Larner Medical School. Photo by Bob LoCicero/VTDigger When Green Mountain Care Board chair Owen Foster first started to dig into Vermont’s hospitals’ budgets, one question kept surfacing: Where could all the money be going?  The solvency of the state’s primary commercial insurer was te etering. Vermonters paid some of the highest rates for healthcare in the country. And still, hospitals’ budgets were tight. How could there not be enough money? Part of the answer, Foster said, lies in the Larner College of Medicine and graduate medical education training at the University of Vermont Medical Center.  In a late July memo, health policy analyst Nancy Kane, who is a professor at the Harvard T.H. Chan School of Public Health, determined that it cost UVM Medical Center $161 million to run its medical education programs in 2025. Of that, $82 million came from commercial insurance payers, Kane found — as in, average Vermonters relying on the UVM Health network for care. She estimated that number would be on track to reach $88 million for 2026.  Now, the care board is asking the medical center to provide more information so the state can better understand Larner’s finances and how the college is serving Vermont’s needs. The medical center is on board. “I personally see this as an opportunity to do a better job at sharing information with the board about what we’re spending our money on,” said Dr. Ramsey Herrington, who leads UVM Health’s Medical Group. “I think it’s an opportunity for us to also think about what needs we’re meeting in our educational program, and what other needs are out there for Vermonters.” The care board approved annual budgets for Vermont’s 14 regulated hospitals earlier this month, and the directives for UVM Medical Center’s budget hinged on the medical center and its affiliated medical college improving their financial transparency.  Vermonters who buy their health insurance through the state’s Affordable Care Act marketplace pay some of the highest premiums in the country. In recent years, the care board’s budget orders have targeted what hospitals charge commercial insurers in an attempt to reign in healthcare spending. Kane, the health policy analyst, determined that only a few senior leaders at UVM Medical Center, the medical school and the affiliated medical group understood and decided what money moved where. She called the whole process a “black box.” Now the care board wants to open that black box.   The Sept. 14 care board order requires the hospital to form a public working group alongside representatives from the medical school, the care board, the office of Vermont’s Health Care Advocate, smaller rural hospitals, federally qualified health centers and other independent stakeholders.  The group must examine the role, expenses and “measureable benefits” of both the Larner College of Medicine and the medical center’s residency programs. They have until Dec. 15 to prepare a plan for how UVM Medical Center should financially support medical education.  At that point, the care board has a month to vote on whether or not to approve the proposal.  Foster said he will be looking for strategies the school can employ to fill gaps that Vermont hospitals have typically filled with expensive traveling nurses or temporary clinicians, called “locums.”  Herrington, with UVM Health’s Medical Group, said that looking across the state at where there are the longest delays in patient care, where there are the most locums and where Vermonters spend the most money on out-of-state clinicians will be key to identify the gaps that medical education can try to fill. He also pointed to primary care, mental health care and anesthesiology as some of the clearest needs.  “Our strategy for where we’re going to expand across the entire spectrum of medicine should be meeting the needs of the health system and of the region,” he said.  Just expanding the number of residents, even if they don’t stay in Vermont, could have its benefits. Residents are some of the most “efficient” parts of the workforce, Herrington said. The federal government contributes money for residents’ salaries and training. That’s a good return on investment for how much a hospital spends on training and paying a resident physician, he said. Still, Herrington wants learning to be at the core of how UVM spends its medical education funding.  “It just has the other added benefits of helping take care of our patient population and creating the pipeline,” he said. Mike Fisher, the state’s healthcare advocate, hopes that the working group can, at the very least, serve as a gathering ground for ideas of how Vermont might be able to get these benefits without relying so heavily on commercial insurance payers to foot the bill.  “What are the options? What are other states doing? What are other medical schools doing?” he said. “Maybe there are no options, but we should at least kick those tires.” If the working group’s December plan fails to garner the support of a majority of care board members, it will trigger a series of reporting requirements on the medical center intended to yield similar accountability and transparency as the working group. Read the story on VTDigger here: Regulators wanted more transparency on Vermont’s medical education. Now they’re getting it.. ...read more read less