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.