The Board of Directors of the Mad River Valley Health Center, Inc. would like to provide an update on the recent decision of CVMC to close the clinic here in the Valley.
As previously indicated, the Directors are as upset and disappointed with the decision to close the CVMC clinics here as most of the Valley residents are. After all, the Board members are all residents themselves, many of whom are also patients at the clinic. To be clear, the Board was never notified in advance of this decision and only learned of the closure on the same day as the announcement was made public.
The primary role of the Board is to maintain the facility housing those entities that provide the health care services. The Board has no control over the decisions made by UVM and/or CVMC as to the operation of the clinic here. Notwithstanding, we have attempted to keep lines of communication open with CVMC in an attempt to keep our options open and to understand better how and why CVMC arrived at its decision.
Members of the Board recently met with Anna Noonan (President and COO of CVMC) and Lisa Goodrich (UVMHN VP for Primary Care services). Based upon several emails that had been circulated in setting up this meeting, we anticipated that they viewed the decision as one that was already made and would not likely hear any requests for reconsideration. In fact, as we started the meeting, that was their opening statement. They are now focused on planning what comes next.
During the course of our meeting they even commented that should their appeal of the GMCB decision be successful, they likely would be making these same cuts. They did also note that any appeal of the Green Mountain Care Board would likely take 6 to 8 months and that they were not overly optimistic of succeeding on that appeal. Further, they indicated that what they are really appealing is the process by which the GMCB reached its decision, not just the numbers. In the meantime, they need to move forward with their budget and addressing the cuts they claim that they are being forced to make.
They claim that the clinic here in the Valley is the smallest of all the 31 clinics that make up the UVM Health Network. They also claim that all 31 of their primary health care clinics lose money. That loss is offset by prescriptions, specialized services, referrals and other income from the network in general. They also claim that consolidating will save them more money in the long run and that they will be able to provide ‘better’ services through consolidation. Eliminating the rent alone is not their only savings as they claim that by consolidating they will be more efficient in the services they can provide. They talked about delivering and dropping off supplies and test samples from the clinic here as an example of other expenses they can avoid and having more centralized support staff will be helpful. As to that support staff, they claim that they have many openings throughout their system and that they do not anticipate having to fire any support staff; that staff might have to work somewhere else.
We talked about the difficulties for many to travel to Waterbury (or elsewhere) including the older segments of our population as well as those working here and the additional time needed off from work. While they recognize that these are concerns, they maintain that cutting their expenses will enable them to provide better care which should offset these difficulties. They did also say that they are looking into some sort of visiting nurse scenario where they would travel to see patients. (Good luck with that in some places here in the Valley, particularly in the winter time.) They also reiterated their hope to increase telemedicine options. They claim that all they need for that is a cell phone and that virtually all of the patients here have cell phones.
We stressed the fact that lack of easy access to primary care will almost certainly result in higher rates of emergency department use and an overall decline in health status. They claim they will be working with all patients here to accommodate them in either Waterbury or another clinic. We also pointed out that the MRVAS is one of two remaining all volunteer EMS services in the state that is already struggling to meet the demands of the Valley and that if there is any increase in service demands, the MRVAS might not be able to meet those needs. They said they would look into that further.
We did question why the Valley clinic was chosen over others. As to the clinic in Barre they said that clinic has more patients and a larger physical space within which to work. Additionally, there is a greater population to support. As to the Northfield Clinic, they said the same thing. There are more patients there and they have greater space available. They are tied in with Norwich University and provide all the health care to the student population as well as the local area. When they mentioned lack of space we asked about our building and the fact that we had briefly discussed in the past renting them additional space on the second floor. They kind of brushed that one off and said that the second floor space was not adequate for their needs. That, the Board believes, is totally false. When we had mentioned providing them more space in the past, their claim was that they were having difficulties in providing additional health care providers and that they could not commit to taking on more space without first having the provider.
At this point they are still in discussions with their providers as to who will remain. Their hope is to retain everyone, but they do not know yet for sure. It sounds like the new doctor that just started at the clinic may not stay. We did point out that they need to communicate better with their patients here, particularly more direct communication. While they may not know who is staying and/or where they will go (which they may not have finalized until February), we stressed the need to at least let patients know of the proposed timeline and to keep them better informed as the process unfolds.
We talked about the need for greater transparency and better communication. They acknowledged that they can do a better job at that and will follow up with patients more. They did apologize for not at least having given us a heads up about their decision before it went public but claim they were trying to reach as many people as possible. While some of their staff was given advance notice, most were not. There are other issues of communication needed as well. They talked about how CVMC provides a mail order pharmacy for prescriptions. We told them that few, if any, people here in the Valley are likely even aware of that option. We pointed them to the community well being survey where a lack of a local pharmacy was one of the biggest concerns of residents here. Now a lack of a local health care provider can be added to that list!
We also discussed the unique history of the clinic here in the Valley, how it was originally created and funded by contributions from the Valley residents in 1981. And how, when it became apparent that the original building was too small to meet the needs of the clinic, the community again raised over $1M to fund the new building.
It is also interesting to note that while the GMCB decision was made with respect to the UVM Health Network as a whole, most of the cuts seem to be affecting CVMC operations.
Anna Noonan also stated that CVMC has struggled financially for many years. Partnering with UVM has helped them survive, but even without the GMCB’s recent decision she claims that they would need to be making changes like the ones they have made at some point in time anyway.
At this point, the Board does not have a clear path as to what can be done next. Some of the ideas we have discussed and are exploring include the following:
- Determine if there are any other means to convince CVMC to alter its decision.
- Finding an independent practitioner to take over the space. This seems highly unlikely to succeed in today’s health care environment. There is a private practice in Bristol that the Board might be able to reach out to and/or use as an example of how to proceed. Most of the current Board members do not have the knowledge or experience in this field and we would need to find others more qualified to lead any such search.
- Trying to partner with some other primary care organization. Gifford Healthcare has its own financial problems and may not be a good fit. Copley Health Systems would be another possibility, but they may not fit the bill either. It has been suggested that Dartmouth-Hitchcock might be an option, but they are overwhelmed already and would not likely ever come this far.
- With either of the above options Valley residents would then also be faced with a difficult choice. They could keep their primary care provider and follow them to Waterbury or hope to find a new provider here that they could get in with. Any ‘new’ practice established here would also face the same problems of finding enough providers to meet the demand.
The Board of Directors has also reached out to our local representatives for their input and assistance. At this point in time the consensus seems to be that the more pressure that can be put on UVM and CVMC the better. This would include contacting Sunny Eappen, President and Chief Executive Officer, University of Vermont Health Network, Anna Noonan, President and Chief Operating Officer, Central Vermont Medical Center, Governor Scott, and our state representatives and senators. The more people that reach out, the better.