Twenty years ago, people in Newport started raising money for a kidney dialysis center in town through bake sales. After receiving $1.5 million from the federal government, the state and North Country Hospital, a clinic finally opened at the hospital in 2006. Since then, the dialysis center has provided care for people with end-stage kidney disease. These patients rely on getting their blood cleaned three days a week, for an average of four hours a day, to stay alive.
The dialysis center in Newport, and two others in Rutland and St. Albans, are currently run by the University of Vermont Health Network. They lose about $3 million a year, according to an estimate from the network.
To save money, the health network said it plans to “transition management and ownership of the sites,” in an announcement last week.
In the interim, UVM Health Network has vowed to keep the clinics open.
“They're saying it's a planned transfer, they're not ending providing dialysis care,” said Sandi Hoffman, a nurse who manages the Newport clinic.
That’s not the case for proposed cuts to other patient services across the hospital network. At Central Vermont Medical Center in Berlin, leaders plan to close the inpatient psychiatry unit as soon as the end of the year, according to multiple nursing staff. Hospital leaders declined to specify a timeline.
Changes are also expected at UVM Medical Center in Burlington, which will accept fewer patients for overnight care. The health network also plans to consolidate primary care and rehab clinics in central Vermont, closing at least two locations in Waitsfield.
The health network announced these cuts after the Green Mountain Care Board (GMCB) ordered UVM Medical Center to reduce the amount it charges commercial insurance companies by 1% for its 2025 budget, plus another reduction for its 2026 budget.
“University of Vermont Health Network vigorously disagrees with these budget orders because it limits the ability to respond to the needs of patients,” the network said in a statement.
GMCB said the reason it wants the hospital to charge commercial insurance companies less is because it found that last year, “UVMMC failed to properly account for government revenue and thereby requested higher than necessary commercial reimbursements from Vermonters.”
State regulators said UVMMC could reduce its prices in several ways, including increasing operational efficiency, reducing administrative costs and evaluating the financial support it provides to other hospitals.
UVM Health Network has said cutting $18 million in administrative expenses is part of its plan to reduce costs. The hospital system also said it’s pursuing legal action so it doesn’t have to comply with the budget orders. In the meantime, they said they have to “reduce the care they provide.”
Dialysis clinics will remain open
For the more than 100 patients with kidney disease who get dialysis treatment in St. Albans, Rutland, and Newport, many rely on public transit to get to their appointments, and could not live without having clinics nearby.
“Most of them are elderly, they're weak, they're poor,” said Hoffman, the nurse at Newport. With limited availability at other dialysis centers across the region, she thinks her patients would have to drive multiple hours to get care, and many wouldn’t be able to.
“Unfortunately, most of our patients will choose to die before they do that,” she said.
Not having a provider in these communities just is outside the realm of possibility for me to consider.Jayesh Shukla, UVM Health Network
Jayesh Shukla, the director of renal services and endoscopy at the UVM Health Network, said closing these clinics would be unimaginable.
“I refuse to believe that that would be a possibility in Vermont,” he said. “Not having a provider in these communities just is outside the realm of possibility for me to consider.”
Leaders at UVM Health Network said they are in early stages of discussions with Northwestern Medical Center, Rutland Regional Medical Center, and North Country Hospital to figure out how to keep these clinics open.
“If we are unable to find local solutions, we would move on to an RFP [Request For Proposal] process – but there is no timeline for that at this time,” a hospital representative wrote in a statement shared with Vermont Public.
Closing in-patient psychiatric care in central Vermont
Some of the proposed changes at Central Vermont Medical Center in Berlin could happen very quickly. In the past year, three of four psychiatrists working at the inpatient psychiatry unit have left. Since then, the hospital has relied on temporary staff to continue to care for patients. They've reduced their capacity from 14 patients to eight, which has kept the unit busy.
“It’s close to full every day,” said Sue Becker, a psychiatric nurse who’s worked at the hospital for decades. As it is, psychiatric patients are often waiting in the emergency room for hours, and sometimes days, before being admitted.
“If this does happen, there will be more people waiting,” Becker said.
“There will be more people in that emergency room waiting to be sent somewhere – so Burlington, Rutland, Brattleboro they’re going to have more pressure to accept these patients.”
Other hospital staff talked about the value of receiving care in the community at a protest at the Berlin hospital campus on Thursday. More than 50 health care workers and community members stood in the rain in front of the hospital.
“Some people will not be able or won’t travel to Dartmouth or UVM or Brattleboro. They need treatment here,” said Patty Bostock, a psychiatric nurse who works per diem at Central Vermont Medical Center and Washington County Mental Health.
“We need more mental health care, not less,” she added.
"It shouldn't even be up for discussion," said Chrissy Searles an LNA and mental health tech at Central Vermont Medical Center. "This shouldn't be happening,"
Consolidation of Waitsfield clinics
About 25 staff and patients held a second rally outside the Mad River Family Medicine clinic in downtown Waitsfield.
While songs like Sister Sledge’s “We Are Family” played in the background, people waved signs reading “cut the cuts, not the care” and “equal health access for all.”
UVM Health Network is planning to close its Waitsfield primary care clinic, plus a rehabilitation therapy clinic down the road, and move those patients and staff to other existing locations to "increase efficiency and reduce costs."
The network said last week that the Waitsfield clinics don't receive enough patients to be sustainable.
But staff said without locations in Waitsfield, some patients may not be able to get care because of a lack of transportation – the next closest clinics are in Waterbury.
Staff are also worried about wait times going up.
“We are one of the more remote clinics that the health network has,” said Ryan Gauvin, the clinical nurse lead for Mad River Family Medicine. “We have a very large patient volume. We have patients waiting to get in these doors – and they wanna be here.”
Eighty-one-year-old Fayston resident and clinic patient Nancy Wilson agreed.
“You can't cut out patient care. Don't tell me I've got to drive another 14 miles,” she said. “First of all, I'm getting old. I'm not going to be able to schlep up to Waterbury.”
In a recent statement, the Green Mountain Care Board said it is “committed to reviewing UVMMC’s decision with the hospital and discussing whether there are alternatives available.”
In a recent email to staff, UVM Health Network said it plans to formally respond to state regulators when it submits revised budgets later this month.
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