Message from the CEO

Last Tuesday morning, my former boss at the Catholic Health Association—Sister Carol Keehan—texted me that she was going to the White House to celebrate the 12th anniversary of the Affordable Care Act with President Biden and President Obama.

Sister Carol’s text (and the photo she shared of her chatting with President Biden) brought back so many memories for me: being in the gallery of the House of Representatives the night the ACA passed that chamber. Meeting President Obama when he came to thank Sister Carol at the annual meeting of the Catholic Health Association. And, most importantly, the work we did over many years to pass, explain and improve the landmark legislation.

Across the country there are still far too many people who are uninsured—at least 25 million by most estimates. But the ACA helped cut that number in half. And here in Vermont, we have a very low uninsured rate, among the lowest in the country. Nearly 97% of Vermonters have health insurance coverage, according to a March 30 report by the Agency of Human Services.

Even with these reassuring figures on the coverage front, Vermonters and hospitals alike face unprecedented inflation, and health care providers continue to manage a growing workforce shortage and associated costs, so it will require a collective effort to make sure health care services continue to be available and affordable going into the future.

As a health care field, we face real and difficult challenges in the coming months and years. I am confident that we can manage them by doing what Sister Carol taught me, which is to be optimistic, smart, realistic and collaborative. If we do those things along with our legislators and regulators, I think we can weather any storm and make sure Vermont stays at the top of the list when it comes to health care cost, quality and access.

Have a great week,
Legislative Update
Devon Green, VP of Government Relations

This week, I am spotlighting an issue that hospitals and all of Vermont continues to struggle with—long wait times in emergency departments (ED's). We continue to see dozens of people regularly waiting days, sometimes even weeks, in emergency departments. Children, adults, families and health care providers are suffering. VAHHS will continue to advocate for and support all initiatives that address long wait times.
Mental Health: VAHHS and the Vermont Program for Quality in Health Care (VPQHC) testified in House Health Care on the adverse impacts of long wait times in emergency departments for patients, families and providers and updated the committee on recent initiatives to address the issue:
  • Trauma-informed care training
  • SMART medical clearance—guidance around the medical clearance process that will help get patients to the right level of care more efficiently
  • Healthworks ACT, a pilot in Windham County where the hospital, designated agency and housing organization clinical services to individuals who have housing insecurity, have a diagnosed serious mental illness and tend to be high utilizers of emergency care and service.
  • Suicide prevention quality initiative lead by VPQHC
  • Statewide emergency telepsychiatry lead by VPQHC
  • Comfort kits for children in emergency departments lead by VPQHC

Additionally, VAHHS advocated for the following initiatives:
  • Inpatient expansion
  • Highly coordinated 988 Suicide Prevention Lifeline
  • Mobile crisis units
  • Alternatives to EDs
  • Peer-run respite
  • DA initiatives—6 ED alternatives being considered
  • Psychiatric urgent care for kids
  • Intensive outpatient care
  • Peer support specialist certification
  • Further coordination with community providers and using wait times in EDs to measure effectiveness of initiatives

Financial Assistance Policies: The Office of the Health Care Advocate and VAHHS testified in Senate Health and Welfare on H.287, an initiative that would help standardize eligibility thresholds and the definition of household for financial assistance policies in Vermont. The bill would also allow all Vermont residents, including those experiencing housing insecurity or undocumented residents, to be eligible for financial assistance policies. The new standards would not take effect until 2024, giving hospitals time implement the changes and determine the financial impact, if any.
VAHHS pointed out to the committee that Vermont does not maximize the matching federal funds available in its allocation of the Disproportionate Share Hospital (DSH) payment, which goes towards reimbursing uncompensated costs. Vermont has about $49 million in potential funding, but only draws down $22 million.
Vermont has a 3% uninsured rate: The House Health Care Committee heard the latest results from 2021 Vermont Household Health Insurance Survey. Vermont continues to have a high rate or coverage with only 3% uninsured. Almost half of Vermonters are covered by private health insurance at 49%; 21% are enrolled in Medicare and 24% are enrolled in Medicaid.
In the News
A record 210 Vermonters died of an opioid overdose last year

State data released on Tuesday shows that 210 Vermonters died of an opioid overdose last year, the first time Vermont has crossed the threshold of 200 such fatalities in a year.

Last year’s death toll is 33% higher than the 158 fatal opioid overdoses the state logged in 2020 — and came as the second year of the coronavirus pandemic unfolded. It’s the second year in a row the state has set a new record for opioid overdose deaths whose causes are either accidental or undetermined.

“That’s a horrific number,” said Gary De Carolis, director of Recovery Partners of Vermont, a network of addiction recovery centers around the state. “I think we're really in a horrible crisis right now as a state and as a country.”

Last year’s overdose fatality numbers are preliminary and could still go up as death certificates from 2021 continue to be processed.
Rutland Hospital is short $7.6 million this year, and its request for higher service charges has been rejected. Now what?

Earlier this week, state regulators ordered Vermont’s second-largest hospital to cover a projected multimillion-dollar deficit without raising prices. 

The dust had barely settled on that decision Friday morning, but already reality was setting in for Rutland Regional Medical Center’s chief executive. Reflecting on Wednesday’s fateful Green Mountain Care Board decision, CEO Claudio Fort couldn’t help but feel that regulators didn’t get the message. 

“We really tried to say, ‘Hey, here’s the story, here are the rules’ and I think the challenging part for us is feeling unheard,” Fort said.

Rutland Regional requested a 9% increase in charges in the middle of this fiscal year to cover inflation and ballooning staffing costs, but the care board denied the request because of the impact that would have on small businesses. 
Green Mountain Care Board Chair Kevin Mullin to Retire This Summer 
Seven Days

The chair of the powerful regulatory body that oversees Vermont's health care system plans to retire this summer ahead of what's expected to be a highly contentious — and expensive — hospital budget process.

Kevin Mullin, a former small-business owner and longtime Republican state lawmaker, has spent the last five years leading the Green Mountain Care Board. The five-member body is tasked with setting health insurance rates and approving hospitals budgets, among other responsibilities.

Mullin, 63, announced his decision to retire at a meeting Wednesday, saying it came after "months and months of soul searching."
A UVMMC doctor on second COVID boosters, and whether you should get one

Last week, the Centers for Disease Control and Prevention authorized a second COVID booster for people who were initially boosted at least four months ago. But the agency is only recommending the shot for certain demographics at this time.

VPR's Grace Benninghoff spoke with Dr. Tim Lahey, an infectious disease specialist with UVM Medical Center, about who should consider getting the second booster, and what information we’re still waiting for. Their conversation below has been edited and condensed for clarity.
Regulators deny UVM Medical Center mid-year rate hike

Vermont’s largest health network says regulators have jeopardized patients’ access to quality care. That’s because regulators rejected a 10% mid-year rate hike at both the UVM Medical Center and Central Vermont Medical Center.

Instead, in a 3-2 vote, the Green Mountain Care Board approved just a fraction of what the hospitals asked for-- a 2.7% increase at Central Vermont and 2.5% at the UVM Medical Center.

Green Mountain Care Board Chair Kevin Mullin said it’s rare to greenlight any mid-year adjustment, but board members recognized UVM’s recent move to increase nurse wages warranted some extra support. He says the lower rate of increase is a compromise.
Hospitals in the News
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