Message from the CEO
Most of my recent columns have been about COVID, which makes sense given it has been such a dominant feature of our lives for two plus years now.

Today, I write about another deeply concerning, but really important, issue: the Green Mountain Care Board and its role in our health care system.

There is no other state that regulates hospitals as completely as the GMCB does in Vermont. Accountability and oversight matter, so effective regulation can protect consumers and health care providers.

Unfortunately, our regulator has lost its connection to reality and reason.

Why such a bold statement? Because in the third year of a pandemic that has upended our lives and our health care system, with hospitals struggling against a staffing and capacity crisis, the GMCB has introduced the idea of moving or subtracting hospital beds.

That’s right. They hired consultants who concluded that we have too many hospital beds in Vermont. And then talked about that strange conclusion publicly as we face another COVID surge and intensifying personnel shortage like nothing we’ve ever seen.

For perspective, our hospitals collectively have fewer beds per capita than most other states in the nation. And right now, as I draft this column, there are 10 ICU beds available in the entire state when we still don’t know the worst Omicron will bring in terms of hospitalization.

GMCB members are quick to say they do not intend to actually carry out the capacity recommendations. But then they spend hours and hours of taxpayer-funded time voicing interest in the controversial ideas.

Just last week, the GMCB featured in its public meeting four consultants to opine for over three hours on Vermont’s hospital system. It was a wild ride: one consultant questioned whether there is really a workforce shortage (which is offensive and outrageous). Another criticized our reform efforts with scant evidence, and a third used decades-old data to make blurry points about today’s hospital capacity.

I am usually a glass half full kind of guy, and it is difficult to shake my optimism. In Vermont especially, I know we can create positive change by working together. Just look at what we have done with our COVID response and with health reform—a work in progress, but also solid steps in the right direction:

  • Nearly every hospital and more than 5,000 total health care providers now participate in the effort to keep people healthy and prevent painful and costly medical interventions later
  • The federal government recently said our reform work shows spending reductions and declines in hospital stays and readmissions
  • In the past three years, hospitals have invested $80 million to focus on outcomes and quality.

So, when I hear regulators disregarding this progress and instead dreaming up ways to move critical beds around and force Vermonters to travel much further for their care, possibly even out of state, I lose my optimism. In fact, I get worried and frightened.

If changes to our health care capacity take place, it should be through a process led by patients, communities and health care providers, not regulators and bureaucrats.

In Vermont we make the most progress working together; we have proven that time and again. It is one of the many reasons I call Vermont home.

As the next few crucial months unfold, I hope to write about the real issues facing our health care system and what we are doing together to address them so that we can recover from the pandemic and make care better and more affordable for Vermonters.

VAHHS and hospitals stand ready to do that.
Legislative Update
Devon Green, VP of Government Relations

A State House Divided…

Late last week, the House overwhelmingly voted to return in person tomorrow with exemptions for those who request it. The Senate will continue to work remotely.

How will this hybrid legislating work? What will happen to all of the non-legislator denizens? Will this allow more or less transparency and access? Stay tuned!

Health Care Workforce: The House Appropriations Committee passed its FY 2022 budget adjustment, including:

  • $60 million, up from the governor’s proposed $33 million in retention funding for health care workers with priority for employers with highest need and greatest impact. These numbers include home- and community-based health care workers.
  • $25 million to cover current traveler contracts, including those for ICUs and long term care facilities
In the House Health Care committee, Dan Bennett, CEO & President at Gifford Medical Center, testified to the impact the health care worker crisis is having on his hospital. VAHHS requested legislative language that would require the Green Mountain Care Board to recognize labor costs and investments during the hospital budget process for fiscal years 2022 and 2023.

Extending regulatory flexibilities: The Senate Health and Welfare and House Health Care committees continued to work on regulatory flexibilities for health care organizations, assigning a number to the committee bill in record timing. Representatives from the Health Care Association Coalition, which includes VAHHS, supported extending almost all of the regulatory flexibilities until March 31, 2023 and came to an agreement with the Office of Professional Regulation and Board of Medical Practice to extend the flexibility for out-of-state licensees practicing in Vermont until March 31, 2023 with the parameter that anyone practicing longer than six months must obtain a Vermont license.

