Seven Days

By Colin Flanders

Patients continue to wait weeks and months for specialty care at Vermont’s largest hospital, new data show.

The University of Vermont Medical Center is seeing only about one third of new patients within two weeks of a referral to a specialist, far short of its stated goal of an 80 percent success rate. And about half of patients are waiting at least a month. That’s according to a report submitted to state regulators this month reflecting a two-week period in June that covered some 7,600 patient referrals.

The data snapshot suggests that delays at UVM may be worse now than they were at the height of the pandemic. The hospital reported last year that it was seeing 46 percent of new patients within two weeks. That report did not disclose the raw number of referrals, however, making direct comparisons difficult.

The release of the new wait time data comes as the UVM Health Network is asking state regulators for permission to charge insurance companies an extra $140 million next fiscal year to help cover rising inflation and labor costs at its three in-state hospitals. The Green Mountain Care Board expects to hand down its budget decisions next month.

UVM officials say the latest wait time figures don’t fully capture the progress they’ve made in expanding access at its specialty clinics.

“We feel there’s been improvement,” said Jason Sanders, executive vice president of clinical affairs at the UVM Health Network. At the same time, “we very much recognize we have much work to do and are fully focusing on that.”

A Seven Days investigation last year found that the long-simmering problem of appointment delays at UVM reached a boiling point amid the pandemic.

More than two dozen people told the paper that they had struggled to get timely specialty appointments despite suffering from painful and debilitating ailments. Staff members said they were burning out under immense workloads and the frustration of not being able to provide high-level care.

A state probe concluded that wait times were problematic across Vermont, but especially bad at UVM, where new patients were waiting an average of about 100 days to see a specialist.

The UVM Health Network released a plan last fall for reducing wait times, promising to step up recruitment and retention efforts, expand a centralized scheduling system and better leverage technology.

Network leaders say they’ve made notable improvements since then. The centralized scheduling system has helped hundreds of UVM patients secure faster appointments, often by sending them to the Central Vermont Medical Center in Berlin. A new MRI machine has helped trim a backlog in radiology from eight weeks to six and a half.

The hospital has also expanded its use of “eConsults,” which allows primary care providers to virtually check in with specialty physicians instead of referring their patients for an appointment. The service has been used about 175 times this year, hospital data show, helping dozens of patients get answers more quickly.

Still, as the newest data show, challenges remain.

In addition to the 14-day window, the hospital’s report publicized for the first time how often patients’ waits extended beyond 30, 90 and 180 days. About 300 people were given waits of six months or more.

Most of those waits came from just a handful of clinics: About 75 of the patients waiting longer than six months were seeking gastroenterology appointments, while another 90 patients were waiting to get in to the memory care clinic.

Sanders, the UVM executive, blamed the continued struggles on workforce challenges.

Despite vowing to ramp up physician recruitment, the hospital has barely managed to keep pace with its turnover, adding only three new doctors to its roster this year. Efforts to fill positions have sometimes been hampered by Vermont’s tight housing market, according to Sanders. One specialist from California who signed an offer letter ultimately backed out after failing to find a place to live. Another hire is currently in limbo for the same reason.

Meanwhile, demands on existing staff have only grown. Patients are showing up sicker than they used to and are staying in the hospital longer on average. Specialists who normally work in outpatient clinics have been asked to help on inpatient floors, limiting their availability.

“Access isn’t just specialty care. It’s making sure we can provide inpatient care, critical care,” UVM spokesperson Annie Mackin said. “A lot of the access work has been, for better or worse, focused on that kind of access.”

For now, regulators with the Green Mountain Care Board seemed satisfied with the latest wait times update. One of the only comments about the data on Friday came from Jessica Holmes, interim chair, who lauded the network for its improvement initiatives.

“I share your optimism that maybe these wait times will fall by next year,” she said.