VAHHS Update 8/30: Hospitals Submit Thoughtful Budgets in Trying Times

What a week. Vermont’s hospitals have just completed their fiscal 2022 budget hearings before the Green Mountain Care Board (GMCB). As I reflect on the hours of hearings—I observe every one of them—I am filled with both immense pride and continued concern for the well-being of our hospitals and the beleaguered Vermonters who keep them running 24/7/365.
I opened the budget hearings now two weeks ago by saying that hospitals are squeezed like never before. And the hospitals themselves told their version of this story over the course of the hearings. They have no extra people, no extra time and no extra space. They are treating more patients every day and filling their beds and their facilities—with people who delayed care during the pandemic, those seeking treatment for mental health, individuals waiting for long-term care placement and the recent uptick in COVID-19 patients. The patients are presenting sicker and with more challenging conditions that are creating an unprecedented demand for care.
Even with our best-in-the-nation COVID response, this pandemic has proved unrelenting and hospitals continue to bear the brunt of its force. With third doses and 60,000 vaccinations for children coming up, hospitals are once again vaccinating. And they are testing more Vermonters than in recent months on top of managing the logistics and issues associated with mandating vaccinations or weekly testing for their own staffs.
Given all of this, the GMCB graciously said it would entertain requests from hospitals that did not feel they had the bandwidth to participate in the hearings. I think it says a lot that despite being so busy and overwhelmed, hospitals showed up to make sure the GMCB and Vermonters in general know what they are doing to stay strong now and to plan for the future.
The budgets that have been submitted, reviewed and described in meticulous detail represent what is necessary to rebuild, recruit and reinvest in facilities. These are the budgets Vermont’s nonprofit hospitals need and deserve to serve their patients and communities. Unlike in most parts of the country, our hospitals do not answer to shareholders; they are accountable to the people and places they serve. And in that spirit, they build budgets that enable them to meet their mission and be leaders in public health during a still critical and uncertain time.
Meanwhile, hospitals continue working to transition to value-based care without the significant transformation funds that were promised as part of the All Payer Model. That also involves managing the administrative complexities of participating in our unique health reform program, which require a lot of staff time and focus.
With so much uncertainty and ongoing challenge, reducing or changing budgets would be incredibly harmful at a time when all of us need our health system to stay safe and manage the pandemic but also improve access and wait times and update facilities to meet patient demand and stay current on technology and equipment.
Over the past couple weeks, our hospitals highlight intractable challenges, including the workforce and mental health crises, lack of affordable housing and increased COVID response needs. As a regulatory body, the GMCB may wonder if these issues are out of their control or purview, but the first and most important step they can take to address these challenges is to approve hospital budgets that are crucial for the health and wellbeing of Vermont.