Prohibition of Firearms in Hospital Buildings: Along with VAHHS, Dr. Ryan Sexton, from Northeastern Vermont Regional Hospital and Claudio Fort, President & CEO of Rutland Regional Medical Center, testified in favor of prohibiting guns in hospital buildings. All stressed that a hospital is a place full of vulnerable patients and workers where emotions can run high. They advocated for S. 30, which would allow health care workers to call law enforcement immediately for help, rather than having to confront the gun owner as required now under current trespass law.

Mask Mandate: Continuing its forward momentum, the Senate Health and Welfare Committee took up the issue of a statewide mask mandate with a draft bill that they plan to vote out on Tuesday. The bill requires all individuals two years and older to wear a mask or cloth facial covering in public indoor spaces, with some limited exceptions. The mandate would stay in place until county transmission rates are below “substantial” as determined by the CDC.

Patient Choice at End-of-Life: The Senate Health and Welfare Committee also heard testimony on S.74, which eliminates certain barriers to the current end-of-life law and broadening immunity to anyone acting in good faith under the law, including pharmacists and other members of the care team.
In the News
Omicron forecast to cause major Vt. disruptions in coming weeks

Delayed COVID numbers from Vermont Health officials released on Wednesday show the impact of the omicron wave that has yet to crest.

Officials say the updated numbers show more than 10,000 new COVID cases in just the last week. With infection rates forecast to reach upwards of 6,000 cases daily, the state is preparing for the impact of possible mass quarantines.

While omicron appears to be less severe than Delta, especially among fully-protected Vermonters, it’s spreading like wildfire. “Many are talking now about not if but when,” said Vt. Health Commissioner Dr. Mark Levine said Tuesday.

Even with record-high case counts, leaders say many cases are going unreported. Fully vaccinated and boosted Vermonters are highly unlikely to experience a severe case, but Governor Phil Scott is concerned that with thousands testing positive and quarantining, it could have a major impact on schools and the broader workforce. “My concern is making sure that we provide for those essential services,” Scott said.
Covid hospitalization hot spots across the U.S., in five charts
NBC News

Covid-19 hospitalizations are once again ticking upward after a lull in October and early November, with tens of thousands more people filling hospital beds across the country in the past two weeks.

The increase is particularly noticeable in certain Midwestern and mid-Atlantic states. As of Friday Jan. 14, Washington, D.C.'s population-adjusted rate is highest in the nation, followed by Delaware and New Jersey.

States in the South are seeing the largest change in hospitalizations in the past two weeks.

Track the hardest-hit states with this NBC News analysis of U.S. Department of Health and Human Services Covid hospitalizations data. This article will be updated daily.

UVM Medical Center imposes emergency staffing as Covid sidelines more than 400 employees

Citing severe staffing shortages amid the Omicron surge of the Covid-19 pandemic, leaders of the largest hospital in Vermont plan to impose emergency staffing policies on Thursday, according to an email a top University of Vermont Medical Center official sent employees this week.

Emergency staffing procedures are an extraordinary — and typically temporary — measure hospitals can employ in order to remain sufficiently staffed to remain open. If staffing levels remain inadequate, hospitals may have to turn patients away and refuse transfers.
Two years into the pandemic, the state of Vermont's nursing workforce

Live call-in discussion: The shortage of nurses in Vermont has reached a crisis point. Sen. Bernie Sanders says the state needs to add 9,000 nurses to the workforce over the next seven years. This hour, we talk with a nurse, a hospital administrator and a nursing school teacher about how they’re addressing the shortage. And we’ll look at how travel nurses are filling the gaps.
Vt. ICU capacity stable ahead of expected omicron peak

COVID hospitalizations hit triple digits in Vermont this week with the flood of omicron cases continuing to burden facilities already stressed from staffing shortages.

At Southwestern Vermont Medical Center in Bennington, officials say staff is managing the surge, which is not expected to crest for at least two weeks. “Everyone knows there’s only so much we can do, and we will do that extremely well. But if that exceeds our capacity, then standards of care will have to change,” said the hospital’s Dr. Trey Tobson.
Hospitals in the News
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