing to see psychiatric hospitals as separate from that system,” said Rep. Anne Donahue, R-Northfield and the committee’s vice chair.
The psychiatric care hospital is state-run under the Department of Mental Health, so is already under state oversight. And Louis Josephson, president and chief executive officer of the Brattleboro Retreat, says he’s fine with the committee’s proposal — though he said some details will have to be worked out with the care board.
“I think it’s reasonable. We are part of the health care system,” Josephson said. “We are a hospital in the state of Vermont — we are just a different kind of facility.”
The Health Care Committee’s deliberations came in the context of S.31, a bill that’s aimed at increasing price transparency for hospital patients. Though the committee has not yet voted on the bill, straw votes taken on Tuesday included support for inserting the psychiatric hospital review provision.
In language that’s similar to a requirement the committee approved for ambulatory surgery centers, the bill now says the Green Mountain Care Board should “collect and review data from each psychiatric hospital licensed” by the state.
The board’s review may include “a psychiatric hospital’s scope of services, volume, utilization, discharges, payer mix, quality, coordination with other aspects of the health care system and financial condition,” the committee’s language says.
Also, the care board’s review “shall be appropriate to psychiatric hospitals’ scale and their role in Vermont’s health care system, and the board shall consider ways in which psychiatric hospitals can be integrated into systemwide payment and delivery system reform,” according to the bill.
The committee initially considered mandating full-scale Green Mountain Care Board budget regulation for the Retreat, as the care board does for Vermont’s 14 medical hospitals.
But lawmakers scaled back that proposal in favor of more general care board review of Retreat operations. They then added the state-run Vermont Psychiatric Care Hospital to the mix.
“We want the Green Mountain Care Board to have as complete a picture of the health care system and data on the health care system as possible,” said Rep. Bill Lippert, D-Hinesburg and the committee’s chair.
Susan Barrett, the care board’s executive director, said it’s not yet clear what the care board’s review of psychiatric hospitals will look like if S.31 passes in its current form. But she said it will be much different than the board’s oversight of medical hospitals, which is a “cost-containment” function that includes setting patient-revenue targets and insurer charges.
“We haven’t had a full discussion of the board on this, but we will,” Barrett said.
Josephson said Retreat administrators would have to “work with the Green Mountain Care Board on what financial information they are looking for.”
With roughly half the Retreat’s patients covered by Medicaid, Josephson said the state – through the Department of Vermont Health Access – already has a lot of information on the hospital’s finances. Last year, the department raised the Retreat’s Medicaid payments after hospital administrators said Medicaid rates weren’t keeping pace with rising costs.
“We’re mostly Medicaid and Medicare,” Josephson said in an interview Tuesday. “Vermont commercial insurance may be 10% of our revenue.”
That’s much different than hospitals, a point acknowledged by members of the Health Care Committee.
“(The Retreat’s) finances are so different – to just throw them into the (care board’s hospital) budget process immediately might not really work,” Donahue said.
But both Donahue and Lippert said it makes sense for the care board to review Retreat operations given the hospital’s increasingly close ties with the state. The Retreat added beds to treat state psychiatric patients after Tropical Storm Irene’s flooding closed the Vermont State Hospital in 2011, and the Retreat is in the process of adding more state-contracted beds.
“There’s a much more significant financial and patient care relationship with the state than there was,” Lippert said.
