BENNINGTON – Area residents got a detailed look Thursday at the “unsustainable” health of the state’s hospital and overall health care systems, and it was not an encouraging picture.
Identifying and developing data-driven solutions to underlying problems is the goal of a multi-year study process set in motion by Act 167 of 2022, which is expected to lead to collaborative efforts toward efficiency and related state legislation.
In a slideshow, Dr. Bruce Hamory, a consultant to the Green Mountain Care Board and the Agency of Human Services, cited data showing projected cost increases and revenue declines for hospitals over several years.
He also identified the general areas of concern, including soaring costs to provide health care services; the rising costs for insurance — up 60 to 80 percent over the past six years — and higher out-of-pocket costs for residents.
Also, there are issues with recruiting primary care physicians and specialists for areas served by a small hospital, long wait times for residents looking for a primary care physician and long wait times to schedule appointments. In addition, a shortage of available or affordable housing for health care staff and limited or unsustainable ambulance transport services in some areas are also issues..
Negative margins
In addition, 9 of Vermont’s 14 hospitals, including SVMC, posted negative operating margins during fiscal year 2023 — representing the difference between revenue for the hospital and operating expenses that year.
Overall, the situation has led to “a really bad prognosis,” for the state’s health care system in the absence of changes, Hamory said.
He later added that “time is not your friend” when it comes to implementing changes that lead to financial stability and universal access to quality health care throughout Vermont.
He advocated participation by citizens as well, through offering feedback and comments, which also can be done online.
Officials acknowledged Thursday that these trends have been known within the health care field for some time, but sharply rising costs in recent years has exacerbated each problem.
Hamory, of the consulting firm Oliver Wyman, led a presentation on those issues that was part of a tour of sites of the state’s 14 hospitals, seeking comment and feedback. The officials have thus far met with approximately 2,100 people during meetings held around the state.
About 40 local and state officials, health care leaders and residents attended the session Thursday at the Bennington Firehouse.
BENNINGTON AREA
Speaking specifically about the Bennington area, Hamory said a population decline also is projected here through 2040, along with a significant rise in the percentage of elderly patients, who typically require more health care services.
At the same time, he said, a shrinking working-age population means fewer residents will have commercial health insurance coverage, which often provides a higher payment level for health care providers than Medicare or Medicaid or similar options.
Commercial insurance firms themselves are also under significant pressure from rising costs, Hamory said, citing losses posted for Blue Cross Blue Shield Vermont for the budget years since 2000, and for the two years prior to 2000.
The consultants expect to issue a report to the Green Mountain Care Board in the fall with findings from the study and feedback tour and recommendations for transitioning to a more sustainable health care system in Vermont.
The five-person board regulates areas of the state’s health care system, including reviewing hospital budgets, health insurance rates and proposals for hospital and health care projects and expansion of services.
Under an earlier phase of the Act 167 process, the consultants and GMCB officials met with leaders and board members associated with the state’s hospitals and other health care organizations.
POSSIBLE SOLUTIONS
Hamory said the study thus far has identified a list of possible responses to the issues health care systems in Vermont and elsewhere are facing.
He spoke in general about several, including regional collaboration among hospitals to provide specialized services, reducing the need for many patients to have to go to larger medical centers; collaboration on medical record storage, administration costs and other operations, and expanding care options that can be provided in the home or a care center, rather than an acute care hospital.
Hamory also noted that the proposed health care system reforms are already “being used somewhere around the country.”
SVMC COMMENTS
Thomas Dee, president and CEO of Southwestern Vermont Medical Center and its associated health care system, said at the meeting that his institution is “generally on the same page,” with the preliminary study recommendations, but there are some differences of opinion over the best responses to the problems for SVMC.
Dee and Kathleen Fisher, chairwoman of the SVMC board of trustees, said the local hospital’s affiliation with Dartmouth Health system, which includes the Dartmouth-Hitchcock Medical Center in New Hampshire, allows the Bennington center more options to respond to problems than other small hospitals.
Dee also said, in a written response to preliminary study findings, that the local system is working to become a regional referral hospital in the Dartmouth Health system as well as in expanding services in areas like cardiac and vascular care, orthopedics and oncology.
The hospital is also expanding its primary care office in the SVMC medical building and planning a Dartmouth Health sponsored family medicine residency program in Bennington.
Dee also said SVMC is expanding mental health care access in collaboration with United Counseling Services; reducing crowding in the emergency room, which is undergoing a major reconstruction project; has established an ExpressCare site for those with less serious medical needs, and has begun a multi-year process of shifting to the Dartmouth Health electronic medical records system.
Dee concluded, “SVMC is bucking many of the state and national trends [the preliminary report] highlights, thanks to the work and ingenuity of our extraordinary team and input from an engaged community.”
State Rep. Jim Carroll, D-Bennington, who attended the session, also asked about the Legislature’s role in the Act 167 process which involves health care reform initiatives, data collection, and access to home and community based services
Hamory, again of the firm Oliver Wyman, said that a response will develop after his company’s report is delivered to the GMCB board this fall, after which funding support for some of proposed health system changes will be considered.
