Are Vermont’s Hospitals Capable of Big Changes?

Blog#88- 11/5/21

Richard Davis

The Green Mountain Care Board, the entity that oversees and regulates Vermont’s health care system, commissioned a consultant’s report, “Green Mountain Care Board: VT Hospital Quality Review and Capacity Planning in Preparation for Value-Based Care October 27, 2021” to point the way for long-overdue systemic reform. Hospitals do not take kindly to being told what to do. They have become institutions that have been resistant to big change because of the power they wield in local communities. But pressure is mounting for real change. That is what this report points out.

We hear talk about the high cost of health care and about how something needs to be done. The only way this country is ever going to control health care costs is for there to be bold change and bold change in not something hospitals are good at. The consultant’s report calls for bold change.

I will quote bits and pieces from the report, which I have scanned but not completely digested yet. They talk about a move toward “value based care” and state, “Hospitals will increasingly be held accountable for the cost and quality of care being provided. This accountability may also be extended to the communities served by the hospital, not just those patients admitted to the facility. In value-based payment models, excess hospital capacity can lead to unnecessary costs being locked into the system and low volume programs have the potential to provide lower quality of care. Potential excess capacity needs to be balanced to ensure appropriate access to care. Poor quality outcomes impact population health, potentially threatening reimbursements and compromising financial sustainability.”

One of the report’s key findings is that there is a low occupancy rate of beds at many Vermont hospitals. In an effort to create better economies of scale the consultant’s have suggested that some hospitals stop providing inpatient care and have their local population drive up to 30 minutes for acute in-patient care.

What will no doubt prove to be controversial is the suggestion that Grace Cottage Hospital in Townshend have patients go to Brattleboro for inpatient care. They base this recommendation on findings that show, “Both facilities have low occupancy rates. Brattleboro (36.1%) ,Grace Cottage (56.6%). Both hospitals are projecting a reduced bed need by 2026. Grace Cotttage (-18), Brattleboro (-26). Travel time – less than 30 min drive time between the two facilities. Cost per discharge – Grace Cottage has one of the highest costs per discharge in the state ($18,485). Age of plant: Brattleboro’s (11.9 years), Grace Cottage (21.1 years). Both serve the same HAS (Health Service Area).”

They also recommend that patients now using Springfield Hospital go to Mt. Ascutney Hospital in Windsor for inpatient care and they note that, “Springfield has a low occupancy rate (45.8%). Quality rating – Mt. Ascutney has a higher quality rating (4 stars). Travel time – 30 min drive time between facilities. Age of plant, Mt. Ascutney (12.6), Springfield (17.2).”

Other recommendations would close some ICU beds in low capacity hospitals and have smaller hospitals stop doing procedures that are not done enough to meet national standards. Vermont would then create what they call “centers of excellence.” This would mean that procedures such as joint replacement would only be done at a few hospitals in Vermont and people would have to travel farther for care.

The big questions have not been addressed as far as I can tell. How much change are Vermonters willing to accept in the way health care is delivered in their state in order to create a system that is designed to keep the cost of health care under better control?
Vermont is a state where there are distinct local pockets of culture that are tied to all of the institutions in a community and health care is no exception. Will Vermonters be willing to give up the local character of health care in order to save money and have a more efficient system?

There needs to be public discussion about this consultants’ report. It deals with many of the most important issues that need to be addressed, but unless we have broad public engagement it will be difficult to make the kinds of changes that need to be made.

Here is a link to the report: PowerPoint Presentation (

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