Duties of the Green Mountain Care Board (S.211) - Jan 19, 2024

The Senate Health and Welfare Committee met on Friday to hear testimonies regarding S.211, which intends to look at the health care reform and regulatory duties of the Green Mountain Care Board (GMCB). The initial testimony was presented by Devon Green (VP of Government Relations, Vermont Association Hospitals and Health Systems). She initially addressed the Vermont Landscape of the Rural and Aging Population. There has been a population increase in the 65 to 79 age group during the last decade, with an increase of about 40,000 from 2010 to 2021. That increase is the largest of any age group and more than double the rate of the overall population. This has impacted hospital stays. In 2021 70 people were waiting for post-hospital placement and now 142 are awaiting placement.

According to the 2020 census, Vermont is the most rural state in the nation with 65% of the population residing in rural areas. Vermont is also one of the oldest states in the nation with aging individuals disbursed throughout the state. The number of hospitals in is lower than the national average, but consistently ranks as one of the top five healthiest states. Financially, 9 out 14 hospitals have negative operating margins, with 60% of expenses being labor and 30% for medical and surgical supplies and pharmaceuticals.

Green reviewed the health care crisis of 2023. In emergency departments (EDs) an average of 30 people needing mental health care were boarding there, and some longer than 24 hours. An average of 25 patients were waiting in the ED for a medical/surgical bed. In ICUs and medical/surgical units an average of 97% beds were full and the largest hospitals were at 100% capacity. In sub-acute units there was an average of 137 patients waiting for discharge because there were no placement options, which might result in 35% of inpatient beds filed by patients waiting to be discharged.

Reviewing current (2024) data, 15% to 25% of people are waiting for mental health placement, with wait times improved to about 50% of the patients waiting less than 24hours. An average of 30 patients may be waiting for a medical/surgical bed. There is an average of 6 ICU beds available statewide. There is a average of 142 patients waiting for discharge because there are no placement options available, with an average of 35% of inpatient beds filled by patients awaiting discharge.

Green moved on to discuss the Health Care Reform timeline. It entails hospital budgeting methodologies being reviewed monthly. The conditions necessary include tight alignment of financial incentives among all participants. It also includes sharing of accurate and timely clinical information and financial performance with all participants. There needs to be adequate resources for primary care, mental health and preventive services in the community, as well as availability of referrals to specialists and necessary diagnostic tests. Appropriate availability of acute inpatient beds, outpatient services, extended care services, and transfer services are also necessary.

According to Green, health care reform needs to include clear definitions without duplication of efforts. Administrative alignment should include quality, data and credentialing, and enrollment. Reforms also need stakeholder representation in the global budget setting process, as well as payment model governance and fee for service regulation.

Owen Foster (Chair GMCB) and Alena Berube (Dir. Health System Finances, GMCB) followed. Foster suggested that the regulatory role of the GMCB should be done in collaboration with Administration. Chairwoman Lyons (also the bill sponsor) suggested that GMCB might have less regulatory responsibility and more of a role in directing and planning health care reform.

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