VPQHC urges lawmakers to build quality measures into S126, outlines suicide-prevention and pediatric psychiatry supports

Hillary Wolfley, executive director of the Vermont Program for Quality in Health Care (VPQHC), told a legislative committee on April 25 that quality should be explicit in any statewide health‑care redesign and that VPQHC stands ready to help shape S126’s measurement and safety provisions.

VPQHC wants a formal role in the bill’s advisory structures and funding to participate. "Picture this like a three‑legged stool," Wolfley said, urging legislators to weigh access, cost and quality together when evaluating reforms.

VPQHC, designated by the Vermont legislature as an independent, non‑regulatory peer‑review organization, described three programs it said are relevant to S126: a statutory patient‑safety surveillance and improvement system, an emergency‑department suicide‑prevention quality‑improvement initiative, and a pediatric/perinatal psychiatry consultation line that supports primary care.

The patient‑safety program, operated under contract with the Department of Health, collects adverse event data from hospitals and ambulatory surgery centers and helps facilities conduct causal analyses. "Analyses of patient safety work product should not be admissible, for example, into the court of law," said Morgan Bedard, a quality improvement specialist at VPQHC, describing legal protections that encourage candid reporting and learning. VPQHC told the committee the program uses National Quality Forum definitions for serious reportable events and that the statewide view helps detect system‑level trends beyond any single institution.

On emergency‑department suicide prevention, VPQHC described a collaborative initiative launched in March 2022 that uses evidence‑based care pathways, training, lethal‑means counseling and workflow support. Presenters said the program has trained more than 400 ED staff and that all of Vermont’s emergency departments participating in the third year are implementing pathways that align with the project’s essential elements. VPQHC highlighted a Northwestern Medical Center example in which, during the first eight weeks after universal screening began, staff identified 251 patients with suicide‑related concerns; 53 were actively considering suicide and 11 disclosed suicidal thoughts although they had arrived for non‑mental‑health issues. VPQHC said the initiative informed Vermont’s model protocol for suicide prevention submitted by the Department of Mental Health and has been recognized by outside organizations including Pew Charitable Trusts and the Federal Office of Rural Health Policy.

Greta Spottswood, child psychiatrist and medical director of the Vermont Consultation and Psychiatry Access Program (now under the VPQHC umbrella), described the consultation line that provides immediate psychiatric consultation to primary‑care clinicians. VPQHC said the program has registered 100% of pediatric practices in Vermont and has supported more than 1,300 calls; it reported that 85% of primary‑care providers said the service improved their working life and that 60% of callers would otherwise have made immediate specialty referrals.

On funding and capacity, Wolfley said VPQHC receives $660,000 annually in bill‑back funding and that amount cannot exceed 75% of its operating budget; VPQHC reported that bill‑back funding currently accounts for 29% of its total operating budget and that the organization also relies on grants, contracts and philanthropy. VPQHC told the committee the Department of Health contract specifying bill‑back work is renewed every two years and said additional appropriation would be needed for the group to perform new duties created by S126.

VPQHC recommended that the S126 delivery plan explicitly call for the identification of opportunities to improve quality, enhance quality reporting and data collection, and share exemplars of high quality care. The organization also said it is already in discussion with state officials about joining the state health‑information exchange steering committee to support data access for quality work.

The presenters asked legislators to include VPQHC in the bill’s advisory committee or otherwise formalize the organization’s advisory role so it can help monitor and implement the delivery plan and related quality measures. They also cautioned that some statutory and federal protections — such as the patient‑safety work product protections described under federal law — should be preserved when data are used for system improvement.

VPQHC offered to provide the committee with its written comments on S126 and said staff would return to brief lawmakers on any section where the committee sought more detail.

Ending: The committee did not vote on language; committee members asked follow‑up questions on VPQHC’s budget and the sustainability of grant funding. VPQHC said it would provide requested budget figures and reiterated its offer to collaborate with the Green Mountain Care Board and other stakeholders on the bill’s quality, data and implementation elements.