University of Vermont Health Network CEO Sunny Eappen runs a not-for-profit health care provider that includes six operating hospitals that serve more than a million patients across Vermont and northern New York. He has been in the position for a little over a year. Eappen joined Vermont Edition to talk about attracting a talented workforce of doctors and nurses, reducing wait times and improving care for patients.
This conversation has been edited and condensed for clarity.
Mikaela Lefrak: Just a couple of weeks ago, UVM Health Network reached a major 11th-hour deal with United Healthcare, the big national health care insurance company. United had previously informed their insured that on March 1, they wouldn’t be able to go see your physicians without triggering higher rates. But this new deal allows people covered by United to continue to receive that in network care until spring of 2026. What was the sticking point and what changed the negotiations to have this deal go through?
Sunny Eappen: These are always complicated. We felt really bad for the patients that were involved. They weren't a big insurer for us–it's 2,000-plus patients here in Vermont and Northern New York. But you know, every one of them, it's 100% of their impact. We feel the frustration that the patients and their family members must have felt. The two biggest things are the same things that we often have with private insurers: rates–how much are you going to pay us–and the bureaucracy that surrounds a lot of the pre-authorization things that happen. They actually came back to the table that we were sitting at the whole time and we had really good, productive conversations. So we sort of stood firm on the idea that as a not-for-profit that has been losing millions of dollars over the year and for them on the for-profit side making billions of dollars on the other side and said I think we thought that this was reasonable, and they came back and they also thought that it was reasonable. So at the end of the day, that's how we reached a compromise.
Mikaela Lefrak: Well, let's keep with the budget and finances talk for a moment here. The Green Mountain Care Board, the state's health care regulator, rejected UVM Medical Center's budget submission last fall and called for a budget cut. They said spending levels were unsustainable. What has happened since that decision came out? And how do you think that through?
Sunny Eappen: Yeah, so they cut about $75 million from our approved budget, the budget that was approved by our board. The real impact that had to us was that we had to do a number of things to make sure that our budget then came back in line. And that meant we had to cut some programs and some projects and some people. And so we cut about 130 open positions, which does have an impact, because every one of those roles plays some impact in the way that we deliver care, or they support other employees. You know, and it's always a fine line, that we're walking about balancing our budget, making sure that there is a margin, we really need that margin, because we have to reinvest in our communities and our patients. And so the impacts will be subtle. So if you're an individual patient, you might come in and notice that, “Oh, my gosh, wow, that elevator’s down today, I wonder what's going on with that?” or I thought we were going to have a particular surgical robot, and we're going to delay that for six months. And so you know, you might see that maybe the waits for access might get a little bit slower, instead of getting a little bit faster in a particular area. Those are the decisions you have to make.
Mikaela Lefrak: Does it also mean the patients might be paying a little bit less for care?
Sunny Eappen: You know, it's really an interesting point, I would say, the insurance companies set the rates by and large. And so those insurance rates were set ahead of time. And so in reality, they probably won't see a difference in this year's budget and what they're going to do, because those rates got set before our budget cuts were set. So it's really about how are we going to utilize the money that is coming in or not utilize it to meet those same demands.
Mikaela Lefrak: Health care networks across the country are facing a shortage of qualified health care workers. What are the main challenges to recruitment?
Sunny Eappen: The reality is there is a shortage of health care workers–nurses, doctors and every other employee group that we have to look at, whether it's respiratory therapists, environmental services, food service workers–the competition for those workers has also gone up. So that means that prices have gone up for what we need to pay to get them to come into the marketplace. And that we've had to hire travelers to cover that in the interim space. All of that, of course drives up costs. So the recruitment piece–I would say that before I got here, when I looked at where Boston was and where Vermont was, there was a little bit of a discount, quite frankly, you could hire a doctor for 10% to 15% less, because people love to live in Vermont and they were willing to take that pay cut because they thought the environment was great [and] housing was a little less expensive. We've lost that now, because of the shortage. … [Now] people are saying, “Oh, I'm willing to go live in Boston and make 25% more now.” And so we've had to actually pay higher than that, to attract people to come live in a more rural area, and still pay really high prices for housing. So that's the really big challenge for us.
