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: