The Board of Directors of the Mad River Valley Health Center, Inc. would like to provide a further update on the decision of Central Vermont Medical Center (CVMC) to close the clinic here in The Valley.
Dr. John Wilson has decided to leave CVMC, and he will be starting his own clinic here. The clinic that Dr. Wilson will be starting will be based upon the small patient volume model – maximizing on time with patients and focusing on disease prevention. This model gives patients more direct access to the doctor. This model does limit the number of patients that a doctor can see, but it also means that the doctor can spend more time with each patient, often offering same-day or next-day appointments and being more available through phone, email, and even house calls. A retainer fee is paid for this service which generally covers the doctor’s availability and time but is separate from a patient’s insurance.
Both the Board and Dr. Wilson are acutely aware that such a practice may not be the ‘ideal’ solution to the decision by CVMC to close its clinic here. However, having looked at a number of other potential options, this is the only one that Dr. Wilson feels can work financially.
It must be noted that many other alternatives have been considered. One was Gifford Health Care. Initially, Gifford seemed to be a good fit as they are a Federally Qualified Health Center. As such they qualify for a higher rate of reimbursement for Medicaid and Medicare purposes and their primary care providers would have enhanced options with respect to paying off any medical school loans. After reviewing information provided by CVMC pursuant to a nondisclosure agreement and talking with providers at The Valley clinic, Gifford came to the conclusion that they would not be able to sustain the practice here without extraordinary changes, which changes they felt would make the odds of success pretty low. Another seemingly good option was PrimaryCare Health Partners. They are a network of medical offices with practitioners in family medicine, internal medicine, and pediatrics with locations in Vermont and upstate New York. They too were able to obtain certain financial information from CVMC pursuant to a nondisclosure agreement. They typically work with primary care providers in assisting them in establishing independent practices. Given the uncertainty of funding for independent practices, they came to the conclusion that The Valley clinic would not be a viable practice that they would be willing to partner with. The Board also had discussions with ClearChoiceMD, a ‘for profit’ company specializing in urgent care clinics. They too, after reviewing financials provided by CVMC pursuant to a nondisclosure agreement, concluded that their type of clinic would not work here. The Board also spoke with Vermont HealthFirst. Vermont HealthFirst is a similar entity to PrimaryCare Health Partners providing support to physicians who are trying to operate their own clinic. Vermont HealthFirst works with Evergreen Family Health which has several clinics in Williston and Essex. Those discussions never progressed to any viable solution either. Discussions were also had with Dartmouth-Hitchock, but they were not interested in establishing a clinic so far away from their main base of operations.
Having exhausted many other options, when Dr. Wilson asked if the Board would be willing to rent space to him for his proposed new practice, the Board agreed. Dr. Wilson has indicated that he wants to remain here in The Valley and wants to continue to see patients here. While not all potential patients will be able to utilize this new service, the Board determined that there were no other solutions available. Note too that Dr. Wilson will not be utilizing all of the space that CVMC has been renting, so there remains room for some other type of practice if one can be found.
Most everyone would agree that keeping CVMC here at the clinic would have been the preferred result. However, after months of discussions with them, the Green Mountain Care Board, representatives from the Governor’s office, Senator Sanders’ office, our state representatives, members of the Board of Trustees of UVM Health Network, and others, there is no realistic chance that CVMC will change its mind about the closure.
The most recent meeting that representatives from the Board had with Anna Noonan (president and COO of CVMC) was on April 30, 2025. Also present at that meeting were two members of the CVMC Board of Trustees, Joyce Judy (the current chair), and Erica Hare (the vice chair). Not surprisingly, there was no change in CVMC’s position to close the clinic here. We talked about the impact of the settlement agreement between the University of Vermont Health Network (UVMHN) and the Green Mountain Care Board (GMCB) that was made in April. That settlement agreement requires UVMHN to spend $11M to fund primary care providers. The Board had been hopeful that this funding obligation might provide an opportunity to keep The Valley clinic open. According to Anna Noonan, this $11M funding obligation is to be used for “non-hospital” primary care providers, i.e., those not in the UVM Health Network. According to CVMC, the GMCB was concerned about the viability of those remaining independent practices and that this funding obligation was about those clinics and not those within the UVM network.
At that meeting Anna Noonan also claimed that the CVMC decision has been made carefully and with the input of their own initial consultants. She also pointed out that three different entities (Gifford Health Care, PrimaryCare Health Partners, and ClearChoiceMD) all looked at the financials and came to the same conclusion that CVMC has, i.e., that this practice is not financially sustainable. She did also claim that CVMC has looked at this practice in the past with a possible view towards closing it. She maintains that while the GMCB’s original order was the primary impetus to close, it is not something CVMC has not previously considered.
The Board has repeatedly asked CVMC to disclose the financial information that led to their decision to close the clinic. The Board had also requested the Green Mountain Care Board to require CVMC to provide more details, but again with no success. Legally, CVMC as a charitable entity, is only obligated to provide copies of their tax returns. Those returns only show total income and expenses without any breakdown by clinic. We have tried to convince CVMC that providing at least some financial details would go a long way in improving the negative view many in The Valley currently have of CVMC, but they contend that they have provided the GMCB with all of the financial information it requested and that because some of that information is competitively sensitive, they were allowed to file that information under seal. Without this disclosure, it is impossible to determine what has changed so dramatically since Dr. Cook ran the practice here, apparently successfully. In fact, CVMC purchased the practice from Dr. Cook, apparently thinking it was valuable enough to purchase. Less than 10 years have elapsed since that sale and CVMC is now telling us that the practice cannot be sustained. Despite our protestations, CVMC remains resolute in refusing to provide reasonable answers.
The only explanation that CVMC has provided to us is as follows: “The landscape of health care in Vermont, and across the country, has changed dramatically over the past decade. Providers across the country and our state are dealing with the impacts of increased costs in pharmaceuticals, medical supplies, provider and staff recruitment, wage increases required for the workforce to stay competitive in the market, just to name a few. These factors coupled with low reimbursement rates that have not kept up with rising costs of providing care, have made providing these services extremely challenging. Those costs combined with our aging population, with higher utilization rates for services, compounds the challenges associated with running a practice in a rural area.” While some of those statements may be broadly correct, it is still difficult to accept the CVMC decision without more detailed financial information.
Clearly, changes need to be made to our health care system. Unfortunately, those changes can’t come fast enough to help save our clinic here.
As noted above, Dr. Wilson will not be utilizing all the space that CVMC has been renting, so there remains room for some other type of practice if one can be found. The Board will continue to pursue alternative options to find another tenant whose purposes and activities are incidental or related to the provision of health services in the space that will remain available once CVMC moves out. The Board would welcome any concrete leads with respect to such a prospective tenant.
