RANDOLPH — Hospital officials are criticizing a Green Mountain Care Board consultant’s findings that there are too many beds at some Upper Valley hospitals, especially given the ongoing bed crunch driven by the COVID-19 pandemic and a workforce shortage.
“The … study suggests an overall reduction in beds and right now, even just the notion of less hospital capacity will frighten our communities, harm our missions and have a potentially chilling effect on provider-led health care reform,” said Jeff Tieman, CEO of the Vermont Association of Hospitals and Health Systems. He called the suggestions in the study, which were released last week, “irresponsible and reckless.”
But Susan Barrett, the Green Mountain Care Board’s executive director, said that the consultant’s ideas are simply intended to begin a longer conversation about how to shore up the state’s hospitals and control costs for the future.
“If we don’t look at what’s in the system right now and understand where we are, any reform is not going to be effective in terms of what we’re dealing with,” Barrett said.
The study from the California-based Berkeley Research Group came as part of the board’s work under the Act 159 of 2020 to consider ways to improve Vermont hospitals’ financial sustainability, while the state continues to shift from a fee-for-service model of care to a model in which hospitals receive fixed per-person payments for keeping people healthy. The board itself cannot implement the consultant’s suggestions, but it is slated to issue a report to the Legislature in January.
Among the “areas of opportunity” for Vermont hospitals included in the consultant’s Wednesday presentation to the board was shifting inpatient care provided at Springfield (Vt.) Hospital to Mt. Ascutney Hospital and Health Center in Windsor; and converting Springfield Hospital to an alternate acute care delivery model such as a rural emergency hospital, freestanding emergency department, an outpatient hospital, or a hospital-at-home service.
Additional suggestions included shifting Gifford Medical Center’s two-bed intensive care unit in Randolph to Central Vermont Medical Center in Berlin; and creating centers of excellence for certain types of care such as orthopedic surgery, due to low volumes of procedures such as hip and knee replacements at some small hospitals, including Gifford and Springfield.
“The opportunities are just areas that we can look to for ideas,” said Alena Berube, the board’s strategic advisor on health policy and finance.
Rather than aiming to cut services, the purpose of the effort is to shore up the state’s hospitals and health systems to ensure that Vermonters have access to essential services, Berube said.
For their part, hospital officials questioned the data Berkeley used to come up with their suggestions. For example, the consultants used hospital volume information from 2019.
“I don’t think most of us can even remember what the system was like in 2019,” said Dan Bennett, Gifford’s CEO.
In particular, Bennett said Berkeley had incomplete data about Gifford’s joint replacement care. The consultants appear to be trying to draw conclusions from incomplete data, he said. In addition, it’s unclear what relation 2019 data has on the future, given that the ongoing effect of the pandemic on health care remains unclear.
“I think it’s disconnected to the reality,” Bennett said.
In looking at the future need for hospital beds around the state, the Berkeley study did factor in the new $150 million patient tower at Dartmouth-Hitchcock Medical Center in Lebanon that is currently under construction. The five-story, roughly 200,000-square-foot building will include 64 single-occupancy rooms and space for 64 more to be built out as needed.
Given that DHMC has trouble staffing the 396 beds it currently has, Bennett said he wonders where the staff for the new beds will come from.
“In terms of the wider area, what is the impact of that when all of us are already having a hard time staffing the programs that we have,” he said.
Factoring in DHMC’s new beds the consultants estimated that by 2026, if current trends continue, Gifford would need eight fewer beds than it currently has; Mt. Ascutney would need two additional beds; and Springfield would be unchanged. All three Upper Valley hospitals each currently have 25 licensed beds. Mt. Ascutney also has a 10-bed rehabilitation unit.
Several other hospitals in the state, including Brattleboro Memorial Hospital and Northwestern Medical Center in St. Albans, would also see a steep drop in bed needs, the study said.
Rather than focusing on restructuring the state’s hospitals, Bennett said he would rather see state officials focus on allocating resources to help hospitals make the transition from fee-for-service to value-based care. He said hospitals need government funding to support primary preventative care, disease management and to build out a data analytics infrastructure.
“I don’t see where this report is very useful,” Bennett said. It would be “good to get back to a conversation about how we’re going to solve the crisis at hand (and) continue to work towards down this road of changing our system over to one that’s embedded in value-based care. This feels like something different.”
Barrett said she agrees that hospitals need financial support to make the shift, but that has to come as officials continue to examine ways to make the health system better fit the needs and pocketbooks of Vermonters.
The examination of the sustainability of the 14 hospitals in the state is, in part, motivated by Springfield Hospital’s bankruptcy and a broader national trend of rural hospitals closing, said Barrett.
The board’s responsibilities include regulating hospital budgets and rate increases for commercial health insurance. More broadly, though, the board’s goals include improving care for Vermonters, while cutting costs.
Because Vermont’s population is aging, more and more Vermonters are covered by Medicare or Medicaid, which has the effect of shifting costs on to a smaller and smaller pool of commercial ratepayers, Barrett said. At the same time, many of the state’s small hospitals have struggled to make revenues match expenses in recent years.
“That is the number one reason we’re doing this, because it’s not sustainable,” Barrett said. “This is really the beginning of such important work for Vermonters.”
Nora Doyle-Burr can be reached at firstname.lastname@example.org or 603-727-3213.