Message from the CEO
The Green Mountain Care Board (GMCB) kicks off the formal process of annually approving hospital budgets this Wednesday. It starts with their initial public overview of the filings of Vermont’s non-profit hospitals. As we prepare, there are so many clichés that come to mind. In fact, in health care, it feels like these past three years have been a series of dramatic clichés. Terms like “unprecedented” and “extraordinary” come to mind in describing each new twist of the pandemic and its fallout. Though we feel numb to yet another series of highs and lows, the fact is we are in new territory. As we try to figure out the new normal and move forward, we must recognize where we’ve been and commit to where we need to go.

Now, it’s not all dramatic; in fact, there’s a lot of good to celebrate—accomplishments that speak to the heart and soul of our hospitals. All of Vermont’s not-for-profit hospitals participate in value-based payment models; this demonstrates our commitment to affordability and to the patients we care for. We remain leaders of one of the nation’s most effective Covid-19 responses. We are also deeply imbedded in our communities and have expanded the definition of a hospital far beyond bricks and mortar. Hospitals are now helping to tackle our housing crisis, manage food insecurity, provide transportation and support the homeless. All of this work is in the spirt of building healthier and stronger communities.

Forces outside of our control threaten our hospitals in this moment and call into question their ability not only to continue these very important community investments, but also their ability to meet patient demand. Hospitals are not alone in this experience. Nearly every industry—from health care to education to law enforcement to the trades—is struggling to fill needed job openings and manage soaring inflation. Services are suffering as a result. When you connect these challenges to the never- ending issues created by the COVID-19 pandemic, a mental health crisis, caring for sicker patients, capacity challenges and deferring maintenance in facilities all have created a very difficult situation for our hospitals.

As you have likely read in the news already, nearly all of our hospitals are asking for the highest rate increases they’ve requested since the GMCB’s inception, but one thing you may not be aware of is that most of our hospitals are projecting negative operating margins for the current fiscal year. That means they are losing money or operating at a loss. All of them have made cuts to their operations—mostly by delaying investments in their buildings and equipment. This might be prudent in the short-term to keep costs down for patients, but it is not sustainable in the long-term if we want to ensure those same patients continue to get the care they deserve in modern buildings with the latest technology.

Our hospitals are managing within a delivery system that does not have the appropriate resources to care for mental health patients or long-term care patients. Keeping these patients in a hospital setting is not only the most expensive way to care for people, causing further strain on the system, but more importantly it is the wrong care setting for these individuals; they are not being treated as they should be. This is completely unacceptable to our hospitals, and we are working hard with our partners at the state level to make progress in this area.

I’ll spare you the dramatic hyperbole about the moment we are in— that’s not my nature anyway—and simply say that to build on the amazing work our hospitals have done in their communities and to shore up these critical community assets, we must stabilize their finances and that starts with the approval of these budgets. We’ll be advocating hard for that because we know that every Vermonter depends on it.
In the News
Inflation to Erode Not-for-Profit Hospital Margins Absent Major Changes
Fitch Ratings

Not-for-profit (NFP) hospital operating margins, which declined during the pandemic, will see further erosion due to ongoing inflationary pressures of elevated labor, supply and capital costs, Fitch Ratings says. Improvement in operating margins from reduced levels will require hospitals to make transformational changes to the business model (long term), while managing cost pressures through a combination of rate hikes (short term) and relentless, on-going cost-cutting and productivity improvements (medium term).

Providers are reporting thinner margins so far this year, some of which are materially lower than 2019 levels and may take years to recover to pre-pandemic levels. The vast majority of our rated credits have strong balance sheets that will offset lower margins for a period of time and allow for operational improvements. Without more substantial changes to the current business model, or with additional coronavirus surges this fall or winter, this balance sheet cushion could eventually erode, which would lead to negative rating actions.
Vermont Covid levels remain ‘low’ while numbers rise nationally

As of last Thursday, the U.S. Centers for Disease Control and Prevention rated 11 of Vermont’s 14 counties as having “low” Covid levels, while Essex, Rutland and Bennington counties have “medium” levels.

Of the underlying metrics published by the health department, only one showed signs of rising: 31 patients were in Vermont hospitals with Covid as of Wednesday, up from a low of 10 on July 13, according to the department, but still far lower than a BA.2 peak of over 60 hospitalizations in mid-May.
BMH and CCV celebrate new graduates of medical assistant program
Brattleboro Reformer

Four newly-minted graduates of the BMH/CCV College to Career Medical Assisting Program were honored in a hybrid gathering held in Brattleboro Memorial Hospital’s Brew Barry Conference Center on Monday, June 13.

Speaking via Zoom, Joyce Judy, president of the Community College of Vermont said, “I am always incredibly humbled by what our graduates can do. And now as you go out into your (paid) practices, you’re launching careers in health care and careers in health care open up amazing opportunities.”

Three of the four graduates were on hand to receive certificates and also learn where they will be working among BMH’s many outpatient practices.

Monique Carson learned she will be joining Maplewood Family Practice. Dawn Cutter will start her career at Putney Family Healthcare and India Martin will become a staff member at Four Seasons OBGYN and Midwifery. Heather Wisell, who was unable to attend the gathering, will begin her new career supporting all BMH Medical Group practices.

What the new 988 lifeline means for mental health care in Vermont

A new nationwide lifeline—988, accessible by a phone call or text message—launched over the weekend. It's designed to give fast help for anyone experiencing suicidal thoughts or a mental health crisis. The number works like 911, but when you call or text, you're connected to a mental health counselor. This hour, we're talking with Vermont mental health professionals about the 988 lifeline and how it works with Vermont's mental health care system to help people in crisis.

Our guests are:

  • Josh Burke, Director of Emergency Services at Northeast Kingdom Human Services
  • Katina Idol, a licensed clinical mental health counselor with Lamoille County Mental Health Services
  • Alison Krompf, Deputy Commissioner of the Vermont Department of Mental Health

HealthWatch: Husband and wife surgery team set up shop at Gifford

Two Vermont surgeons are partners in the operating room and in life. And the doctor duo say it’s their marriage that makes them better physicians.

For more than two decades, Dr. Dawn Holman and Dr. Aleksandr Sokolovsky have been each other’s right and left hand. The husband and wife know each other inside and out.

“I think it’s because we know how each other thinks and how each other operates. So, able to anticipate what’s going to happen next in terms of the surgery, not having to wait to be told to do something,” Holman said.

The general surgeons say it’s like having a built-in assistant who intuitively knows exactly where to stand over the table and which tools to use. The couple’s connection is stitched into every complicated operation, and together, their skills are as sharp as a scalpel. “The home life and the work life are one in the same. They’re inseparable,” Sokolovsky said.

The CDC endorses Novavax, a more traditional COVID vaccine, for adults

U.S. adults who haven't gotten any COVID-19 shots yet should consider a new option from Novavax — a more traditional kind of vaccine, health officials said Tuesday.

Regulators authorized the nation's first so-called protein vaccine against COVID-19 last week, but the final hurdle was a recommendation from the Centers for Disease Control and Prevention.

"If you have been waiting for a COVID-19 vaccine built on a different technology than those previously available, now is the time to join the millions of Americans who have been vaccinated," Dr. Rochelle Walensky, CDC's director, said in a statement, endorsing an earlier decision from an influential advisory panel.

Most Americans have gotten at least their primary COVID-19 vaccinations by now, but CDC officials said between 26 million and 37 million adults haven't had a single dose — the population that Novavax, for now, will be targeting.
Hospitals in the News
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