Can't afford to ignore report on Vermont's hospitals

If things in Vermont's healthcare world don't change Vermonters will continue to see an unacceptable increase in their health insurance premiums and will end up subsidizing our hospitals with an additional $700 million to $2.4 billion over the next five years, according to Dr. Bruce Hamory, of Oliver Wyman, an international consultancy funded by the Legislature to find ways to improve the state's health care system.

This is not the first time the state's health care system has been examined, but Mr. Hamory's report is the most thorough yet and most controversial. The report's timing is also noteworthy. Our hospitals are operating in the red, health care premiums have doubled in the last six years, wait times are long and the quality of care is being challenged. What we have is not affordable, according to the report, and what we have will continue to deteriorate if we don't change how our healthcare system is managed.

Mr. Hamory's report is 144 pages and it examines each of Vermont's 14 hospitals. [Northwestern Medical Center fares relatively well; it's one of the "safe ones."] The report details specific recommendations for each hospital, including ways to reduce inefficiencies, improve access to better care, and improve healthcare outcomes. Mr. Hamory makes it clear that we have four hospitals [on our eastern border] whose existence is questionable. It also recognizes the obvious: we can't afford what we have and our population is rapidly aging. By 2040 over 30 percent of Vermont's population will be over the age of 65, which, according to the report will "exacerbate current strains on the healthcare system due to increasingly complex care needs."

In other words, if we think things are bad now, do nothing and see how much worse they will become.

The consultant's report is full of recommendations, all of which focus on making hospitals more efficient, including things like moving some care out of hospitals and into homes, consolidating services between hospitals, standardizing accounting and pricing practices, regionalize specialty care services, moving EMS systems into more professional organizations with regional responsibilities and closing inpatient facilities that are near bankruptcy. [There can't be a hospital CEO in Vermont who read the report whose jaw didn't hit the floor. The proposals, after all, argued for total transformation.]

All together the consultant's recommendations would yield $400 million in direct savings over the next five years. That is $400 million that could be plowed back into improving the state's health care system and, in the words of the consultant "bend the trend of rising health insurance premiums."

The report makes it clear that the health care crisis affects us all - no one is spared, no region suffers while another benefits. The "solution" involves correcting things system-wide.

The challenge, put simply, is telling Vermonters the story, to make clear the consequences of the status quo.

This should be a story with no political slants. Republicans and Democrats alike should embrace the report's direction: its purpose is to reduce costs, make health insurance premiums more affordable, and, over time, improve the financial strength of our hospitals.

For Gov. Phil Scott this should be a no-brainer. His political life revolves around the issue of affordability, and soaring healthcare premiums are at the tip of that spear. He should make available all the resources necessary to explore the consultant's recommendations. He should use the report to begin the discussion as to how Vermont can not only make itself more affordable but do so in a way that makes Vermont a more appealing place to live and work.

Vermont's legislators should also step up. When Act 167 was passed in 2022, it was the intent of the law to explore options for Vermont's health care system and for the Green Mountain Care Board and Vermont's Agency of Human Services to figure out ways to make health care more affordable and more accessible. This should be a joint exercise - the resources of both are needed to arrive at a meaningful conclusion. Working separately, or against one another, is the antithesis of what's needed.

It's time now for the Legislature, along with the governor and the Green Mountain Care Board to do all that's within their power to bring these recommendations to Vermonters. It's their responsibility to cull through the proposals, determine what's best, and then to sell it to each of our communities and their respective healthcare providers.

What's not acceptable is to allow dust to settle on the report as it has with all its predecessors. The competing forces in this debate are legion. The internecine battles are already underway. If there is a single take-away from the consultant's report it is the need to sidestep the inertia that has left us holding a healthcare bill none of us can afford and a healthcare system on the brink of insolvency.

In other words, do something.

By Emerson Lynn