Bill would make hospitals subject to open meeting law


Should Vermont hospitals be subject to the state’s open meeting law?

That’s the question legislators will consider Wednesday at a joint hearing of the House and Senate health committees . If House Bill 440 is enacted, the government transparency law  would apply to board meetings for hospitals and accountable care organizations come July 1.

“I think hospitals essentially operate as public institutions. They account for an enormous amount of our taxpayer dollars,” he said. “We should be able to better understand their decision-making processes. … As we engage in an era of health care reform, we ought to be opening up the process to public scrutiny whenever possible.”

Democratic Sen. Claire Ayer, who chairs the Senate Health and Welfare Committee, had a similar bill drafted, but she hasn’t introduced it. She said she wants to mull it over.

“We want to know if it makes sense for hospital meetings to be subject to the (open meeting) law,” she said. “The reason is that more than half of their dollars come from the public … so we have a real public interest in seeing that they’re well spent.”

But hospitals aren’t so keen on the idea. They point out that they are not government entities and that their budgets are subject to a public review process by the Green Mountain Care Board, which must adhere to the open meeting law.

The Vermont Association of Hospitals and Health Systems notes that the federal Centers for Medicare and Medicaid Services survey hospitals every three years and investigate patient complaints. When hospitals bring on new services and make capital improvements, they also must obtain a certificate of need from the state. The hospital association also points out that nonprofits have competitors, including those across state borders.

“We understand Vermonters are concerned about changes to how they receive and pay for their health care,” said Jill Olson, the association’s vice president of policy. “The open meeting law is an overly blunt instrument that could impede a constructive decision-making process. Community hospital board members should have the opportunity to consider and debate proposals before presenting them to their communities and regulators.”

Fletcher Allen Health Care shares the association’s position, spokesman Mike Noble said. Fletcher Allen’s board provides time for public input at each board meeting, he said.

“Fletcher Allen board meetings have had a period for public comment at the beginning of each meeting since it was founded in 1995,” he said. “Further, a portion of the board meetings (is) open to the public beyond the comment period. We publish a notice for those meetings in the Free Press and on our website.”

Democratic Rep. Mike Fisher, who chairs the House Health Care Committee, said he’s concerned that in light of the many federal and state regulatory shifts being thrust upon hospitals in the next year, such a bill might hinder their ability to quickly adapt.

“There are a lot of changes going on in the world of health care delivery at this moment, and while open access to decisions that affect the public is important, this is a difficult time to be making major changes like this to private nonprofits,” he said.

Last week, the Green Mountain Care Board met with leadership from the 501(c)(3) nonprofit Vermont Health Care for All — a single payer advocacy group, which is pushing for the hospital open meeting bill. The nonprofit representatives told the board that they support greater transparency, not necessarily the bill’s exact language.

Con Hogan, a board member and former secretary of the Agency of Human Services, said that if the group desired more transparency, it should take a different track.

“You’re on a worthy hunt here, but my thought would be that you really do need to redo this — not to make it part of the open meeting law, but to get it done in another way,” he said.

Ellen Oxfeld, a Middlebury College professor and vice president of the nonprofit, told the board that she fears another incident like Fletcher Allen’s Renaissance Project, when millions of dollars in costs were kept off the books and executives went to jail.

“That will not happen again,” said Dr. Allan Ramsay, a Green Mountain Care Board member who formerly worked at Fletcher Allen.

Ramsay said he is concerned that hospital boards don’t represent the true diversity of the populations they serve. If boards aren’t held accountable by an open meeting law, he said, they should at least better represent the public.

“I’ll give you an example,” Ramsay told Bea Grause, the hospital association’s president. “On a (Federally Qualified Health Center) board more than half the board members have to be enrolled as patients. And, at least in the community health center in Burlington, one member at one point had to be homeless. That’s diversity.”