In November 2024 the Board of Directors learned that Central Vermont Medical Center would be closing the Mad River Family Practice here. Like most Valley residents, members of the Board were upset and disappointed with this decision. After all, the Board members are all residents themselves, many of whom had been 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. Ultimately, CVMC did, in fact, close the clinic at the end of September 2025. The Board of Directors spent months pushing for answers and specific reasons for the decision, but CVMC was unwilling to provide those answers or reasons. The Board reached out to the Green Mountain Care Board, representatives from the Governor’s office, Senator Sanders’ office, our state representatives, members of the Board of Trustees of UVM Health Network, and others, but no one indicated that they have the ability to change the decision that has been made. Set forth below is a detailed recap of the entire process.
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, the Board 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 met with representatives of the UVM Health Network and Central Vermont Medical Center, namely, Lisa Goodrich (UVMHN VP for Primary Care services), Jay Ericson (Director of Communications & Engagement of CVMC), Jim Alvarez (VP of Support Service) and Anna Noonan (President and COO of CVMC) shortly after the announcement. At the first meeting in November CVMC and UVM began the meeting by telling us they were there only to explain why they had made their decision to close and were not prepared to discuss alternatives. CVMC claimed that the cutbacks are a response to the Green Mountain Care Board’s (GMCB) rulings. The GMCB mandated that UVM cut back its revenue since they exceeded their budgeted revenue. As that pertains to the clinic here in the Valley, if the intent is that most of the Valley clinic patients will be moved to Waterbury, there is not going to be any reduction in revenue. The cost savings by consolidating those two clinics would appear to be minimal. At the same time, this closure will clearly have an adverse impact on Valley residents. There is the additional time and expense of traveling to Waterbury and the fact that many residents do not have ready access to transportation to get them to the clinic. And there is the long-term disincentive to those who might otherwise want to move to the Valley when there is no local medical care available.
During the course of that initial meeting CVMC 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 in succeeding on that appeal. Further, they indicated that what they were really appealing was the process by which the GMCB reached its decision, not just the numbers. In the meantime, they needed to move forward with their budget and address the cuts they claim that they are being forced to make.
They claimed that the clinic here in the Valley is the smallest of all the 31 clinics that make up the UVM Health Network. They also claimed 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 claimed that consolidating would save them more money in the long run and that they will be able to provide ‘better’ services through consolidation. Eliminating the rent alone would not be their only savings as they claimed that by consolidating, they would 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 would be helpful. As to that support staff, they claimed that they had many openings throughout their system and that they did not anticipate having to fire any support staff; although that staff might have to work somewhere else.
The Board 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 UVM recognized that these are concerns, they maintained that cutting their expenses would enable them to provide better care which should offset these difficulties. They did also say that they would look 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 the patients here have cell phones.
The Board 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. UVM claimed that 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 and that it is already struggling to meet the demands of the Valley and that if there is to be 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 brushed that one off and said that the second floor space was not adequate for their needs. (In fact, CVMC’s lease included two offices on the second floor.) 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.
The Board also talked about the need for greater transparency and better communication. UVM acknowledged that they could do a better job at that and would follow up with patients more. They did apologize for not at least having given the Board a heads up about their decision before it went public but claimed they were trying to reach as many people as possible in a short amount of time. 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 were 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 was 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 claimed that they would need to be making changes like the ones they have made at some point in time anyway.
After that initial meeting with UVM and CVMC, the Board discussed and explored other options include the following:
- Determine if there might be any other means to convince CVMC to alter its decision.
- Find an independent practitioner to take over the space. That seemed highly unlikely to succeed in today’s health care environment. Most of the current Board members do not have the knowledge or experience in this field and would need to find others more qualified to lead any such search.
- 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.
- If the Board were to be successful in finding another provider, 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.
At subsequent meetings it was made clear that CVMC was not willing to reconsider their decision and would move forward with planning for the closure.
