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Hospitals Participate in Budget Hearings in Montpelier, Castleton

August 20, 2017

VAHHS Update 8-21-17

Last week, hospitals began presenting their proposed 2018 fiscal year budgets to the Green Mountain Care Board. On average, hospital budgets showed historically low growth and reflected innovative efforts to improve care delivery and ensure affordable access.  

“It is encouraging to see Vermont hospitals continue to work towards meeting our hospital budget instructions, and the continued downward trend in net patient revenue,” said Andy Pallito, Director Health Systems Finance for the Green Mountain Care Board, in a press release 

In their presentations to the Green Mountain Care Board and the Health Care Advocate (HCA), hospitals told compelling stories about fulfilling their mission, serving their communities and investing in health reform.  Some of the themes covered in the hearings:

  • Risk-taking and the All-Payer Model (APM) – With the APM requiring Vermont to reduce the total cost of care growth rate, hospitals fielded questions about their plans to move into the space of managing financial risk for the care of a patient population. Hospitals discussed how they are identifying and carrying out initiatives to help achieve the APM’s 3.5% target. 
  • Mental health – Emergency Department (ED) crowding continues to challenge hospitals, other providers and the state, as mental health patients are treated and often stuck in EDs. Many hospitals included an update on their efforts to treat patients compassionately while contributing to longer-term, systemic solutions.
  • Workforce – The GMCB expressed concern about the growing difficulty of recruiting nurses and other professionals along the continuum of care. There is a national market for health care workers, requiring hospitals to offer salaries and benefits that compete with Boston and other major markets. Hospital leaders discussed employing costly “travelers” to manage nursing shortages, but also reported creative new programs like hiring RN candidates before graduation for practicums, then employing them full-time.
  • Physician compensation – The HCA asked whether hospitals are changing incentives to align with a coordinated care model. Several hospitals reported reducing or rethinking productivity incentives; others said it was important to find the right balance between those incentives and a population-health model of care delivery.
  • Shared decision making – The HCA was particularly interested in hospitals’ adoption of shared decision making programs in which clinicians and patients collaborate on treatment decisions and care plans that honor patients’ values and preferences. Hospitals described different approaches to shared decision making, but all said patients take an active role in their care. CMOs reported that this work has been ongoing for many years, as providers work hard to keep patients at the center of the process.
  • Federal uncertainty – Several hospitals discussed the still-perilous nature of the Affordable Care Act’s uncertain fate. They also expressed concern about the effects of slashing Medicaid or cutting the critical 340B drug discount program.
  • Budget hearings continue this Tuesday, August 22 at Main Street Landing in Burlington (where we’ll hear from UVM Medical Center, Central Vermont Medical Center, Porter Medical Center and Northwestern Medical Center) and Thursday, August 24 at the Capitol Plaza in Montpelier (where we’ll hear from Mt. Ascutney Hospital & Health Center and Springfield Hospital).


VAHHS applauds hospitals for the excellent work they did to prepare for these hearings and demonstrate to the GMCB the vital role we play as providers, employers and community partners.  ##