Legislative Update
Hospitals at the health care reform table
As we hit the middle of the session and crossover week, I’m struck by how much has changed since January. Going into the session, I wrote a letter to key legislators laying out the fragile state of our hospital system and what we were up against with workforce and capacity challenges in addition to COVID. VAHHS appreciates the quick legislative action on extending COVID regulatory flexibilities and move to increase clinical slots for nurses, but the tone has massively shifted towards health care reform.
This week, the Senate Health and Welfare Committee will be looking to quickly pass S.285, which provides the Green Mountain Care Board with $5 million to pay consultants to develop a process for establishing and implementing hospital global budgets, which is a fixed payment to hospitals, and a “community-inclusive” redesign of Vermont’s health care system that will detect “low-value” care.
The thing is, “low value” care occurs when 100 people are waiting in our hospitals because there is no available or appropriate placement after discharge. It occurs when 30 people, including children, are waiting in emergency departments right now because there is no place for them to get the best psychiatric treatment. The consultants ignore these issues, and it’s difficult to see how hospital global budgets will help these individuals. Hospital global budgets assume that hospitals have sufficient resources, but our hospitals are depleted right now. The Green Mountain Care Board confirmed that Vermont’s hospitals posted a combined $3 million operating margin in budget year 2020. That’s not one hospital, that’s all of the hospitals in Vermont. In other words, all the hospitals had a combined operating margin that is almost half of what taxpayers would pay consultants to “design” a health care system.
Everyone knows hospitals stepped up to provide vaccinations, COVID testing and COVID therapeutics, but it is difficult to convey the myriad other improvisations hospitals have had to make in everything from STI testing shortages to blood shortages to, most importantly, the biggest workforce shortage we have ever seen. We are a fragile system dealing with verbal abuse and violence in our patient rooms and parking lots. And no policy consultant factors that into their academic recommendations.
Global budgets could work, and we need to continue the move to value-based reimbursement, but Vermont should be very cautious about paying millions of dollars to consultants to figure out how to do it without intensely collaborating with providers and payers to preserve access to care and quality in each community. More than a “community-inclusive” redesign, we need providers, payers, businesses and community members at the table to inform, craft and approve the design, rather than react after the fact. Our system is too fragile right now for a top-down approach headed by a consultant and the Green Mountain Care Board. This is something we need to do together.
If you agree, or is you want to contact a legislator to let them know what you’re seeing, you can e-mail the members of the Senate Health and Welfare Committee at:
In the News
Telemedicine Is Helping Some Vermont Hospitals Manage a Growing Number of Psychiatric Patients 
Seven Days

Last year, a woman in her twenties sought treatment at the Northeastern Vermont Regional Hospital because acute depression had driven her to consider suicide.

The 25-bed St. Johnsbury hospital doesn't have its own clinical psychiatrist, let alone an entire unit dedicated to treating patients in mental health crisis. Once the woman was admitted to the emergency room, staff members set out to find an open bed at one of Vermont's few inpatient psych facilities.

The same scenario has played out at rural hospitals for years and typically ends one of two ways: The hospital gets lucky and finds an opening immediately. Or, more often, the patient lands on a waiting list and goes days or even weeks without receiving treatment from an expert.
With Covid cases tanking, hospitals still have fewer beds

Every metric in the latest Vermont Covid-19 modeling report points to a better outlook for the state. 

The seven-day Covid case average has tanked 91% since the peak of the Omicron variant wave. With about 163 new infections per day, Vermont is reporting about the same case counts it did in mid-September, according to the Department of Financial Regulation.

Covid testing has changed significantly in the past few months, leading officials to warn that fewer cases than ever are represented in official case data. But other metrics are trending downward, too.
State report on wait times quantifies patient experiences but offers no path forward

Kristi Kilpatrick is running out of time. 

The 36-year-old has benign cysts on her ovaries, a condition the Burlington resident discovered last spring when she landed at the University of Vermont Medical Center emergency department with debilitating stomach pain. 

The cysts have to come out if she wants the pain to stop, doctors said. And if she plans on having children, Kilpatrick learned, she would have to get the surgery sooner rather than later.

It’s been almost 10 months since that first emergency visit, and Kilpatrick isn’t even scheduled to get the surgery. 

“I just want to get this over with,” she said. “And now it just feels like this interminable waiting, and I feel like now it’s starting to affect my reproductive choices.”
Sanders holds town hall with infectious disease expert

As COVID cases continue to decline in Vermont and across the country, many are wondering what’s next.

Sen. Bernie Sanders held a statewide telephone town meeting Wednesday night with UVM Medical Center infectious disease expert Dr. Tim Lahey to discuss the challenges from the pandemic and how to safely return to normalcy.

“Things are improving. I think the challenge is that in the face of that great news, it would be so easy for us to just call it good, you know, clap our hands and say we are done and back to normal life. And I think the hard part is that we have to balance that optimism that we should have and that hope that we should have with some realities,” Lahey said.

He says while COVID deaths and hospitalizations are declining from their peak, they are still high and that we are going to have to ride the pandemic wave for some time.
Hospitals in the News
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