Why Should Delaware Care?
Legislators who crafted House Bill 350 largely looked to Vermont’s Green Mountain Care Board for guidance on how to establish an oversight framework on hospitals. Industry leaders have testified in Delaware that the board hasn’t met its mission, but those in Vermont reached by Spotlight Delaware tell a different story.
In the debate over House Bill 350, much has been made of the track record of the Vermont Green Mountain Care Board, which served as a model for Delaware legislators.
Industry leaders and Republicans say the lack of progress in lowering health care costs in the Green Mountain State is proof that the model hasn’t worked, but patient advocates from up north say that is a misleading characterization.
It is true that a decade after it was created, the board has yet to lower health care costs below states that lack such oversight or improved health outcomes above many peers: Delaware ranks 13th for health outcomes compared to Vermont’s 17th.
Whether that blame should be laid on the regulator or the health care providers is a point still up for debate though.
Vermont CEO weighs in
One of the most influential voices to be heard during a recent State Senate hearing in Dover on the controversial health care cost review board proposal was actually sitting hundreds of miles away.
Dr. John Brumsted, the former president and CEO of the University of Vermont Health Network, the largest hospital system in the state, testified as a witness in the May 7 hearing after being called by Delaware Republicans.
He said that the Green Mountain Care Board’s negotiated hospital budgets have seen artificially low margins, frequently below the rate of inflation, and that they have been “implemented in a very non-collaborative, top-down fashion.”
“The results have been dramatically declining hospital and health system margins,” he said, noting that most have operated on negative margins in recent years. “If there’s no margin in the hospital, there’s no capital reinvestment. So there really hasn’t been any investment in facilities, programs, rejuvenation or certainly innovation over the past several years.”
Brumsted’s testimony confirmed the fears that many in opposition to House Bill 350 have been trumpeting for several months.
Led by the Delaware Healthcare Association, which represents the interests of the state’s hospital operators, an expensive lobbying campaign swamped Legislative Hall this year. CEOs and executive leadership have frequently testified against the bill that would require state hospitals to submit budgets and financial information annual to a state-appointed review board, telling the public to “keep health care in the hands of doctors, not politicians.”
Senate Minority Whip Brian Pettyjohn (R-Georgetown), who called Brumsted’s testimony, said the advancement of House Bill 350 by Democrats over the objections of industry leaders has been disrespectful.
“Experts say HB 350 will severely harm the state’s non-profit hospitals, result in employment cuts, and ultimately reduce Delawareans’ access to healthcare. States with similar laws in place are seeing hospitals shut their doors and experienced physicians leave,” he said in a statement last week along with Rep. Valerie Jones Giltner (R-Georgetown). “Democrats have thus far refused to listen to these experts and are instead rushing bad legislation through that will do nothing but limit healthcare options for the people of Delaware.”
Vermont advocate refutes
According to Vermont’s chief patient advocate, however, the Green Mountain Care Board has had little to do with the struggles of his state’s hospitals – and he actually believes that the panel should be tougher on hospital leaders.
Michael Fisher, who was chair of the Vermont House of Representatives’ Healthcare Committee in 2011 when the Green Mountain Care Board was created, told Spotlight Delaware that “from a consumer’s perspective, the board was a significant step to introduce independence and transparency into the process” of setting health care and insurance costs.
“The regulated entities hate being regulated. So, it’s not surprising to me in the least that Vermont hospitals would say that the board hasn’t worked for them. Actually, I think very much the opposite,” he said, noting the board has served as a defensive mechanism for them. “Over the first eight years of the board’s life, Vermont hospitals have gotten, I think, 99% of what they’ve asked for in their budgets.”
“Structure alone doesn’t answer all the problems, but it creates opportunity.”
Michael fisher, director of the vermont office of the health care advocate
Scoffing at the argument that the Green Mountain Care Board has over-regulated the industry and squeezed hospital margins, Fisher said that, “Vermont hospitals jump up and down with frustration” at the tiniest adjustment to revenue strategy, much less expenditures.
Fisher, who today serves as the executive director of the Office of the Health Care Advocate, a nonprofit agency under the Vermont Legal Aid that advocates on behalf of state consumers, was similarly aghast at the notion that the bankruptcy of Springfield Hospital was related to the cost review board.
“It’s a ridiculous assertion,” he said of the health system that accumulated some $20 million in debt before reorganizing in a Chapter 11 bankruptcy. “Shortly before Springfield’s budget woes were apparent, Springfield was in front of the Green Mountain Care Board presenting a budget with significant cash on hand … if anything, you could say the board wasn’t strong enough in its enforcement.”
While the Green Mountain Care Board has often favored concerns over organizational solvency compared to consumer affordability, according to Fisher, he said that he remains in favor of it for bringing needed transparency to the system. He also sees hope that a recent membership change on the board is bringing a stricter approach to bending the curve of health care costs in Vermont.
The regulator trimmed the charge increases requested by multiple hospitals and ordered OneCare Vermont, a UVM Health Network subsidiary, to cap executives’ 2023 salaries, according to the nonprofit newsroom VT Digger.
“Structure alone doesn’t answer all the problems, but it creates opportunity,” he said.
Coalition defends Care Board
While lawmakers and health care leaders are fighting over the prospect of a review board in the First State, colleagues up north are fighting over the future of the Green Mountain Care Board.
The Vermont Association of Hospitals and Health Systems, which features the primary backing of the University of Vermont Health Network, has been advocating this year for Vermont Senate Bill 211, which would remove hospitals from the board’s oversight.
A coalition of more than a dozen patient advocates, health insurers, state employee groups and physicians published a letter criticizing the bill that would move regulation of UVM hospitals to a single appointed official.
“Over the past decade, the UVM Health Network has acquired smaller hospitals and practices under the guise of improving care coordination and pirated community-based primary care providers. At the same time, health insurance costs have skyrocketed, primary care doctors, mental health counselors, nurses, and other community-based caregivers have suffered, and the number of Vermonters who cannot afford medical care or prescriptions without the risk of incurring debt has increased substantially.
“The UVM Health Network leverages its increased market dominance to demand exorbitant price hikes. In fact, UVM’s price increases are among the highest in the U.S. Consequently, commercial insurers charge higher premiums to all Vermonters, regardless of whether they receive care at a UVM facility.
Despite increasing prices, the UVM Health Network has failed to provide better care for the people of Vermont. Care coordination is still poor, access to care is even worse, and the quality of care is declining. Many Vermont families have a story of long waits for appointments, poor outcomes, poor services, and huge debt after receiving treatment at one of their facilities,” they wrote.