Mikaela Lefrak: Let's get to that topic of housing for a moment here. So you are not just the CEO of the health network, but you're kind of in the business of real estate. Can you tell us a little bit about what the UVM Health Network is doing to try to address the statewide housing shortage?
Sunny Eappen: Sure. So we've partnered with some developers to actually build housing for employees. We opened up 60 apartment units in South Burlington last year, and we're gonna open up another 120 this summer. We're gonna have childcare in that unit for maybe 50 to 75. We've got a long waiting list, even for the units that haven't even opened up yet. But it's really a drop in the bucket. … But we're doing our part, and we're going to continue to do that. We're looking at the Central Vermont site, and we're looking in Northern New York, and in Burlington again to continue to do this because our employees need it.
Mikaela Lefrak: Let's pivot to the experiences that patients have when they come to one of the facilities that you run. I'll start with wait times because I know it's an issue, at least anecdotally that we hear a lot about these days. Just as a personal example, a colleague of mine had to take his child to the ER in Burlington a few weeks ago, and they waited five hours to see a doctor. Do you have data available on the average wait times in in your ERs and what are you doing to make them shorter?
Sunny Eappen: This is totally a complete challenge. And I appreciate that the individual times can be horrible. On average, we're about 30 minutes across our network. Of course, you can imagine all the factors that play into that, right? The obvious one is acuity, if you come in, and you need to be seen urgently, or emergency, you'll get seen in minutes. If you come in and you get triaged out to something that's not so urgent, you're going to wait. But it also depends on the time of day, the day of week, how busy they are in that particular area. There's many factors. Let me just start with this: If you need to come to the emergency room, you should come to the emergency room, because we want to take care of you and and we want to serve our patients there if that's what they need. But the things that are holding us back are that there are many patients waiting in the emergency room to get admitted. They're waiting to get admitted, because there's many patients in our hospital at any given time–80 to 100 across our hospitals–who don't need to be in the hospital, but they have no place else to go. Because the nursing homes or the post-acute programs aren't ready to take them because they've had staffing issues or they've closed down. We've probably had 500 beds closed down across Vermont and northern New York for our post acute. So those patients are sitting in the hospital waiting to go home, or go out to another place. So that backlog backs up into the emergency room.
Mikaela Lefrak: So what role does telehealth and telemedicine play in all of this, with reducing wait times to see a physician?
Sunny Eappen: So one of the really positive things that came out of the pandemic was that our adoption of virtual care skyrocketed. We went from probably less than 1% to about 20%. Certain specialties have adopted it much more. Something like Behavioral Health has loved it. It’s been great because once you know the patient, you can actually see them and talk to them. And you can get a lot of care done that way. The other way that we've used digital health more globally is for our internal consults. We started a pilot program about 2021, where we said, if you need a consult, our primary care doc can communicate with the specialist. This year, we're hoping to do about 4000 of those.
Mikaela Lefrak: So instead of you going to see the specialist yourself, you would talk to your primary care physician, and they would reach out to the specialist and get you the information you need?
Sunny Eappen: That's exactly right. What we're doing is the primary care doc is taking all the information and sending it to that specialist to look at and then respond directly back to the primary care physician. It keeps the slots open for people who really need to see that specialist and gets the answer back to the primary care doc, probably about 75% of the time or greater, and it prevents that patient from needing to make another appointment. … It's better for our patients, it's better for our community.
This episode of Vermont Edition also included a conversation with Dr. Tim Lahey, an infectious disease physician at UVM Medical Center, about the rise in norovirus cases and the CDC's new COVID guidelines.
Broadcast at noon Wednesday, March 6, 2024; rebroadcast at 7 p.m.
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