The Green Mountain Care Board continues to wrestle with how to handle funds held by the University of Vermont Health Network earmarked for increasing inpatient psychiatric care.
Regulators were set to vote Wednesday on whether to give the state’s largest health care provider greater leeway on how it spends what remains of $21 million in surplus profits from 2017. But Owen Foster, the care board chair, pulled the question in order to give staff and board members more time to consider a more restrictive approach.
“I personally would like a bit more time to think about this because it is really critically important,” said Foster, pointing to the significant number of public comments on the issue.
One letter signed by the medical directors of nine emergency departments around the state supported additional flexibility. They also urged the board to ensure the funds are used to directly address the needs of those Vermonters, around 30 on any given day, who are stuck waiting in their hospitals for more than 24 hours to access crisis psychiatric care.
“The situation in our emergency departments constitutes a slow-moving public health emergency” and “is a full-on human rights crisis,” the medical directors wrote. “None of this should be tolerable to Vermonters, and it does not reflect our values.”
The health network — which includes University of Vermont Medical Center in the Burlington area, Central Vermont Medical Center in Berlin and Porter Medical Center in Middlebury — had committed to build a new psychiatric wing at CVMC that would have added 25 inpatient beds. But leaders dropped the project last spring citing operating losses that hobbled the network’s ability to make capital investments.
The network spent around $3 million over the past four years on planning the Berlin hospital renovation. Estimates put the cost of the project, which was to include a new emergency entrance and parking garage, at more than $150 million. Also, UVM Health Network leaders told the board that lower-than-cost reimbursements for psychiatric care by both private and public insurers would mean at least a $20 million annual loss on the service.
Meanwhile, UVMMC submitted a detailed application to the Green Mountain Care Board last month for construction of a $130 million outpatient surgery center in South Burlington. Leaders estimated that service would start to turn a profit and begin paying back the cost of construction within six months.
Wednesday’s vote by the board could have allowed the health network to spend the remaining 2017 surplus on a wider range of investments to improve mental health care more broadly. The board would have asked UVM Health Network for a plan developed “in consultation” with the Vermont Department of Mental Health by May 31.
Board member Jessica Holmes suggested that the board could allow flexibility while still requiring that the plan be targeted at reducing the number of people waiting in emergency rooms for care. Foster said he wanted to explore whether the board could require that the state mental health department play a more substantial role in determining the most effective steps toward meeting that goal.
In her own written comment, State Rep. Anne Donohue, R-Northfield, pointed out that the Department of Mental Health had already told the legislature what its top priority investment was: a hospital-based inpatient psychiatric unit for youth. UVM Health Network initially showed interest in adding that service at its pediatric hospital in Burlington, but stepped away from that project as well.
In January, the Scott administration requested a $9.25 million appropriation in this year’s budget adjustment to support development of a youth inpatient psychiatric unit at Southwestern Vermont Medical Center in Bennington. But that request was shelved by the legislature pending the conclusion of the hospital’s own feasibility study.
“Very clearly, this highest-level-of-need unit belongs adjacent to and in collaboration with the state’s only Children’s Hospital, located at UVMMC in Burlington,” Donohue wrote in her letter to the care board. She urged the board to require UVM Health Network to evaluate using the remaining 2017 funds on that project.
Board member Thom Walsh expressed concern that without an explicit requirement, inpatient capacity — whether for youth or adults — may never be built because it is not seen as profitable.
“That is what the past several years, more than several, have shown,” he said. “Unless there is a way to compel, I worry that it won’t be done.”
Whether the care board will, or even can, require that kind of action is an open question.
Eric Schultheis, an attorney with Vermont Legal Aid’s Office of the Health Care Advocate, called the situation an opportunity for the board to consider whether it has ever fully utilized the power that the legislature gave it.
“In the past, in my opinion, the board has taken an exceedingly conservative stance to the detriment of Vermonters,” Schultheis said.