UVM/CVMC was totally unwilling to provide the Board with any specific financial information, other than to tell us that the Waitsfield clinic is their biggest losing clinic and that is part of why they chose to close it down. They would only tell us that their costs of running this practice are 46% higher than any other primary care location but declined to tell us what their actual claimed loss is.
UVM/CVMC did not deny that a lack of access to primary care can lead to higher rates of emergency department use and an overall decline in health status. However, they maintained that primary care would remain available, simply in a new location!
Efforts to move patients elsewhere ignore the reality that if patients cannot be seen locally, many will likely skip or miss their regular primary care checkups. It’s easy to say that Waterbury is only 12 miles away, but in actual travel time, that can be a 20- or 30-minute additional drive. Moreover, many of the individuals being cared for in the clinic do not live in Waitsfield but live in Warren, and other towns on the periphery of Waitsfield making the distance more than 12 miles. That says nothing about winter conditions. The section of Route 100 from Waitsfield to Waterbury over Duxbury hill can be one of the worst sections of Route 100 to travel on.
CVMC had previously mentioned utilizing some type of visiting nurse scenario. Between the costs of that and winter travel issues, the Board does not see this as a valid option and CVMC has apparently not considered this any further.
CVMC talked about increasing telemedicine options. They claimed that even those patients who might not have internet access would still be able to take advantage of this option as long as they have a cell phone. They claimed that 80% of the patients here use MyChart. That is one of the higher percentages of similar clinics. They maintain that this indicates that patients here are savvy enough to deal with telemedicine and similar services. What that ignores is the fact that the Valley has a great many areas where cell phone service is spotty at best and in some places, nonexistent. Additionally, with the elimination of Federal funding for telemedicine, this option may not be realistic.
CVMC’s lease automatically renewed for two years starting on October 1, 2025. In our discussions, it seemed obvious that they had overlooked that fact. CVMC did say they would honor that lease and would either pay us through the end of the term or discuss some type of buy-out when they had a definitive move out date. Clearly, saving money on leasing space here in our clinic was not a financial factor in their decision to close if they will continue to pay that lease even when not using the space!
There was also uncertainty as to the correct number of current patients at the clinic as well as the number on a waiting list to become patients. The Board had been told by personnel at the clinic that the waiting list was around 650 potential patients, yet CVMC claimed the correct number was only 317.
The Board asked why this practice was such a loss leader and what steps, if any, could be taken to improve that. We specifically asked about the potential of using additional space on the second floor as an option. (Obviously, that could only be done with sufficient advance notice to work with current tenants, but we were more curious about their answers.) CVMC said that they prefer to use one-story buildings as those are more efficient. They claimed that they would have certain duplicate costs associated with having additional exam rooms on the second floor. They also talked about the fact that there is only one small elevator and claimed that they would need to have plans in place to deal with patients should the elevator break down. They said that the first-floor space only has 6 exam rooms which can effectively only accommodate 3 Primary Care Providers (PCPs). Thus, they maintain that our building is simply not designed to accommodate more patients. They also talked about the difficulties of hiring staff, not just PCPs, but support staff as the cost of housing in the Valley is so high. They even talked about filling in for staff who call in sick and how if they don’t have someone available to cover from the Waterbury location, that most others are not willing to travel here to work. (We quickly pointed out the irony of that statement; if staff has a hard time traveling here, what about Valley residents who will now have to travel elsewhere for care?) They did acknowledge that some of their other sites are not ideal either, but most have much larger first floor space.
The Board briefly asked about whether there were any steps we could take to help them potentially stay here, such as adjustments to rent. They were not interested in pursuing that discussion.
CVMC also told us that 28% of the current patients here drive by other clinics that are closer to them. Their plan is to encourage those patients to start using those other clinics but did state that if the current providers here go to Waterbury and a patient wants to keep their current provider, they will still have the option of staying with that provider.
The Board pointed out that the amount of rent paid is a small line item in CVMC’s overall budget. We argued that the actual dollar savings of closing the clinic would likely be minimal, but that the impact of the Valley losing this clinic would be devastating. All they could say was that they understood that the decision is a hard one, but one they claim they had to make.
