Message From the CEO

It has been about three weeks since the Green Mountain Care Board’s (GMCB) consultant, Oliver Wyman (OW), issued its report on the restructuring of our health care system. A lot has happened since then, as communities have read and digested the report’s recommendations and what they would mean for our state if this report were deemed credible and its findings implemented.

What has become crystal clear is this report is not just about hospitals. It’s about the future of Vermont and the viability of all of our communities. I’ll try in this piece to break down the report by outlining the flaws, opportunities and what we view as next steps to not let this distract us from the real and urgent work needed in our state.

First, for any of the hundreds of recommendations and changes to occur, the report

concedes that we need to have on hand the following foundational infrastructure:

housing (for staff, low-income Vermonters, group housing, etc.); transportation for

patients, including a coordinated, statewide EMS, expanded workforce; investments in

community-based care like nursing homes and mental health support; as well as a

statewide electronic medical record. This is a massive undertaking, to put it mildly.

Imagine the costs, complexity and time it will take to have these essential footings in

place to make the recommended transformation of the delivery system even possible.

Suffice to stay, the costs are astronomical – likely in the hundreds of millions or more –

and the timeline is many years out.

Many of the recommendations are deeply concerning. Cutting, consolidating and

closing services across Vermont will have devastating impacts to our patients and

communities. The report essentially calls for the closure of four hospitals, creating

health care deserts in rural regions. It has no compassion or acknowledgment for the

damaging health care outcomes that will result from delayed care and long drives in

emergency situations or the ripple effects on community health care and the local

economy. It calls for the consolidation of orthopedics to northern and southern Vermont,

leaving Vermonters along the spine of the Green Mountains with nowhere to go but to

drive hours or leave the state. It suggests women should have no choice but to give

birth in yet-to-be-built stand-alone birthing centers with no assurances of higher-level

care in an emergency. And the list goes on.

What’s even harder to understand, and what seems to be terribly obvious to those of us

who have analyzed the recommendations, is the simple fact that this will actually

increase costs for our state. When more Vermonters delay care, they almost always

need more expensive care down the road. When Vermonters go out of state for care,

we still pay in insurance for those patients, but our hospitals and providers lose the

revenue. And, of course, as our hospitals close and providers leave, so too will our large

employers and young families; this will be catastrophic to our state’s economy.

When you close schools, hospitals, libraries, general stores and other essential

services, you lose the heart of a region and population decline follows. We cannot cut,

close and consolidate our way to economic vitality. By way of example, under-resourcing long-term care and mental health services has actually led to increased expenses at hospitals.

Hospitals always consider their community needs and will continue to look at the

services they provide, but that is a decision to be made with their communities. Unfortunately, the report has become a distraction from the real work we are already

doing and the work we know we need to do in the future.

Now is the time to invest in our rural communities to grow the population. That requires

a focused housing plan, hospital and community-based supports to get people the right

services in the right place at the right time, and transportation to move them efficiently.

We need more providers, not fewer, and more local care not less.

Hospitals are eager to lean in to this work with our partners at the Agency of Human

Services and our lawmakers. There is a much brighter and more vibrant Vermont on the

horizon if we resist the urge to make short-term decisions like cuts that cannot be

sustained in the long run. Instead, we need to grow opportunities for all. There is a

better way to strengthen Vermont if we have the courage to work together to get there.

Your nonprofit hospitals will be there every step of the way.

Thanks for reading and please join in the conversation.