For the many who are in need of inpatient psychiatric care, Vermont is decidedly inhospitable. Until there is a change in approach, and regulatory leadership, it will become even more inhospitable. There will continue to be far more in need than there will be beds to accommodate them, and people to care for them.

On Wednesday, the University of Vermont Health Network pulled the plug on a proposed 25-bed facility to be built on its campus at Central Vermont Medical Center in Berlin. The hospital explained to the Green Mountain Care Board that it did not have the money to run the facility, let alone the $158 million needed to build it. 

John Brumsted, president and CEO of the network, and UVMMC, told the regulators “the ball is in your court.” He was referring to the board’s refusal to grant UVMMC and CVMC a 10 percent mid-year increase in rates earlier in the month. The board, instead, allowed them to raise rates 2.5 percent. 

The regulators Wednesday were sympathetic to the hospitals’ decision not to proceed with the psychiatric unit, although they also noted how badly the state needs the facility. They urged the hospital to remain involved, to seek help from the state, and, perhaps other hospitals.

Board chair Kevin Mullin told Mr. Brumsted: “I don’t think your request is unreasonable. You can’t lose additional money. I’m just trying to figure out what would make this project [the psychiatric unit] viable so that it could happen.” Fellow board member Jessica Holmes said, “It’s deeply troubling the state that we’re in.”

True enough. But the board put the hospital in the position it is in. The hospital is underwater, on its way to losing roughly $44 million. The board denied the hospital the help it needed.

Politically, it is easy to see the board’s position. It was getting hammered by the state’s insurers, business leaders and politicians who did not want to see premiums increase. It was easier to say no, knowing that, as a last resort, the hospitals could always dig into their reserves,, their debt loads notwithstanding.

So here we are, betwixt and between. The health care community does not have the resources to build a $158 million psychiatric center, and to pay for its day to day operation, under the current guidance given by the GMCB. And the GMCB isn’t willing to give hospitals the revenue they need to do so, nor does the board have the regulatory authority to force the issue.

It is also about to get worse. Substantially. There are two key psychiatric institutions in Vermont: the Brattleboro Retreat and the 15-bed psychiatric center in Berlin. Together, they receive about $25 million in Medicare money each year. But that ends in 2025. For years they have depended on a waiver from the federal government to qualify for the assistance. The law says the assistance can only be given if the psychiatric units are physically part of a hospital. Neither is. The feds were kind enough to allow let Vermont down slowly. But in three short years that $25 million goes away. 

When that ends Vermont has a $25 million hole to fill to maintain services that currently exist. That’s $25 million [each year] on top of any proposal to build and operate a new $158 million psychiatric center. The backdrop to these fiscal and financial challenges is one in which, as a state, we have far more patients than we are able to care for. Old and young. And the gap is widening.

If the GMCB is sincere in saying it “desperately” wants the Vermont health care system to expand its psychiatric services then two things need to happen. The board needs the regulatory authority, and direction, to get the job done. When that happens the board would need to spread the cost out so that it’s shouldered as far and wide as possible. This isn’t a one-hospital trick. Not if the board is going to force hospitals to operate on revenues far below the cost of inflation. The board would also need to explore the advantages of working with hospitals and local mental health providers to identify those in need and to find places for them within the community when possible.

But does the GMCB really want that authority, which also carries with it the responsibility of fixing something that is broken? The board would have to be more convincing than it has been thus far. It says it wants more psychiatric beds, but then hobbles the hospitals that would pay the bills. The board cannot have it both ways.

Until this contradiction is addressed, the mental health environment in Vermont will remain inhospitable.

By Emerson Lynn

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