This commentary is by Steven Lidofsky of South Burlington. He is director of hepatology at the University of Vermont Medical Center and a professor at the University of Vermont Larner College of Medicine, where he has worked for over 27 years. He is completing a term as chair of public policy for the American Association for the Study of Liver Diseases.The health care landscape in Vermont continues to be roiled by recent decisions spurred by the Green Mountain Care Board, a state-authorized regulatory authority with a mandate to control health care costs. Under siege is the University of Vermont Medical Center, where I work.In 2023, the Board engaged a team from Oliver Wyman Management Consulting to examine the health burden in Vermont and to develop cost-effective solutions to reduce it. The report, released this past summer, accurately diagnosed systemic problems that have prevented many Vermonters from living in good health. It also contained a cost-conscious treatment plan to correct these ills.However, the reasoning behind the plan was based on assumptions that were not always correct, and the result was a series of prescriptions for a regimen of bitter pills. The Board is on track to follow the Oliver Wyman blueprint. One of the key issues identified in the report was patient access to clinical care. Rather than focusing on problems with the supply and distribution of clinicians accessible to patients (and with sufficient personnel to support the infrastructure that coordinates appointments), the report focused on clinician productivity, which was judged to be inferior. The implication was that if clinicians could be harnessed to see more patients in a shorter period of time, that would improve access.READ MORE To justify their opinion, the Oliver Wyman team turned to the Sullivan Cotter Survey, a nationwide database of health care professionals. According to their analysis, clinician productivity at UVMMC was well below the database median. The report consequently recommended that UVMMC take actions to boost clinician productivity to exceed the 60th percentile.There are several troubling aspects with this, not the least of which is that if the median of the Sullivan Cotter database is a reasonable benchmark for productivity, then the median (and not higher and higher percentiles) should be a satisfactory target for UVMMC. Of course, whether the database is a fair comparator can be debated. But there is more to it than just that. A limitation of the logic used by the Oliver Wyman report starts with the definition of productivity. As written by the United States Bureau of Labor Statistics, “Productivity is a measure of economic performance that compares the amount of goods and services produced (output) with the amount of inputs used to produce those goods and services.”The Sullivan Cotter database measures clinical productivity from relative value units, or RVUS, a byzantine scale developed by the Center for Medicare and Medicaid Services to determine payments for clinical appointments and procedures. In other words, from Sullivan Cotter’s viewpoint (and by extension, Oliver Wyman’s), productivity output equates with volume of RVUs generated, but it does not account for improved outcomes in human health. Clinicians often spend considerable amounts of time, which are not captured by RVUs, such as reviewing test reports, responding to messages from patients, and communicating with other clinicians who are also involved in the care of these individuals. Although these actions are likely to have a benefit on health, their worth cannot be measured easily. Ironically, if they reduce the need for appointments or procedures, then clinical productivity, according to Sullivan Cotter metrics, would decrease as well.The Oliver Wyman report may have also neglected the fact that many clinicians at UVMMC, the principal teaching hospital of Vermont’s only medical school, receive salary support, independent of health care dollars, for activities beyond direct patient care, including training the next generation of physicians and conducting medical research. Although these clinicians may appear to be underproductive by Sullivan Cotter standards, their cost to the health care system may not be as high as those who are involved exclusively in patient care. This plus other flaws in the Oliver Wyman report could be taking the Green Mountain Care Board in the wrong direction. The Oliver Wyman report has failed to recognize that the value of work performed by clinicians cannot be quantified as goods and services. Human health is priceless, and those who work to preserve it are not widgets. To be sure, the system of health care delivery is in sore need of improvement, but the way to start is to examine how it can function with greater creativity and efficiency.The report’s solutions are reminiscent of a chocolate factory scene from the mid-twentieth century situation comedy “I Love Lucy,” in which the two leading ladies struggle frantically to keep up with an ever rapidly speeding conveyor belt, with predictable results. The emphasis on improving health care should not be to drive clinicians to generate greater volumes of services in shorter periods of time, but to tailor these services to meet the health care needs of the population. If the Green Mountain Care Board chooses to drive clinicians to work harder and faster than they are already doing, it may instead drive them out of the state, and the consequences will be far costlier than the Board ever envisioned. Read the story on VTDigger here: Steven Lidofsky: The Green Mountain Care Board needs a vision exam .