GMCB Adds a Dab of Lipstick, Hopes You Won’t Notice It’s Still a Pig

Well, that didn’t take long. In fact, it couldn’t have happened any faster.

Two weeks after public comment forced the Green Mountain Care Board to defer cancellation of a plan that might have led to a badly-needed increase in inpatient mental health beds, the Board came right back and went ahead with the deal today with minimal amendment. It stands essentially as it did before: it lets the University of Vermont Health Network off the hook for designing a new inpatient facility, thus closing the door on the best opportunity to resolve our 12-years-old-and-counting* crisis on inpatient mental health care.

*That’s the generous count, starting the clock with Tropical Storm Irene. If you want to include the dilapidated, outdated old state hospital, well, the crisis goes back a lot further.

The revised plan requires UVMHN to invest $18 million in boosting “capacity of mental health services in the state.” Not “inpatient,” mind you, but “mental health services” of any sort. The Board then punted review of UVMHN’s plan to the Department of Mental Health because, as Board member Jessica Holmes put it, “we’re not the experts” and DMH is.

It also allows the GMCB to wash its hands of the whole mess, but that’s just a bonus.

This all began back in 2018, when UVMHN had racked up $21 million in excess revenue. The GMCB chose not to make UVM give the money back, instead ordering that it be spent on boosting inpatient mental health care. It was a convenient way to resolve one dilemma by tying it to an unconnected issue — UVMHN’s excess revenue and the shortage of inpatient mental health beds. It was simply a way to avoid making UVMHN pay the money back.

UVMHN spent roughly $3 million devising a plan to build a new inpatient unit at Central Vermont Medical Center at a cost of $158 million plus a projected operating loss of $20 million a year. Everybody got sticker shock at that, and the proposal was shelved. UVMHN held on to the remaining $18 million, presumably earning interest on it, until this year, when it emerged into the public discourse to the embarrassment of all concerned.

Well, I can hope they had the decency to be embarrassed.

But rather than tell UVMHN to go back to the drawing board and come up with a workable inpatient plan, the Board proposed giving the Network a lot more flexibility in spending the money. The plan approved today is not terribly different from its original proposal.

Oh, there is one improvement. The Board will mandate that from now on, UVMHN must invest any interest earned on the $18 million in improving mental health care. There’s also a fig leaf:

The care board is requiring that the health network’s new proposal show how the investment could be expected to reduce the frequency and length of stays in emergency departments for adults, adolescents and children experiencing a mental health crisis.

That sounds tough, but it really isn’t. You can make a case that boosting outpatient care will reduce the burden on emergency departments. It’s not a good case, but you can make it sound good. It’s true that there isn’t enough outpatient care to meet demand but it’s also true that there will always be a people who need inpatient care, and no amount of counselors or group homes or support groups or social workers or psychologists will change that. And we simply don’t have enough beds to accommodate the few dozen Vermonters who need inpatient care at any moment.

It already sounds like UVMHN is firmly on this track.

Projects already mentioned by the health network in statements to the board include the opening of a second outpatient therapeutic program and working with the Howard Center to establish a mental health urgent care location in South Burlington.

Again, improving outpatient care will help a lot of people but it won’t help the relative handful of Vermonters with serious mental health challenges. The “mental health urgent care location” could ease the burden on the University of Vermont Medical Center’s emergency department, but it’s unlikely to help all the other hospitals in the state.

But hey, they’ll come up with a plan that meets the GMCB’s watered-down guidelines, everyone will declare victory, and we’ll continue to have severely mentally ill people stockpiled in emergency rooms for days or weeks at a time.

When will it end? I’m not confident it ever will. We are highly skilled at kicking cans down roads.


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