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UVM Medical Center to appeal to regulators

The University of Vermont Medical Center will appeal orders from the Green Mountain Care Board limiting its revenue and prices for the next 12 months, the hospital announced Tuesday.

Vermont’s largest hospital is seeking to overturn two orders from the board, a key health care regulator. Those rulings cap how much revenue the 499-bed hospital can bring in from caring for patients — and compel it to reduce its charges to commercial insurance companies.

On Monday, UVM Medical Center filed a motion with the board asking it to hold off on forcing the hospital to reduce its commercial insurance prices while it appeals.

The move caps weeks of frustration at the medical center over the Green Mountain Care Board’s decisions, which hospital leadership sees as heavy-handed and harmful to patients. For weeks, the hospital has been laying the groundwork for an appeal, filing a series of letters contesting the legality of the board’s deliberation process and decisions.

In its filing Monday, UVM Medical Center argued that the board did not give administrators an opportunity to fully make their case and cross-examine witnesses before it ordered a reduction in commercial insurance charges.

“We filed this motion because it is our responsibility to take every possible step to limit the impact of the board’s decisions on our patients, communities and staff and we want to have the opportunity to present our case about why this decision is wrong,” Stephen Leffler, the hospital’s president and chief operating officer, said in a Tuesday press release.

Annie Mackin, a spokesperson for the hospital, said that appeals would be filed formally in the coming weeks.

In a statement, the Green Mountain Care Board denied acting improperly and pushed back forcefully against the hospital’s announcement.

“UVMMC’s statement is inaccurate and a disservice to the community and the many hard-working employees of the hospital,” the board said in an unsigned statement.

The board regulates how much revenue from patient care hospitals can bring in each year, and how much they can charge private insurance companies for providing that care. (The board has no authority over the amounts paid by Medicare and Medicaid, which are set by the state and federal government.)

Hospitals must seek permission from the board to increase patient revenue and to negotiate higher charges with commercial insurers. Earlier this year, UVM Medical Center came before the board and asked to increase its patient revenue by 9.3% and to increase its costs to commercial insurers by 5.7%.

But the board instead held the hospital’s revenue growth to just 3.5%. And it ordered the hospital to actually decrease its charges to commercial insurance by 1%.

That decrease is due to the fact that the hospital violated a previous board order: In its 2023 fiscal year, it brought in $80 million more revenue than it was allowed to.

In its statement Tuesday, the Green Mountain Care Board said that the hospital “violated its statutory obligation to comply with its budget order, which resulted in unnecessary and excessive costs to Vermonters.”

But the medical center’s leadership has expressed outrage at the reduction, arguing that the extra revenue — which came from treating more, and more complicated, patients — did not translate into excess profits. Rather, the hospital lost money by providing that extra care, administrators say.

“There were serious problems with the way this enforcement action was handed down, and due to the potential impacts on patient care, we need to highlight those issues,” Leffler said in the press release.

Owen Foster, chair of the Green Mountain Care Board, said in a text message that it was not yet certain when the board would consider the motion but that it could be as soon as next month.

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