This commentary is by Dr. Sunny Eappen, president and CEO of the University of Vermont Health Network.
As an anesthesiologist who largely practiced in reproductive health, I know firsthand how vital it is for patients to have access to the medical expertise they need, whether for a planned appointment or procedure, or during an unforeseen life-threatening situation. In my role now as president and chief executive officer of University of Vermont Health Network, it’s the responsibility of my team and me to make sure our staff have what they need to provide that care, and to control our costs at a time where Vermonters are facing increased costs overall.
The budgets we presented to the Green Mountain Care Board this past summer reflected what our Vermont hospitals needed to serve our patients and communities. We detailed what it would take to continue reducing wait times for appointments and surgeries, stabilize our workforce by supporting our employees facing high housing costs and move care out of the hospital setting when doing so reduces costs and improves the experience for patients.
Disappointingly, those budgets were cut, and we were penalized for providing more care than was approved, even though we lost money providing it. Because of those legal orders, we have had to make difficult decisions. We followed a consistent process to limit impacts to patients as much as possible, but these are not steps we wanted to take. I sincerely apologize to our patients, staff and community members who are being affected.
I have heard from people who are confused by misinformation that has proliferated following our announcement. When it comes down to it, although the legal budget orders forced us to make these hard decisions, as the leader of this health system, I am ultimately responsible for them — and I want to share the facts directly with you.
- The GMCB’s orders for University of Vermont Medical Center and Central Vermont Medical Center called for $122 million in revenue cuts from our budgets. In health care, revenue is patient care. Some have suggested that we could simply cut administrative expenses. Cutting costs alone would not satisfy the order because expenses — salaries, equipment, etc., are not revenue. We did cut $18 million in administrative expenses this year, on top of $20 million last year, but that is not revenue.
- In October, we filed legal motions to delay the enforcement that led to these cuts. In that submission, we shared an unredacted version of this document with the GMCB, highlighting which services would be at risk if the enforcement went forward.
- We cannot simply “lower prices” to comply. As a nonprofit organization, when we take in less revenue, we must reduce expenses, or we have nothing left to invest in our people, facilities and equipment. Medicare and Medicaid account for two thirds of our revenue, and they pay us a set amount regardless of our “prices.” We have already been ordered to accept 1% less from insurance companies like BlueCross BlueShield VT and UnitedHealthcare for care that we provide their members. Lowering that even further would mean having to reduce more services.
- Vermont hospitals submit budgets months in advance, basing them on information available at the time. When UVM Medical Center submitted its proposed budget to the GMCB, it was not clear that some additional government revenue — specifically, FEMA reimbursement grants from the pandemic, and graduate medical education funding for training the next generation of physicians — would be granted. GMCB staff were provided with updated budget information throughout the year, which included this new revenue.
- UVM Medical Center has consistently been shown to provide high-quality, safe care — including recognition by U.S. News & World Report. There are comments wrongly suggesting UVM Medical Center’s quality has decreased, pointing to a single measure of hospital-acquired conditions and the annual CMS star ratings. The current rankings are based off data from 2021-2022, when we were in the midst of responding to COVID-19, which was an anomaly for all hospitals. To be clear: our care teams already implemented strategies to address this area. This is not a reflection of our overall quality and safety, which is evaluated by multiple external organizations, and of which we are proud.
I share these facts because to move forward productively on behalf of our patients, staff and communities, we have to start from a shared place of transparency and accuracy. Predictable and effective regulation is vital to control health care costs, and we understand that our regulators are under pressure to achieve that goal. But cuts that force us to reduce patient care will not make care more affordable. They will only force patients to wait longer, seek care elsewhere, or in some cases, not get the care they need at all.
I truly believe that all of us — Vermont’s hospitals, the GMCB, the state of Vermont, the many local organizations and independent providers who provide care side by side with us — share similar goals. We want to be a valuable partner on solutions that will truly help Vermonters access more affordable, high-quality health care. We remain committed to pursuing solutions that enable us to meet our mission of improving people’s lives.