CVMC did also claim that the order from Green Mountain Care Board (GMCB) to reduce their budget was issued on 10/1/2024 which was the first day of CVMC’s fiscal year, leaving them little time to adequately prepare and plan for the $16M in cuts they were ordered to make. They claimed they looked at administrative costs first and did cut $1.2M, but that was well short of the $16M they were ordered to cut. They did acknowledge that their plan was developed on the fly, but claimed they had little choice in the matter.
The Board did talk about the fact that it did not make sense that the GMCB was so focused on patient revenues as it seemed that reducing revenues would hardly be at all beneficial. Clearly, if CVMC and UVM are seeing more patients and sicker patients, revenues will be up. And if they are increasing revenues, and not their margins, then they are incurring higher costs to deliver this care. This should not be a problem, but with the current metrics being used by the GMCB there seemed to be little room for movement. Anna Noonan did say that she had been in touch with the GMCB and that she hoped to meet with them and work on making their relationship less adversarial and more focused on serving Vermonters. While that is a good idea, it was too little and too late for our clinic!
The Board tried to emphasize that the people that will likely be impacted the most, those that cannot travel, those who do not have internet access, those who do not have reliable cell service, and those who do not have a real voice in what is happening here, i.e., the most marginalized in our community, will be the ones that will lose the most. Their care will deteriorate; they will likely have less preventative care and more emergency room visits.
This entire process was difficult and frustrating for the Board. It was hard to have a real discussion about the merits of keeping or closing this clinic when CVMC and UVM showed no willingness to even have that discussion.
Compounding the Board’s frustration was the fact that there seemed to be no one that could effect a change. The GMCB told us that they had no authority to delve into the specifics of what is or is not cut from a hospital’s budget but that they only had the power to set limits on that budget. Our legislators similarly told us that the legislature doesn’t get to vote on such cuts or hospital budgets. The Governor’s office has did not provide any specific help other than to state that “The Agency of Human Services will continue to press all healthcare stakeholders to make accurate and informed decisions.”
After unsuccessful attempts to deal directly with UVM and CVMC, the Board also reached out to the Green Mountain Care Board with a statement and set of questions. See email to the Green Mountain Care Board.
In response to our email, the Chairman of the GMCB did respond thanking us for our email and our advocacy for the community and its patients. He did indicate that he has been speaking with UVM leadership about this and related issues and had sent them a series of questions similar to many of those noted above. He indicated that he would reach out to us when they hear back. We never received any concrete response.
During this process a letter was sent out by UVM President Sunny Eappen to patients of the UVM Health Network. In that letter he stated that “much of our work this year is focused on providing high quality care as close to home as possible and finding innovative ways to control health care costs.” The Board responded with an email to Dr. Eappen noting that we were appalled by and incredibly insulted by this statement. We pointed out that we had had several essentially worthless meetings with representatives of the UVM Health Network and that not only were we not able to make a case for keeping the clinics here open, we were never provided with a reasonable explanation of how and why this decision was made other than the generic statement that ‘consolidation will save money’ in the long run. We also pointed out that the decision to close the clinic was made only weeks after the lease automatically renewed for two years. We questioned how paying rent long after the building was to be vacated could be considered as controlling health care costs.
Not surprisingly, Dr. Eappen never responded to our email.
The next step that the Board took was to reach out to entities who might possibly take over the practice. The first such party was Gifford Health Care. Gifford seemed to be a good fit as they are a Federally Qualified Health Center. As such they qualify for a higher rate of reimbursement for Medicaid and Medicare purposes and their primary care providers would have enhanced options with respect to paying off any medical school loans. Gifford also claimed to be competitive with respect to salaries paid to their employees. Gifford was able to obtain certain financial information from CVMC pursuant to a nondisclosure agreement. After reviewing that information and talking with providers at the Valley clinic, Gifford came to the conclusion that they would not be able to sustain the practice here without “extraordinary” changes. They indicated that the current level of staff would need to change in a material way, making the odds of success pretty low. They were also concerned as their own economic position was fragile at the time. Finally, they were concerned with events in Washington, D.C. and the uncertainty of federal funding for health programs which made them reluctant to make any future commitments.
