This commentary is by Patrick Flood of Woodbury. He is former commissioner of the Vermont Department of Mental Health and the Department of Disabilities, Aging and Independent Living, and former deputy secretary of the Agency of Human Services.
Lately, there has been growing controversy about rising health care costs in Vermont and the central role the UVM Medical Center plays in creating these high costs. The Green Mountain Care Board recently approved UVMMC’s budget for 2025, but reduced the prices it charges insurance companies. The hospital has appealed the Board’s budget order.
But there’s more to this story. In the budget order, unnoticed by nearly everyone, GMCB regulators cited problems at UVMMC with the quality of care. On page 22 is the following:
“Review of UVMMC’s budget and performance reveal concerns of declining quality and safety at Vermont’s only tertiary, academic medical center. Despite significant commercial rate and revenue growth the last several years, UVMMC’s quality and safety has declined and resulted in a ratings downgrade and federal financial penalties.”
It turns out that the federal government, through Medicare, has cited UVMMC for a serious decline in the quality of care it provides. Again, on page 22 of the order, we find,
“Medicare Star ratings are based on safety of care delivered, the quality of care, and patient satisfaction surveys. UVMMC previously received 5-star ratings; however, its rating dropped in July 2024 to 4 stars. UVMMC believes its rating could stay at 4 stars for some time.”
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And, “Furthermore, UVMMC was penalized by Medicare due to quality and safety issues, specifically the level of hospital acquired conditions (HAC) experienced by UVMMC patients around 2021-2022. UVMMC described its current performance as variable and mixed.”
“Hospital acquired conditions” most often refers to infections that develop while in the hospital. Such infections can cause further complications for the patient, delay discharge and sometimes result in death. There has been a huge push in the hospital world to reduce hospital acquired conditions, which are most often preventable through proper care and proper infection control techniques.
For the Medical Center to be cited for an unacceptable level of these conditions points to a failure of leadership and clinical expertise. In layman’s terms it means that the hospital, through its own failure, is putting patients at risk.
Additionally, according to the Board’s order, because of this failure, the federal government has reduced Medicare payments to UVMMC and is likely to reduce them further in 2025.
While this situation has been unfolding, the UVMMC Board awarded its CEO a bonus of $481,648 in 2023, on top of a base salary of more than $1.3 million for a total annual salary of more than $1.8 million. It is hard to comprehend how the hospital’s declining quality merits such a bonus.
The leadership of the hospital is now implementing cuts to services in response to GMCB’s budget order. The nurses’ union, to its credit, has pushed back, citing the high administrative salaries at UVMMC. The nurses also said, in written public comments to GMCB: “Attempting to fear monger and turn staff against the GMCB is the definition of bullying behavior we have come to expect from the UVMHN. If it was also meant as a scare tactic, the hospital has succeeded in causing staff to become alarmed.”
Anyone concerned about the high cost of health care in Vermont would do well to read the Green Mountain Care Board’s budget order for UVMMC. It is a legal document and sometimes complex, but there are many important findings about high costs, poor quality and the lack of transparency at the Medical Center. (Conclusions begin on page 16.)
We all should be grateful to the Green Mountain Care Board for its integrity and openness in addressing these concerns. Vermont needs an honest and independent regulator to deal with our systemic health care problems.
The UVM Health Network is by far the biggest player in Vermont’s health care system. Its multifaceted problems — lack of affordable services, long wait times, bloated administrative costs and deteriorating quality — impact our entire health care system, economy and Vermonters receiving care.
It is high time for a different approach from the hospital’s leaders. They should acknowledge the problems at the hospital and pledge to work collaboratively with the Green Mountain Care Board to resolve them. Vermonters deserve no less.
Read the story on VTDigger here: Patrick Flood: It’s time for a different approach from the UVM Medical Center’s leaders.