Green Mountain Care Board Prepares to Punt Away an Investment in Inpatient Mental Health Care

Our health care guardians at the Green Mountain Care Board are trying to sneak through a bit of business that combines bad policy with questionable procedure.

Well, I guess that explains the “sneak through” part. They can’t be proud of this.

Six years ago, the GMCB ordered the University of Vermont Medical Center to take $21 million in surplus revenue and spend it on developing a plan to boost inpatient mental health care, which has been abysmally lacking since Tropical Storm Irene wiped out the old state hospital in 2011. We’re now in our twelfth year of inadequate inpatient care that has left severely mentally ill patients languishing in emergency rooms and frontline providers dealing with the consequences.

The failure to address this situation ought to be a source of embarrassment if not shame to Our Political Leaders.

Anyway, it seemed like a decent idea: Let UVMMC use the surplus to tackle a challenge that nobody else would.

Well, now the GMCB is about to let UVMMC off the hook, further delaying any meaningful response to the shortage of inpatient care. And the Board trying to rush it through with the least possible fanfare.

It took UVMMC three years and $3 million to come up with a plan that no one liked. It called for creation of a 25-bed inpatient facility on the grounds of the Central Vermont Medical Center, which is just down the street from the Vermont Psychiatric Care Hospital. That part of it was fine, but the price tag was a staggering $150 million. And operating losses were projected at $20 million per year.

Yeah, everybody ran away from that like it was a live grenade. But those numbers seem ridiculously high, as if the proposal was designed to be unacceptable. Maybe somebody could have asked UVMMC some pointed questions, or had some expert on hospital construction take an objective look at the numbers.

I don’t know if anybody did, but I do know this. The proposal was DOA and nothing else was done. UVMMC sat on the remaining $18 million.

Fast forward to January 25 of this year. Ken Libertoff, retired head of the Vermont Alliance for Mental Health and respected policy expert, wrote an essay posted on VTDigger questioning why this $18 million was going unused in the midst of a crisis.

For the past decade, empty rhetoric, endless handwringing, countless studies, special hearings, and inept leadership have proven to be a case study in one of many failed responses to a mental health system that is overwhelmed and overworked.

It may be pure coincidence, but Libertoff’s essay seems to have lit a few fires under a few generously-padded posteriors. Shortly afterward, GMCB staff met with UVM Health Network officials to discuss the unspent $18 million. On February 9, UVMHN Executive VP and Chief Financial Officer Rick Vincent sent a letter to the GMCB stating the Network’s commitment to “improving mental health services in Vermont” and its intent to use the $18 million “to address mental health needs.”

In a completely undefined manner. No commitment to inpatient care.

That’s what we call moving the goalposts.

Now, GMCB staff is recommending that the “inpatient” requirement be dropped, allowing UVMMC to spend the $18 million on mental health care, broadly defined.

And get this: The GMCB is soliciting public comment on the proposal until March 8.

That’s little more than a week from now, and less than two weeks after the February 23 meeting.

Rush to judgment much?

It tells me the fix is in. The GMCB is going to let this sail through.

To be fair, the financial position of UVMMC and out other hospitals is weaker now than it was in the late teens. You can make a case for giving UVMHN more flexibility in using the money. If spent wisely, it would do some good for the overstressed mental health care system.

But it would do nothing to address the inpatient care shortage. And it would extinguish the distant light at the end of the tunnel: The hope that UVMHN could devise a workable plan.

What would happen if this crisis was happening in any other field of health care? If, say, cancer patients were stacked up in ERs across the state because there weren’t enough inpatient oncology beds? I can tell you this: It wouldn’t go unaddressed for well over a decade. We wouldn’t just wring our hands and cry about costs. We’d drop everything and find a way to fix it.

We’ve been hearing about alternatives to inpatient care since Irene washed through the state hospital. Certainly we need a full range of strategies on mental health. But there will always be a tiny cohort of people who are so severely ill that they need inpatient care and nothing else will do. (How tiny? Somewhere around 0.01% of our population.)

This proposed deal with UVMHN is just another way of saying ‘The state of Vermont doesn’t care.”

If we did, we’d be doing something about it.

We’re not.


1 thought on “Green Mountain Care Board Prepares to Punt Away an Investment in Inpatient Mental Health Care

  1. gunslingeress

    Maybe our almighty State should take some of the millions of dollars they shovel at Planned Parenthood to do abortions on tiny unborn human beings, and redirect it to this mental health need for born adult human beings instead. There never seems to be a shortage of funds the state of Vermont is willing to spend on PP. Priorities, people. Priorities.


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