(This story has been updated to add new information.)

Top leaders at the University of Vermont Health Network have announced cuts to staff and services, saying it’s a problem. response to orders from the Green Mountain Care Board which forces them to cut the budgets of UVM Medical Center and Central Vermont Medical Center, during a virtual press conference Thursday morning.

The GMCB quickly issued a response Thursday, saying it had not been consulted and did not approve of the reductions, and that it was “reaching out” to UVMMC to better understand the rationale for these reductions and how he evaluated alternatives, “like these.” identified in the budget and implementing orders of the GMCB.“

“THE The GMCB approved a $1.9 billion budget for UVMMC for FY25, an increase of $64 million over UVMMC’s FY24 budget,” the release said. “As noted in its budget order, GMCB found that, compared to other hospitals, the UVMMC has a significant opportunity to improve its expense management and control the excessively high prices it charges commercially. insured in Vermont.”

The Green Mountain Care Board is Vermont’s independent health care regulator, responsible for approving hospital budgets and charged with reducing the cost of health care in the state while increasing access.

The GMCB caps the amount of “net patient revenue” each hospital can receive each year and has penalized UVMMC for exceeding that cap by $80 million in 2023.

What is UVM Health Network cutting and what medical services will the hospital stop providing

UVM Health Network leaders announced the following actions:

• 200 jobs will be eliminated: 150 at UVMMC and 50 at CVMC. About half of the jobs lost will be travel nurses, hired on a contract basis to fill permanent staff shortages. Dr. Sunil Eappen, president and CEO of the UVM Health Network, hopes the 100 permanent employees eliminated can be placed at other hospitals, within or outside the UVM Health Network.

• UVMMC will no longer manage dialysis units at clinics in St. Albans, Rutland and Newportand will seek “alternative suppliers” to operate the sites. Dr. Stephen Leffler, president and chief operating officer of UVMMC, said the hospital loses about $3 million each year on dialysis units, which serve about 115 patients. Leffler stressed that the transition would take months and there would be no immediate change. The goal is to keep the service local and not move it out of state.

• The UVMMC will reduce its “census”, essentially the number of beds available for overnight patients, from about 450 to about 400, thereby reducing the number of transfers smaller hospitals can make to the hospital, according to Leffler. The reduction will be done “slowly and deliberately” over the next year. Leffler said UVMMC welcomed 500 patient transfers in September, the highest number ever, but will have to turn away patients. Bob Ortmyer, president of Porter Medical Center in Middlebury, said limiting transfers to the state’s only high-acuity care center is serious and will negatively impact our patients.

• UVMMC will stop doing kidney transplants and began discussions with Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, to resume these transplants. UVMMC would continue to provide care to its patients on kidney transplant waiting lists, with the actual transplant taking place at Dartmouth. UVMMC performs 12 to 15 transplants each year, according to Eappen.

• CVMC will merge its primary care practices on its main campus and in the Mad River Valley, as well as the merger of its Mad River and Barre Rehab clinics.

• The CVMC inpatient psychiatric unit will be closed and the hospital will explore options for its eight patients, including placing mental health clinicians in all primary care clinics.

• UVM Health Network reduces administrative costs by more than $18 million this year due to GMCB budget orders, according to a news release, scaling back initiatives to reduce wait times and delaying facility maintenance and technology upgrades.

“When you reduce net patient revenue, there is no alternative but to reduce care,” Eappen said.

What the hospital unions say

Hospital unions published a statement Thursday denouncing the budget cuts.

“The plan to close CMVC’s inpatient psychiatric unit will devastate mental health care in our community and throughout our organization,” said Sue Becker, a nurse at CVMC. “This is an unacceptable decision. UVM Health Network and CVMC leadership blame the Green Mountain Care Board, however, it is the fault of the leadership and executives who failed to plan their budgets accordingly. We are not going to stand by and let this happen.”

Deb Snell, president of the UVMMC Nurses and Technicians Union, added that the union is concerned that the UVM Health Network “is a net loss in providing the quality patient care residents deserve of Vermont.

Green Mountain Care Board budget orders create $122 million hole for UVM Health Network to fill

The GMCB rejected a request from UVMMC to increase the rates that commercial payers such as Blue Cross Blue Shield of Vermont pay to the hospital by 3.4 percent, and instead reduced the rate by 1 percent. Eappen said Thursday it was the first time in his career he had seen a commercial rate go down.

Eappen said the net result of GMCB’s actions requires UVMMC and CVMC to cut a combined $122 million from their budgets, with the majority coming from UVMMC.

“That’s the challenge we’re being asked to take on, to find that $122 million,” he said. “We do this against the backdrop of an additional 25,000 new patients over the past five years, including 8,000 in the past year alone. Additionally, patients are getting older and sicker. We need to provide care of higher acuity and more frequently in all hospitals.

Green Mountain Care Board questions why New York Health Network hospital owes UVM Medical Center $60 million

In its statement, GMCB raised another revenue issue, saying it found that as of Sept. 30, 2023, UVMMC is owed $87 million from other hospitals in the UVM Health Network, including its hospitals based in New York.

“This included $60 million from Champlain Valley Physicians Hospital in Plattsburgh, New York,” the release said. “These funds included $30 million in pharmaceutical spending, $20 million in physician salaries and benefits, and $10 million in shared services. The GMCB has inquired about the status of reimbursement of these amounts and is awaiting further information on this issue.

Asked at the morning press conference about the debt owed to UVMMC by CVPH in New York, Eappen said “the movement of dollars through the network has no impact on Vermont hospital budgets.” .

“We made that clear to the Green Mountain Care Board,” he said.

Contact Dan D’Ambrosio at 660-1841 or [email protected]. Follow him on Twitter @DanDambrosioVT.

This article was originally published on Burlington Free Press: UVM Health Network budget cuts: which services will be cut