The second interested party that the Board had discussions with was PrimaryCare Health Partners. They are a network of medical offices with practitioners in family medicine, internal medicine, and pediatrics with locations in Vermont and upstate New York. They too were able to obtain certain financial information from CVMC pursuant to a nondisclosure agreement. They typically work with primary care providers in assisting them in establishing independent practices. They had several concerns, the first being that with the Vermont Accountable Care Organization ending in 2025, it would be hard for independent practices to survive. (The Vermont All-Payer Accountable Care Organization (ACO) brings together physicians, hospitals, and other health care providers to better coordinate care for their patients who have Medicare, Medicaid or commercial insurance. As a result, these patients are more likely to receive treatments that meet their specific and unique needs and less likely to get unnecessary, repeat medical tests. Additionally, doctors are better positioned to identify potential problems sooner, including chronic conditions, mental health issues and substance misuse, and begin early intervention, all of which can improve the patient’s overall health.) Their second concern was the new Medicare program called AHEAD was being delayed by the State until 2027. While AHEAD did not make up for the ACO funding, it provided some relief. Given the uncertainty of funding for independent practices, they came to the conclusion that the Valley clinic would not be a viable practice that PrimaryCare Health Partners would be willing to partner with.
Unfortunately, CVMC was only willing to disclose financial information pursuant to a non-disclosure agreement. The Board could not be certain of exactly what they did disclose to Gifford and PrimaryCare. The Board had also requested the Green Mountain Care Board to ask CVMC for more details, but the only response was a non-detailed letter that was nothing more than a long-winded way of saying ‘consolidation saves money’ without any hard data. We followed up with the GMCB again asking for more details, noting that this process was incredibly frustrating, mostly because of the lack of transparency and lack of hard information. Patients in the Valley (and throughout the State) deserve better.
The Board also had discussions with ClearChoiceMD, a ‘for profit’ company specializing in urgent care clinics. They too, after reviewing financials provided by CVMC pursuant to a nondisclosure agreement, concluded that their type of clinic would not work here. The Board also spoke with Vermont HealthFirst. Vermont HealthFirst is a similar entity to PrimaryCare Health Partners providing support to physicians who are trying to operate their own clinic. Vermont HealthFirst works with Evergreen Family Health which has several clinics in Williston and Essex. Those discussions never progressed to any viable solution either. Discussions were also had with Dartmouth-Hitchock, but they were not interested in establishing a clinic so far away from their main base of operations.
The Board continued to meet with representatives from CVMC, with the last meeting on April 30, 2025 with Anna Noonan (President and COO of CVMC) as well as two members of the CVMC Board of Trustees, Joyce Judy (the current Chair), and Erica Hare (the vice Chair). Not surprisingly, there was no change in CVMC’s position to close the clinic here. We talked about the impact of the settlement agreement between the University of Vermont Health Network (UVMHN) and the Green Mountain Care Board (GMCB) that was made in early April. That settlement agreement required UVMHN to spend $11M to fund primary care providers. The Board had been hopeful that this funding obligation might provide an opportunity to keep the Valley clinic open. According to Anna Noonan, this $11M funding obligation was to be used for “non-hospital” primary care providers, i.e., those not in the UVM Health Network. According to CVMC, the GMCB was concerned about the viability of those remaining independent practices and that this funding obligation was about those clinics and not those within the UVM network.
At that meeting Anna Noonan also claimed that the CVMC decision had been made carefully and with the input of their own initial consultants. She also pointed out that three different entities (Gifford Health Care, PrimaryCare Health Partners, and ClearChoiceMD) all looked at the financials and came to the same conclusion that CVMC had, i.e., that this practice was not financially sustainable. She did also claim that CVMC had looked at this practice in the past with a possible view towards closing it. She maintained that while the GMCB’s original order was the primary impetus to close, it was not something CVMC had not previously considered.
