About 80 demonstrators gathered for a noontime honk and wave outside the Central Vermont Medical Center in Berlin to protest against proposed health care service cuts on Thursday, November 21. Photo by Glenn Russell/VTDiggerFor 18 years, Patty Croccolo has been a patient at Waitsfield’s family medicine clinic. The facility, which is affiliated with Central Vermont Medical Center, is a 15-minute drive from her home in Warren. Her daughter works as a part-time nurse there, and the medical staff is “fabulous,” she said. Roughly a decade ago, when she was diagnosed with colon cancer, Croccolo’s providers at the clinic were excellent, she said. “They got me in here right away, sent me to the hospital right away. I was diagnosed within a week,” she said. “They were so supportive — oh my gosh. They helped me get into Boston for care. This office means a lot to me personally.”  Croccolo was one of roughly 25 community members and providers who braved a chilly rain in Waitsfield Thursday to protest the impending closure of the clinic. As passing cars honked in support, she and others held up signs and cheered.“I don’t want to see this facility taken away,” she said. CVMC Family Medicine Mad River is slated to be a casualty of sweeping service cuts announced by the University of Vermont Health Network last week. Those cuts include: shuttering an inpatient psychiatric unit at Central Vermont Medical Center, closing two clinics in Waitsfield, offloading dialysis facilities in Rutland, Newport and St. Albans, ending UVM Medical Center’s transplant services and reducing the number of inpatients at the Burlington hospital by about 10%. Photo by Glenn Russell/VTDiggerHealth network leaders have placed the blame on the Green Mountain Care Board. Recent orders from the health care regulator — orders that limit the network’s revenue growth and cut commercial insurance prices at its Burlington hospital — forced their hand, administrators say.But the health network’s planned cuts have sparked anger and disappointment among advocates, health care unions and community members across the state.The network’s “recent and abrupt decision to cut essential medical services for Vermonters — despite being in a strong financial position by well-established measures — harms our collective ability to chart a path forward to stabilize health care financing,” Mike Fisher, Vermont’s chief health care advocate, wrote in a Nov. 20 public letter.“Reducing medical services to patients is an option of last resort for a financially distressed hospital network,” Fisher wrote. “In this case, it comes across as a punitive political strategy by a profitable one.”Stephen Leffler, the president and chief operating officer of UVM Medical Center, said in an interview Thursday that the hospital network is also frustrated by the situation. “I don’t blame people for being upset,” Leffler said. “I’m upset we have to do this. This is not what anyone wants.”But, he said, the network had limited room to maneuver within the realities of health care regulation. The Green Mountain Care Board capped the amount of patient revenue that the network could raise and ordered UVM Medical Center to cut its commercial insurance charges by 1%.Because Medicaid and Medicare reimbursement rates are fixed, Leffler argued, the mandate to limit patient revenue growth necessarily meant cuts to patient care. The network could not afford further commercial insurance cuts, he said.“If we cut our rates, let’s say, to minus 5%, then we would have to reduce our expenses by that amount as well, right?” Leffler said. “So now you’re talking about taking another 30-plus million dollars out of expenses that would have to come out of patient care. There’s no other place for $30 million of money, of expense, to come out.” Leffler did not provide firm timelines for most of the planned changes, although he said that UVM Medical Center would lower its census from 450 beds to 400 beds over the next six months. The first part of that reduction, a closure of nearly 20 beds, will come by the first week of December, he said. The network is seeking to pause a Green Mountain Care Board order cutting its commercial insurance rates —  a pause that, if granted, could allow it to “reevaluate” the cuts, he said.  Some of the reductions will target services that are already in short supply across the state. Closing the Waitsfield family medicine clinic, for example, means that the facility’s primary care providers will relocate to Waterbury — meaning, potentially, a longer drive and reduced access for many patients.Both locations have waiting lists of 500 or more people seeking to become patients, according to Barry Bolio, the operations support specialist at the CVMC Family Medicine at Mad River. “How is that not going to flood that system?” Bolio said in an interview. “If nothing else changes — if we just take this clinic and transplant it into another building — I don’t see where that does anything other than just shuffle the deck chairs on the Titanic.”Desiree de Waal, the treasurer of the Vermont Kidney Association, said in an email that the organization was “surprised at the announcement” of changes to the UVM Health Network’s transplant unit and dialysis services in Rutland, St. Albans and Newport.Photo by Glenn Russell/VTDigger“Dialysis patients are dependent on transportation to dialysis which is scarce and challenging in a rural state,” de Waal wrote. “The dialysis units affected in the announcement are in the areas of Vermont that have challenging transportation needs.”UVM Health Network has said that it is in discussions with other hospitals about maintaining the dialysis centers.In central Vermont, the news about the shuttering of Central Vermont Medical Center’s inpatient psychiatric beds elicited “shock and real fear about what happens to people,” Rep. Anne Donahue, R-Northfield, said in an interview. Just last year, in fact, UVM Health Network told the Green Mountain Care Board that it planned to invest $4.5 million — part of an earlier surplus of approximately $20 million — into improvements for that unit. Roughly six years ago, the board ordered the network to invest that surplus into expanding the state’s inpatient mental health capacity. Now, plans to close it represent an abrupt about-face for the network. Annie Mackin, a spokesperson for the UVM Health Network, said that leaders are still committed to spending those funds on bolstering mental health capacity in Vermont.  The network has invested in “integrating mental health clinicians in all of our primary care practices, including at CVMC,” Mackin said in an email. “We would like to explore repurposing funds to support a mental health urgent care service in central Vermont.”But Donahue, who is on a psychiatric advisory committee at the hospital and has spent time as a patient in the psychiatric unit, said that the change could potentially put people with mental illness in danger. “These are people who are at risk of their lives,” Donahue said. “You don’t get admitted to inpatient care because you’re feeling depressed. You’re admitted to inpatient care because you’re at immediate threat — if you’re not stabilized — you’re at threat of dying by suicide or something along those lines.”Read the story on VTDigger here: UVM Health Network cuts elicit dismay, frustration.