The Green Mountain Care Board is reviewing Rutland Regional Medical Center’s decision to close its inpatient pediatric unit, testing a new law that gives the state’s top health care regulator enhanced oversight powers.
The legislation was prompted by a series of controversial patient-facing cuts the University of Vermont Health Network announced last year after state regulators ordered the health care provider to reduce hospital budgets.
“It seemed as though the service line cuts that they were making were almost in a way retaliatory,” said Democratic Rep. Alyssa Black, the chair of the House Health Care Committee. Black said lawmakers wanted the board to be able to review such cuts in the future to make sure they really were necessary, and wouldn’t be overly detrimental to patients.
The new law gives regulators quite a bit of discretion, said board chair Owen Foster. If regulators decide a line of service is too important to cut, it can amend a hospital’s budget, he said. Or it can also block the cut and demand a hospital live within its preexisting spending plan.
“That would mean that a hospital may have to cut administrative staff, they may have to cut marketing, they may have to cut lobbying, they may have to come up with the money from somewhere else,” he said. “They may have to eat into their reserves.”
Regulators in Vermont must strike a difficult balance. Most rural hospitals are financially fragile, but the high cost of their services contribute to insurance premiums that are among the priciest in the nation. And with access already difficult in many communities, any service cuts can create health care deserts.
“I don't envy the board,” said Mike Fisher, Vermont’s health advocate. “They are going to have to weigh very tough dynamics to make these decisions.”
Another complication? The board is supposed to consider whether such cuts align with the state’s larger vision for regionalized care. But Vermont’s Agency of Human Services is still developing that vision.
Rutland Regional has pushed back at the additional scrutiny. In filings, RRMC’s chief legal officer, Mitchell Baroody, suggested the board might not actually have the authority to review the hospital’s decision. He also argued the hospital can’t afford to maintain its pediatric inpatient unit. A new drug price cap enacted by lawmakers, he noted, will cost RRMC an estimated $17 million a year.
The pediatric unit currently includes five beds. Hospital officials say they’re unoccupied half the time, and that most patients go home within a day. They’ve argued pediatric patients could be served in the emergency department — or transferred to other hospitals, including the University of Vermont Medical Center or Dartmouth Hitchcock.
The board has scheduled a public hearing for Dec. 5. Fisher said he’d be there, paying particular attention to the impacts on patients and families. The board won’t have long to deliberate — the hospital plans to close the unit on Dec. 21.
Written comments have been flooding in. Pediatricians at the hospital have said they weren’t consulted about the change, and parents have described what the unit’s closure would mean for their families.
In one message, a mother wrote about her son’s rare genetic condition, and how any delay in administering medications could lead to dangerous complications.
“When Isaac becomes sick, there is no time to wait," she wrote. "At Rutland, we could work with the doctors to get immediate IV access as soon as he became sick. That quick response has protected his brain, his mobility, and his future."
To travel an hour and half to UVM Medical Center, she added, is “more than a logistical change — it’s a life-altering loss.”
