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The Green Mountain Care Board and its role in our health care system

Most of my recent columns have been about COVID, which makes sense given it has been such a dominant feature of our lives for two plus years now.

Today, I write about another deeply concerning, but really important, issue: the Green Mountain Care Board and its role in our health care system.

There is no other state that regulates hospitals as completely as the GMCB does in Vermont. Accountability and oversight matter, so effective regulation can protect consumers and health care providers.

Unfortunately, our regulator has lost its connection to reality and reason.

Why such a bold statement? Because in the third year of a pandemic that has upended our lives and our health care system, with hospitals struggling against a staffing and capacity crisis, the GMCB has introduced the idea of moving or subtracting hospital beds.

That’s right. They hired consultants who concluded that we have too many hospital beds in Vermont. And then talked about that strange conclusion publicly as we face another COVID surge and intensifying personnel shortage like nothing we’ve ever seen.

For perspective, our hospitals collectively have fewer beds per capita than most other states in the nation. And right now, as I draft this column, there are 10 ICU beds available in the entire state when we still don’t know the worst Omicron will bring in terms of hospitalization.

GMCB members are quick to say they do not intend to actually carry out the capacity recommendations. But then they spend hours and hours of taxpayer-funded time voicing interest in the controversial ideas.

Just last week, the GMCB featured in its public meeting four consultants to opine for over three hours on Vermont’s hospital system. It was a wild ride: one consultant questioned whether there is really a workforce shortage (which is offensive and outrageous). Another criticized our reform efforts with scant evidence, and a third used decades-old data to make blurry points about today’s hospital capacity.

I am usually a glass half full kind of guy, and it is difficult to shake my optimism. In Vermont especially, I know we can create positive change by working together. Just look at what we have done with our COVID response and with health reform—a work in progress, but also solid steps in the right direction:

Nearly every hospital and more than 5,000 total health care providers now participate in the effort to keep people healthy and prevent painful and costly medical interventions later
The federal government recently said our reform work shows spending reductions and declines in hospital stays and readmissions
In the past three years, hospitals have invested $80 million to focus on outcomes and quality.

So, when I hear regulators disregarding this progress and instead dreaming up ways to move critical beds around and force Vermonters to travel much further for their care, possibly even out of state, I lose my optimism. In fact, I get worried and frightened.

If changes to our health care capacity take place, it should be through a process led by patients, communities and health care providers, not regulators and bureaucrats.

In Vermont we make the most progress working together; we have proven that time and again. It is one of the many reasons I call Vermont home.

As the next few crucial months unfold, I hope to write about the real issues facing our health care system and what we are doing together to address them so that we can recover from the pandemic and make care better and more affordable for Vermonters.

VAHHS and hospitals stand ready to do that.