The Board of Directors of the Mad River Valley Health Center, Inc. would like to provide a further update on the decision of CVMC to close the clinic here in the Valley. As was most recently announced in a letter to the editor in the Valley Reporter from Anna Noonan (President and COO of CVMC) the clinic will likely remain open until June after which patients will be seen at the Waterbury location.
As we have said before, this entire process has been difficult and frustrating for the Board. It is hard to have a real discussion about the merits of keeping this clinic when CVMC and UVM show no willingness to have that discussion.
As was noted in Anna Noonan’s letter, two parties did request and receive information about possibly taking over the practice. The first such party was Gifford Health Care. The Board had reached out to Gifford to ascertain their potential interest in taking over the clinic here. 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 is fragile. Finally, they were concerned with what is currently happening 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 this year, 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 will only disclose financial information pursuant to a non-disclosure agreement. The Board is unaware 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 have followed up with the GMCB again asking for more details, noting that this process has been incredibly frustrating, mostly because of the lack of transparency and lack of hard information. Patients in the Valley (and throughout the State) deserve better.
Today’s healthcare environment is incredibly complex and there are no easy solutions. While of little comfort to Valley residents, we are not the only community losing its primary health care practice as Lamoille Health Partners recently announced that it will close Stowe Family Associates, its primary care practice. And there are other concerning trends. Health care costs are soaring across the state and health insurance premiums here are amongst the highest in the country. BlueCross BlueShield, which insures roughly a third of Vermonters, says that they have paid out more in claims than they have collected in premiums, causing them to use their reserves to meet those claims and that those declining reserves could put them in jeopardy of insolvency.
Clearly, changes need to be made to our health care system. Unfortunately, those changes can’t come fast enough to help save our clinic here.
The Board is continuing to pursue alternative options to find another tenant whose purposes and activities are incidental or related to the provision of health services. The Board would welcome any concrete leads with respect to such a prospective tenant.