UVM Health Network Announces Service Cuts, Blames Regulators

UVM Medical Center president and chief operating officer Dr. Stephen Leffler at a press conference Thursday at the hospital. Credit: File: Colin Flanders ©️ Seven Days

Updated at 1:57 p.m.

The University of Vermont Health Network on Thursday announced sweeping service cuts, including the closure of an inpatient mental health unit in Berlin and the elimination of dozens of beds at its Burlington hospital.

Officials blamed the service reductions on recent regulatory decisions.

Up to 200 jobs could be eliminated, network officials said, though roughly half of those positions are currently filled by temporary travel workers. Any permanent employees who are impacted will likely be offered comparable jobs elsewhere in the network.

Stephen Leffler, the UVM Medical Center’s president and chief operating officer, told reporters on Thursday morning that the “extremely difficult” decisions will make it harder for patients to access care. But with state regulators mandating that the hospital take in less revenue than it had hoped for next year, the network has no choice.

“There’s no way forward except decreasing the amount of care we deliver,” Leffler said.

The announcement ratchets up a long-simmering tension between Vermont’s largest health care provider and its chief health care regulator, the Green Mountain Care Board, which has been attempting — unsuccessfully — to rein in hospital spending in response to an unsustainable growth in insurance premiums.

In a statement on Thursday, the care board said it was “deeply concerned” about how the network’s decision will impact patients, staff and the entire health care system.

“The GMCB was not consulted on, and did not approve, these reductions,” the statement read. It added that regulators were reaching out to the network to better understand its rationale and what alternatives were considered.

In October, regulators approved budgets for both the University of Vermont Medical Center and the Central Vermont Medical Center in Berlin that the network says will force it to take in about $122 million less revenue than it had proposed.

In response, the network announced plans to delay construction on a new outpatient surgical center and appealed the decisions, a process that could drag on for months.

On Thursday, network officials said they must begin taking steps to comply with the regulators’ orders. They highlighted a handful of cuts that they say will curb the growth of their expenses and revenues.

The network will consolidate some family medicine and rehab clinics at CVMC and eliminate surgical kidney transplants at UVMMC; the hospital performed about a dozen kidney transplants this year. A potential collaboration with Dartmouth Hitchcock Medical Center would allow transplant patients on a waiting list to be treated in Vermont before the actual procedure takes place at the New Hampshire hospital, officials said.

The network will also stop managing three kidney dialysis clinics — in St. Albans, Rutland and Newport — that serve about 115 patients. That change will take place over a period of months as the network seeks to find someone else who can oversee the service — the local hospitals, perhaps, or a third-party provider.

And the network will close down the CVMC inpatient psychiatric unit, which currently serves about eight people on average, while it explores the potential for a new mental health urgent care clinic, similar to one that recently opened in Burlington.

But perhaps the most consequential change will occur at the UVM Medical Center itself. The hospital will aim over the next six months to gradually reduce its bed capacity from an existing 450 to about 400, similar to where it was before the pandemic.

Caring for more patients outside of the hospital was one of the main takeaways from a recent consultant’s report that laid out how Vermont could create a more sustainable health care system. And medical center leaders say they are continuing to seek better ways to quickly discharge patients into community-based facilities or to home, where their care is cheaper.

But the bed reduction will have unavoidable consequences, Leffler said.

As the only Level 1 trauma center in Vermont, the Burlington hospital routinely accepts transfers from smaller, rural hospitals that don’t have the capacity or expertise to care for certain illnesses. The hospital took in 500 transfers in September alone, the most ever.

Fewer available beds will force the hospital to limit the number of transfers it accepts, Leffler said, meaning Vermont’s smaller hospitals will need to send some of them elsewhere: Dartmouth, perhaps, or even as far away as Boston. The reductions could also lead to more crowded emergency departments.

More cuts could be necessary if a judge strikes down the network’s appeal of the recent budget decisions, officials said.

It’s unclear whether any reductions to executive pay might be considered. In 2020, staring down a $152 million budget gap borne from COVID-19-related disruptions, the health network announced base salary reductions for its top 300 employees.

Sunny Eappen, the network’s president and CEO, said on Thursday that executives are paid on an incentive-based schedule set each December by a compensation committee.

“I’m sure that all of these factors will play into that,” Eappen said.

High executive salaries have long been a source of frustration to AFT Vermont, the union that represents more than 6,000 nurses, technicians and support staff at the UVM Health Network. The union on Thursday began circulating a petition to stop the cuts, which it said would have devastating impacts. It also challenged the idea that regulators bear responsibility for the hospital’s financial situation.

“This is the fault of executives and leaders who have failed to plan their budgets accordingly,” said Sue Becker, a longtime CVMC nurse and union representative. “We are not going to stand by and let this happen.”