During this process, the Board also began having discussions with Dr. John Wilson. He was involved with all of the discussions with other potential providers as well as a few of his own choosing. Ultimately, Dr. Wilson decided to leave CVMC and to start his own clinic here. The clinic that Dr. Wilson chose to start is based upon the small patient volume model – maximizing on time with patients and focusing on disease prevention. This model gives patients more direct access to the doctor. This model does limit the number of patients that a doctor can see, but it also means that the doctor can spend more time with each patient, often offering same-day or next-day appointments and being more available through phone, email, and even house calls. A retainer fee is paid for this service which generally covers the doctor’s availability and time but is separate from a patient’s insurance.
Both the Board and Dr. Wilson were acutely aware that such a practice may not be the ‘ideal’ solution to the decision by CVMC to close its clinic here. However, having looked at a number of other potential options, this was the only one that Dr. Wilson felt could work financially.
Having exhausted many other options, when Dr. Wilson asked if the Board would be willing to rent space to him for his proposed new practice, the Board agreed. Dr. Wilson indicated that he wanted to remain here in the Valley and wanted to continue to see patients here. While not all potential patients will be able to utilize this new service, the Board determined that there were no other solutions available. Note too that at least initially, Dr. Wilson would not be utilizing all of the space that CVMC had been renting, so there remains room for some other type of practice if one can be found.
Most everyone would agree that keeping CVMC here at the clinic would have been the preferred result. However, after months of discussions with them, the Green Mountain Care Board, representatives from the Governor’s office, Senator Sanders’ office, our state representatives, members of the Board of Trustees of UVM Health Network, and others, it was clear to the Board that there was no realistic chance that CVMC would change its mind about the closure.
The Board repeatedly asked CVMC to disclose the financial information that led to their decision to close the clinic. The Board had also requested the Green Mountain Care Board to require CVMC to provide more details, but again with no success. Legally, CVMC as a charitable entity, is only obligated to provide copies of their tax returns. Those returns only show total income and expenses without any breakdown by clinic. We tried to convince CVMC that providing at least some financial details would go a long way in improving the negative view many in the Valley currently have of CVMC, but they contend that they have provided the GMCB with all of the financial information it requested and that because some of that information is competitively sensitive, they were allowed to file that information under seal. Without this disclosure, it is impossible to determine what has changed so dramatically since Dr. Cook ran the practice here, apparently successfully. In fact, CVMC purchased the practice from Dr. Cook, apparently thinking it was valuable enough to purchase. Less than 10 years elapsed since that sale and suddenly CVMC claimed that the practice cannot be sustained. Despite our protestations, CVMC was resolute in refusing to provide reasonable answers.
The only explanation that CVMC provided to us is as follows: “The landscape of healthcare in Vermont, and across the country, has changed dramatically over the past decade. Providers across the country and our state are dealing with the impacts of increased costs in pharmaceuticals, medical supplies, provider and staff recruitment, wage increases required for the workforce to stay competitive in the market, just to name a few. These factors coupled with low reimbursement rates that have not kept up with rising costs of providing care, have made providing these services extremely challenging. Those costs combined with our aging population, with higher utilization rates for services, compounds the challenges associated with running a practice in a rural area.” While some of those statements may be broadly correct, it is still difficult to accept the CVMC decision without more detailed financial information.
The Board did also discuss a possible lawsuit against CVMC. Parties are entitled to equitable relief (an injunction) provided there is no legal remedy. The Board’s connection with CVMC is contractual in nature and we would be entitled to monetary damages in light of a breach. The Board has no cause of action or right to require CVMC to remain. Our only recourse would be to sue for any unpaid rent. If other parties wish to pursue a lawsuit, that would be up to them.
Clearly, changes need to be made to our health care system. Unfortunately, those changes won’t come fast enough to help save our clinic here.