Medical Group Will Lobby To Get Provider On Health Care Board

Dec 4, 2017

A key medical group says doctors do not have enough representation in health care oversight, and will take its case to the Vermont Legislature.

Who should be at the table making decisions that affect your medical care? One advocacy group thinks clinicians should be, and the group says Vermont should have a law saying so.

Jessa Barnard represents doctors and physician assistants at the Vermont Medical Society. The organization wants the Legislature to pass a law in 2018 saying that at least one of five seats on a health care regulatory panel should go to a clinician.

That panel, called the Green Mountain Care Board, regulates hospitals, health insurers, and companies that are trying to change the way doctors work with their patients. Up until a year ago, two clinicians sat on that five-member board.

One of them, a nurse practitioner, left her post in January, and Gov. Phil Scott replaced her with a financial analyst. The other, a family doctor, left his post about a year ago and former Gov. Peter Shumlin replaced him with a health policy expert.

Now, there are zero clinicians on the board. And Barnard sees a problem.

"That clinician perspective is unique, and having someone who’s been in the exam room with patients and managed patient care and seen how health care works on the ground is a necessary and valuable perspective," Barnard says.

She says that on-the-ground experience can help other regulators on the board understand whether a great concept on paper would translate to better patient care in the exam room.

"That clinician perspective is unique, and having someone who's been in the exam room with patients and managed patient care and seen how health care works on the ground is a necessary and valuable perspective." - Jessa Barnard, Vermont Medical Society

Barnard is pushing for the law change just weeks after Scott chose a retired government official, Tom Pelham, to take an open seat on the Green Mountain Care Board.

Pelham is not a clinician. He managed government finances under four different governors. He's a controversial figure in some political circles, known for his fiscal conservatism and strong opinions.

Scott chose Pelham from a list of names he received from a multi-partisan group of lawmakers who sit on a nominating committee. Barnard had encouraged her members to apply for the post, and she says there were two clinicians who ended up on that list, including a doctor. Neither of them was chosen.

And she says her advocacy to have a clinician on the board started long before Pelham’s appointment.

"Our policy on having a clinician on the board is not in response to any particular board member or recent appointment," Barnard says. "That's been in the works since our board met over the summer, so it's an overall policy and direction we hope to see the board go regardless of any specific member on the board."

"Our policy on having a clinician on the board is not in response to any particular board member or recent appointment."

Sen. Ginny Lyons, a Democrat from Chittenden County, agrees with Barnard. Lyons says she is writing a bill that would require a clinician to sit on the board. She called the issue "critically important."

"The Green Mountain Care Board is of course charged with containing costs but at the same time, improving quality and increasing access to care. So you can’t just address cost," she says. "If you do that, you might be throwing the baby out with the bathwater."

However, it's not clear if the governor’s office will support the bill Lyons is writing.

Rebecca Kelley, the governor’s spokeswoman, says there should be a discussion about appointing a practicing clinician because, for example, governors do not appoint utility executives to jobs regulating utility companies.  

"It's a discussion that I think maybe we should have … particularly if there’s legislation being proposed to change the statute," Kelley says.

Meanwhile, Kevin Mullin, a businessman who serves as the chair of the Green Mountain Care Board, says the board wants more input from clinicians. He says the board is moving forward with strengthening an existing advisory panel of 21 primary care clinicians.

"You can only do your job if you have the best information available, and so it just gives a different perspective of information that maybe someone with a financial background may not understand," Mullin says.

Mullin's change would also require the Legislature to change Vermont law.

This story was updated at 5:30 pm on Tues., Dec. 5 to include additional information about recent vacancies on the Green Mountain Care Board.