A push for more healthcare training opportunities


Devon Green, VP of Government Relations
Happy Valentine’s Day! Every year, just as the legislative grind is really hitting, Montpelier pulls off a small miracle and covers itself in hearts. Thank you to the forces behind this effort—it never fails to make me smile.
And now, for what’s happening underneath the golden dome and in all the Zoom rooms:
Workforce: VAHHS testified in House Health Care on hospital workforce needs, citing 2,600 open positions statewide with the highest need for RNs and LNAs—a big thank you to our HR Directors for getting us this information. VAHHS recommended the following:
  • Data hub housed within state government to better target need and measure success of initiatives
  • Resources for hospital partnerships with higher education to increase shared clinical faculty and develop talent pipeline programs
  • Dedicated health care workforce liaison at the state to focus on retaining recent grads and attracting international professionals
  • Student loan forgiveness and scholarships
  • Reduced administrative burden, such as less prior authorization, to retain current workforce
  • Sustainable funding through increased Medicaid rates so that hospitals can invest in retaining, training, and attracting workforce
Combined with hearing last week’s testimony from higher education institutions, the committee appears to be coalescing around supporting nurse faculty and training opportunities.
Mental Health: The Department of Mental Health presented its report on Residential Beds for Individuals Discharged from Inpatient Psychiatric Care to the Senate Institutions Committee. The DMH put out a request for information on transitional support in unlocked community residences for individuals discharged from inpatient psychiatric care or to prevent inpatient admissions. The Department received six responses from community organizations.
Senate Institutions also heard from the Agency of Human Services with an update on the IMD Waiver phasedown. At this point, CMS has not required further phasedown until June of 2022, when Vermont is renegotiating its Medicaid waiver and sustainable IMD funding will be a top priority.
Hospital Sustainability: The Green Mountain Care Board presented its Hospital Sustainability Planning Report required under Act 159 of 2020 to both Senate and House health care committees. The GMCB pointed out that Medicaid rates do not cover the cost of care. Under the current fee-for-service system, hospitals must raise commercial rates or make changes to their service mix to cover costs. While Vermont has moved toward a value-based model through its All-Payer Model agreement and OneCare, GMCB believes the transition has not been fast enough. To address these issues, the GMCB is proposing a $5 million appropriation in the FY ’23 budget to do the following:
  • Design predictable, flexible, and sufficient global payments to hospitals and apply the design to the next All-Payer Model agreement. Currently, global payments follow attributed lives in OneCare; this would attempt to apply a global payment to the whole hospital, although many details, including how commercial payers would be included, remain to be ironed out.
  • Bring in experts in health systems optimization and engage communities to reduce inefficiencies, lower costs, improve population health outcomes and increase access to essential services
  • Provide hospitals with technical assistance for care delivery reform efforts
The health care committees were very interested in moving forward with this work. VAHHS will continue to provide hospitals’ perspective as discussion continues. While hospitals have long supported reform work, any consideration of a new model must be careful and process-driven.
Primary Care: The Senate Health and Welfare Committee took testimony on S.244, which proposes to boost spending on primary care to 12% of overall health care spending. The bill also aims to bring audio-only reimbursement back to parity with in-person visits.
Prohibition of Firearms in Hospitals: The House passed S.30 in a vote of 91-53, and it now makes its way to the governor’s desk. VAHHS members, please be on the lookout for action alert e-mails in the coming weeks.
Prescription Drug Repository: The Senate Health and Welfare committee heard testimony from the Vermont Department of Health supporting S.243, requiring the Agency of Human Services to conduct a study on the feasibility of a centralized repository to accept, provide quality control, and re-dispense unused prescription drugs safely and affordably. VAHHS supports this effort.