Unacceptable Health Care Reform?

Blog#217-9/30/24

UNACCEPTABLE HEALTH CARE REFORM?
By
Richard Davis

When I first read the report “Act 167 Community Engagement: Recommendations”, I almost laughed because I had a pretty good idea of how hospitals would react. The passage of Act 167 was a recognition that Vermont’s health care system needs serious change if it is to survive and this report was commissioned to find out what to do. It focused on the state’s hospitals.

Many of the recommendations make sense, but what I find difficult to understand is how all of the affected hospitals could possibly make the changes called for in the report. They talk about regional centers of excellence where only certain hospitals would do specific procedures. There could be fewer hospitals doing joint replacements and those who continue would become more expert at the procedures.

There is also a call for hospitals to share staff. That makes sense from an intellectual perspective, but how many nurses are going to want to travel an extra hour or more to work each day just to fulfill the aims of systemic restructuring?

Both Grace Cottage Hospital (GCH) and Brattleboro Memorial Hospital (BMH) are on the chopping block for suggested changes. GCH is in a category titled “Major Restructuring Needed” and BMH is earmarked for “Changes to Existing Service Lines”.

In the case of GCH the report rationale states, “Minimal growth potential and poor financial position requiring significant subsidization to improve aging physical plant needing upkeep / replacement, low procedure / admission volumes due to shrinking insufficient populations, care sought outside HAS, nearby facility available to care for inpatients.”

What this boils down to is a recommendation for GCH to no longer be an acute care hospital and switch its beds to mental health, geriatric psychiatry and memory care. In other words the report thinks GCH should totally revamp its mission and pretty much turn into a nursing home. I’m sure that didn’t sit well with anyone associated with the facility.

I was director of nursing at GCH for a short time in the late 1980’s and I always felt that it was not a good use of health care resources for the facility to invest in acute care, but their community supports them and they always have found a way to survive. It is a very insular community and the Act 167 report blows apart and ignores the uniqueness of the place. My thought was that GCH would make an amazing inpatient hospice facility, but no one was interested in that idea.

Then there is BMH. They are in a category described as “Changes to Existing Service Lines.” The report rationale for BMH states, “Financial trends show potential for improvement through targeted cost management programs and/or service line reconfiguration, existing procedure volumes and projected population needs are sufficient to support certain specialties.”

The report recommends that BMH create a consortium with GCH and Springfield Hospital, provide mobile clinics, form regional specialty groups, support SASH and help support low income housing, strengthen relationship with EMS. It is also recommends that, in the long term, BMH grow inpatient beds, add inpatient dialysis, grow OB/GYN practices as well as orthopedics practices and general surgery.

The people who put this report together have been singing a song of doom and gloom for Vermont’s health care system if these changes are not made. Who will try to make all of this play out as described in the report and do Vermont’s hospitals really have to do anything? The Green Mountain Care Board could force these issues, so it will be interesting to see how this all plays out in the coming months and years.