VERMONT — The University of Vermont Health Network (UVMHN) on Thursday announced plans for a sprawling series of health service cuts at its facilities — reductions that could affect how and where patients across Vermont could receive medical care.

Officials at Porter Medical Center, a UVMHN affiliate in Middlebury, said the cuts will not directly affect health care operations here but will have some impact on Addison County residents seeking health care.

The network plans to eliminate the transplant department at UVM Medical Center; shutter the inpatient psychiatric unit at Central Vermont Medical Center; offload dialysis programs in Newport, Rutland and St. Albans; and close two clinics in the Mad River Valley.

UVM Medical Center, in Burlington, is also slated to reduce its census of inpatients — currently about 450 — by about 50 in the coming months.

Health network leaders blamed the reductions on recent orders from the Green Mountain Care Board, a key state health care regulator. Those orders limit how much revenue the network’s hospitals can raise from medical services, and how much it can charge commercial insurance for those services.

“Today’s a hard day for our organization and for our leaders,” Sunny Eappen, the CEO of the UVM Health Network, said at a press briefing Thursday morning. “We’re having to take action on a number of measures that we don’t want to be doing. But as a result of the decisions by the Green Mountain Care Board, we’re being forced to do that.”

Porter Medical Center appears to have emerged relatively unscathed from Thursday’s announced cuts.

“There are no layoffs or reduction in services at Porter as the result of the Green Mountain Care Board actions that were discussed this morning,” Bob Ortmyer, president of both Porter and Elizabethtown Community Hospital in New York, said through an email exchange Thursday afternoon.

But PMC clients will nonetheless feel the effects as they navigate the state hospitals’ interconnected web of services.

“Porter will feel the downstream impact of managing the difficulty in transfers and the impact to the cuts in the administrative shared services that all the hospitals in the network rely on,” he said.

A STRUGGLING HEALTH CARE SYSTEM

Vermont’s aging population — as well as labor shortages, high pharmaceutical costs, a lack of long term care facilities and other factors — has pushed prices for health care up around the state.

In an attempt to keep those costs in check, the Green Mountain Care Board has recently taken a harder line with Vermont hospitals, placing firmer limits on patient revenue and commercial insurance charges.

But the board’s recent orders have caused friction between the regulator and UVM Health Network administrators, who say they plan to appeal them. In the meantime, however, the network will move forward with cuts, executives say.

“We unfortunately need to take these actions because this is for this fiscal year,” Eappen said Thursday, “and so we need to keep moving forward while that legal process continues down the road.”

The Green Mountain Care Board said in a statement Thursday that members learned about the network’s plans just one day before and are seeking to better understand the rationale behind them.

Board members are “deeply concerned about the impact of UVMMC’s decisions on patients, its dedicated staff, and the broader healthcare system,” the board said.

CHANGES ACROSS THE STATE

If implemented as planned, the changes at the UVM Health Network — which includes UVM Medical Center in Burlington, Central Vermont Medical Center in Berlin and Middlebury’s Porter Medical Center, as well as three hospitals in New York, including Elizabethtown Community Hospital — could affect care throughout Vermont.

In Burlington, UVM Medical Center is seeking to decrease, by roughly 50, the number of patients who stay overnight, by limiting transfers to the hospital and removing barriers to getting patients into lower-level facilities like nursing homes. It was not immediately clear how that would be achieved.

The Burlington hospital currently performs roughly a dozen kidney transplants a year. Halting those would likely send patients to New Hampshire’s Dartmouth Hitchcock Medical Center, UVM Health Network administrators said.

The health network is also hoping to transfer dialysis centers in St. Albans, Newport and Rutland to other non-network operators. Those centers serve about 115 patients and lose about $3 million annually, the network said.

UVM Health Network also plans to shutter a family medicine clinic and a rehabilitation clinic, both affiliated with Central Vermont Medical Center, in Waitsfield.

“Those providers and staff will be moved to existing primary care locations,” said Anna Tempesta Noonan, Central Vermont Medical Center’s president and chief operating officer. “The closest being the Waterbury clinic that we have, which is approximately 12 miles from where our current practice is in the Valley.”

Central Vermont Medical Center’s inpatient psychiatric unit, which currently has eight patients, would also shut down. Noonan said that the hospital was working to provide lower-level psychiatric care elsewhere in the hospital, through “enhanced services” in the emergency department and “psychiatric supports” in primary care facilities.

Administrators said they have also implemented or planned cuts to non-clinical expenses totaling $38 million, which include delaying maintenance and upgrades and halting programs to improve patients’ access to care, according to a Thursday press release.

Network administrators said that the cuts would affect about 200 employees in total. The hospitals plan to not renew contracts for roughly 100 traveling staffers and find other positions within the network for approximately another 100 permanent staff.

The changes announced Thursday come just a month after UVM Health Network announced that it would delay construction of an outpatient surgical center — another action it blamed on orders from the Green Mountain Care Board.

UVM administrators did not provide a hard timeline for the cuts, saying they will likely take months to implement.

CONCERNS FROM STAKEHOLDERS

In an interview Thursday, Owen Foster, the chair of the Green Mountain Care Board, pushed back against UVM Health Network executives’ argument that the regulator was to blame for the cuts.

“I think that the board’s responsibility is to contain costs and ensure access and quality is sufficient,” Foster said. “And our findings explain that UVM did not hit those marks. They have extremely high prices, their quality was declining, and their access was poor. So I think in that circumstance, with those budgets, we made the right decisions.”

Foster said that the hospital could have taken multiple other steps to cut costs other than reducing health care services, such as improving efficiency, repaying loans from the network’s New York hospitals and correctly budgeting federal grant money.

“I think that there’s many other hospitals, other academic medical centers across the country, other Vermont hospitals, that (did) a far better job of controlling expenses over the last five years,” Foster said.

Thursday’s announcement also drew a rebuke from the Vermont Federation of Nurses and Health Professionals, which represents nearly 3,000 nurses and other staff at the UVM Medical Center. Deb Snell, the president of the federation, called news of the cuts “very disappointing” in an interview Thursday.

“The UVM Health Network seems to be taking no responsibility for their poor management of their finances the last few years,” Snell said. “And now these decisions are coming on the back of Vermonters.”

Mike Fisher — a former state representative from Lincoln who now serves as Vermont’s chief health care advocate — also expressed concern about the network’s announcement.

“I’m frustrated at UVM for blaming the economic situation we’re in on the Green Mountain Care Board,” Fisher said. “We desperately need UVM and other hospitals to come to the table in good faith to figure out how we can best serve Vermonters, given the financial crisis we’re in.”

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The Addison Independent’s John Flowers contributed to this report.