The plan that the board’s majority approved was essentially what hospital officials put forward two weeks ago. As partners in the University of Vermont Health Network, the hospitals submitted the proposal jointly. The board deleted a proposed $3 million investment in health payment reform initiatives, redirecting that money to rate reduction.
The board wrestled for nearly two hours over what the two hospitals should do with their excess revenues. “We have been together, some of us, for five years, and we have never been at this point,” chair Al Gobeille said of the stalemate. “The real question is, can the two camps come together?”
The answer turned out to be no.
Con Hogan and Allan Ramsay wanted to allow the hospitals to invest $12 million in community mental health, housing and substance abuse prevention — and they wouldn’t budge.
Ramsay, a primary care doctor, said that he couldn’t pass up the chance to approve investments to address social problems that affect health. Hogan argued that the proposed social investments would address the problems that drive up medical costs and insurance rates.
Betty Rambur and Jessica Holmes argued for allocating all the money to insurance rate reductions, because insurance was the source of the extra revenues. They reluctantly agreed to allow $6 million for community health, but that failed to nudge Hogan and Ramsay.
“That is as far as I can move,” Holmes declared. She said she worried that if the board approved the proposal to distribute money to community organizations, it would give hospitals incentives to generate extra revenues in the future “to make everyone in your community love you.”
The Green Mountain Care Board looks annually at the difference between the projected budgets it approved for hospitals and their actual revenues. If variances exceed 0.5 percent, the board requires hospitals to explain.
UVMMC had a 2 percent variance for the budget year that ended last October, which amounted to $22 million in surplus. CVMC’s variance was 4.2 percent, or $6.9 million. UVM Health Network officials said the hospitals saw more patients than they expected and provided less free care because more people had coverage through Vermont Health Connect and Medicaid.
Rutland Regional Medical Center also had excess revenue, but CEO Tom Huebner had proposed a week ago to put all of it toward a $5 million rate reduction that would take effect May 1. The board voted unanimously Thursday to accept the Rutland plan.
Gobeille initially voted against the Hogan-Ramsay allocation of $12 million for community health to try to force the board to find consensus. “We have got to come together,” he told his colleagues.
When they couldn’t, Gobeille told Ramsay to propose the 60-40 split again, and that time the chair broke the tie.
The UVM network’s community health package includes:
- $6 million for UVMMC’s Day One substance abuse program, a new pain management initiative and dental care
- $3 million to Champlain Housing Trust
- $1 million to Washington County Mental Health
- $1 million to the Howard Center
- $500,000 to UVMMC’s community health investment committee
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It seems a little strange that UVMMC can eliminate $6.5 million of their overage and by giving it back to themselves.
Safe, decent housing should be paid for by housing appropriations, not by Vermonters’ insurance premiums. Commercially insured Vermonters (those not on Medicare or Medicaid) already pay hugely inflated insurance premiums to make up for Medicaid and Medicare shortfalls. Every penny of this surplus should have gone to lowering future premiums for the payers. This is bad policy and poor decision making. The 2 GMCB member minority was right. I hope this is the beginning and the end of this chicanery.
This is outrageous that individuals on the GMCB can hand over power to the very entity they are supposed to manage. This ruling effectively undermined the very intent they are supposed to uphold. They should be renamed the UVMMC puppets. It is a disgraceful pathetic governmental board with no backbone.
Thank you Chair Gobielle, Ramsay and Hogan! Care Board Cares! Legislature refuses to spend money on mental health, addiction, prevention. Care board primary duty is health of a financially suffering and health suffering Vermont while lots of Vermonters go skiing (when it snows!). So if money is around why not spend on Vermonters in need? Bloated health care system will survive and thanks to a little mea culpa from UVMMC.
Yes, it is strange that the real needs of Vermonters get consideration in the bureaucratic “elites” management systems of our government.
Tony Redington
ARE YOU KIDDING ME!!! “Surplus” is accumulated as a result of revenues exceeding program expenses. Private insurance payments likely contribute to the bulk of surplus – public payments (Medicaid, Medicare) are woefully short in paying for actual costs. This “TRANSFER” should be investigated as insurance fraud. The HONEST thing to do would be to apply the surplus to OFFSET NEGOTIATED HOSPITAL BUDGET INCREASES thereby returning the surplus benefit more equitable to users of direct hospital services.
Using this “Robin Hood” approach over the years raiding transportation and education funds to pay for services NOT OTHERWISE SUPPORTED BY THE LEGLSATURE was irresponsible.
At what point do we reduce the public budget to just a few line items that are palatable so as to redistribute “surpluses” by UNELECTED OFFICIALS (political appointees) to needs with merit but NOT PUBLICLY DEBATED and funded on merit.
SHAME ON EVERY BOARD MEMBER SUPPORTING THIS MOVE.
The voting on the Green Mountain Care Board is questionable. The surplus money belongs to the taxpayers, patients and public. Making donations to community organizations should remain by fund raising, wealthy people who make millions of dollars as salary, who can write it off as a tax deductible. We know those people or should I say CEO’s who make millions of dollars, including bonuses. There is a much bigger picture in regards to fixing homelessness, joblessness, and poverty.
The surplus needs to be put back into the healthcare system. We need to move forward improving a single payer system. This money is due back to the taxpayers and the public.
Thank you.
The surplus money needs to be put back into healthcare where it belongs! Over hauling our national tax system so that big business, banks, financial institutions, cooperations, and the wealthy pay taxes, creating jobs in the field of: renewable energy, rebuilding our infrastructure, bringing back companies to the USA, affordable housing and controlled rent, Universal Prek, affordable college education, raising minimum wage to a realistic value, equal pay for women,………are a few ways to eliminate poverty and homelessness…….
Does the Board live on the same planet as the rest of us? The extremely high costs of health care have been a major concern discussed widely in the news and legislature in recent years. Hospital rates are basesd on the hospitals’ best estimate of what they need to charge in order to cover their costs, and annual board approval is based on their trust of the hosptitals’ numbers: Now that the board sees that last year’s approved-rates were higher than they needed to be, it is simple feduciary responsibility to roll those excess funds back into the next year’s budget, not re-direct to other entities, no matter how honorable or needy those other entities are.