At $9,995 per person in 2018, Vermont residents spent more on health care than people in many other states in the nation, according to data from the Green Mountain Care Board. That average rose to almost $10,442 per person in 2019, an almost 4.5% increase, the data shows.
Exactly how hospital systems arrive at that cost is a process that often happens behind closed doors in other states. In most cases, consumers are not involved in these discussions, but they may see the impact on their medical bills.
Not so in Vermont, which is one of a handful of states where hospital budgets are subject to government oversight. In Vermont, that job falls to the Green Mountain Care Board — a five-person panel that has the final say over how much hospitals can grow and charge their patients each year.
A major part of that process will be on public view this month as executives from the state’s 14 nonprofit hospitals and health systems present their financial projections for the next fiscal year.
This year’s budget process is likely to be more consequential than past years’ due to the shadow cast by the coronavirus pandemic. Though they received significant assistance from the federal government, hospitals in the state contended with longstanding issues, including staffing challenges, burnout and the financial impact of delaying care. These and related issues are likely to come up in this month’s discussions.
Here’s what you need to know ahead of these presentations.
How does the budget review work?
The Green Mountain Care Board’s budget discussions are slated to begin on Tuesday, Aug. 17, and conclude Aug. 27. Each session is expected to focus on one hospital, beginning with Southwestern Vermont Medical Center in Bennington.
Most presentations last roughly an hour, but the presentation for the University of Vermont Health Network, the largest system in the state, is scheduled to last several hours.
These public meetings are not the end of the discussion. The board is expected to deliberate and vote on the budget proposals next month. The schedule and the livestreams of the meetings are online.
The final budgets — and the increase in revenue the board approves — go into effect in October, the beginning of the hospitals’ fiscal year. The board can adjust these budgets after the approval process if unforeseen circumstances develop, but by and large, systems must adhere to their budgets or face fines.
Who is presenting? Who isn’t presenting?
The board sets growth targets each year. Hospitals whose budgets fall below that target can have their budgets approved automatically and without a hearing. Two hospitals — Gifford Medical Center in Randolph and Northwestern Medical Center in Saint Albans — have met these criteria.
Federal hospitals, such as the Veterans Health Administration facility in White River Junction, are also exempt. The Brattleboro Retreat, the state’s only nonprofit psychiatric hospital, isn’t participating in this public round of presentations but will be subject to full review in 2024, according to state statutes.
How can I participate?
You can ask questions after each presentation or submit written comments to the board anytime between now and mid-September. The public can attend the meetings at 144 State St. in Montpelier or attend remotely. The hearings will also be available to watch on the Green Mountain Care Board’s meeting page.
I’m not a numbers person. What do I need to know?
First, the documents themselves: Every document the board will consider in the coming weeks is available online. A quick overview might begin with the budget narrative. That’s a written statement from each hospital reporting on what executives think the board and the public need to know.
This year’s narratives include tidbits such as the financial impact of suspending elective surgeries on hospitals, the amount of coronavirus aid received from state and federal agencies and an assessment of finances in the coming year.
The narrative also gives an overview of revenues, expenses and cost of big line items.
Does that mean health care prices won’t increase in the coming year?
Not necessarily. Hospital patient revenue is an important contributor to health care pricing, but it is not the only one. The board also reviews major insurer premiums in a separate process that covers roughly 15% of the insurance market.
Correction: An earlier version of the story compared two different data sets for 2018 and 2019 to outline health care spending in Vermont.
