Talking about health care

Discussion with governor's cabinet focuses on challenges, successes BY JIM T HERRIEN Vermont News & Media correspondent

BENNINGTON - More than two dozen healthcare professionals and area residents attended a roundtable discussion Friday, led by several members of Gov. Phil Scott's cabinet.

The 90-minute session focused on questions and concerns about healthcare in Vermont, as well as on some positive news despite rising health insurance and other costs.

COSTS, INNOVATIONS

The afternoon event was part of the governor's ongoing outreach initiative, Capital for a Day, which brings top administration officials to one Vermont county at a time to meet with local officials and residents in a variety of settings.

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Among state officials attending the healthcare roundtable at Southwestern Vermont Medical Center were Human Services Secretary Jenney Samuelson; Disabilities, Aging and Independent Living Commissioner Jill Bowen; Vermont Health Access Commissioner DaShawn Groves and Health Commissioner Rick Hildebrant.

"Our goal is to listen," said Samuelson, who led the discussion. "We are here to hear from you."

She asked, "What is going well in your communities, what are the challenges you face, and what are some of the opportunities that you see [for state government] to pursue."

SVMC President and CEO Tom Dee and Dr. Trey Dobson, chief medical officer and an emergency medicine physician, outlined some of the challenges the Bennington hospital faces.

Those include seeing too many patients in the emergency department who would be better treated in a non-acute healthcare setting, and a need for more emphasis on fostering health before patients became seriously ill.

Challenges in treating patients with mental health or addiction issues and threats to hospital personnel were also mentioned, along with difficulties in placing patients in other more suitable facilities.

Low insurance reimbursement rates and inadequate or no insurance coverage for many patients; a heavy load of bureaucratic paperwork, and limited patient access to primary care medicine were among other concerns expressed by the hospital officials and leaders of other care organizations.

Dobson said some patients remain too long in the emergency department because they are "boarding there because they do not belong in the hospital and because there is nowhere else for them to go."

While always a problem for emergency departments, he said, "It is definitely worse since the pandemic."

Another issue, he said, "is verbal or physical assault against health care workers," which can lead to employees leaving the hospital or the field.

Dobson and others referred to an emerging obstacle to recruiting health care professionals to Vermont in light of media reports on hospitals in Vermont closing or struggling to remain open.

"It actually scares people that are trying to come into the state for work, and it actually scares current staff," Dobson said.

However, "A lot of things are going well," Dobson said. "Collaboration among local agencies is excellent," he said, with a "willingness to engage together with very little disagreement. It is more about trying to figure out the complexities of health care."

He advocated more "novel approaches toward reimbursements so that we can put dollars toward preventative care, not just acute response to sick people."

HOUSING ISSUES

Lorna Mattern, CEO of United Counseling Service, said housing is another significant challenge for potential employees and for clients of UCS.

"We just offered a position to a licensed clinician who wants to move here from Washington state," she said, "and he looked at housing and decided against it."

Some potential employees coming to Vermont face high student loan costs, she said, alongside the prospect of lower pay than in other states and high housing costs.

Concerning UCS clients, Mattern said that "finding housing for them that is not a motel is very difficult."

"What's going well," she said, "is we have amazing collaboration and partner with the hospital and other providers in the community, in part because we have limited resources and we can't do it alone ... This has really brought about some exceptional relationships; it has brought about some innovations to be able to respond to some of the issues."

Dee said he has worked in many communities during his career, adding, "I think here is probably the best I've seen. I think it is pretty remarkable how well organizations try to work together."

Kayla Davis, co-executive director of Battenkill Valley Health Center, said her organization has realized how providing more of a wraparound primary care service - including in related areas like nutrition - has a positive impact on reducing health care costs while also better supporting patient health.

"I think the thing that we need [from the state] is a listening ear, which you are providing," she said. "It is the continued partnership, the continued listening ear, and then investment when we tell you we can save you money. Believe us and invest in that."

She added, "There are so many of these grassroots things that we are doing. Even though there is no money; it's not compensated, but we have an obligation to take care of our community, and so we find ways to do it."

Citing a particular need, Davis said the health center would expand services but lacks a funding source to acquire building space and renovate it.

FEDERAL BUDGET CUTS

The budget cuts being implemented by the Trump administration also are having a negative impact on the ability to provide services amid the costs, the officials said.

"I'm out of space, completely," Davis said. "We bought a building in Bennington, and we were going to renovate it with congressionally directed spending; all that money went away. So we could be expanding into the Bennington region, which is one of our goals, but there is no money to renovate that property."

The health center also has staff recruiting issues, she said, adding, "The housing market - if you can't afford a $750,000 house, it is pretty dire."

PRIMARY CARE

In terms of recruitment, Dee noted that bringing in new primary care physicians has been difficult. But the health care organization is working on a proposal for establishing a family physician residency program at SVMC, for which state funding will be sought.

"It could have really a transformational impact on our region," he said. "So the ask [of the state] is coming. It's not here yet. But the lights are looking green from our standpoint to go ahead and do it."

Pamela Duchene, SVMC's chief nursing officer and vice president for patient quality, said an ongoing pipeline program for area residents who want to become nurses has been a successful approach to addressing nurse shortages as older nurses retire.

Student nurses in the program are already in Vermont and don't have to adjust to the state after being recruited from elsewhere.

"Our vacancy in nursing is probably the lowest in the state," Dee said.

The health care leaders also advised against too much pessimism over Trump administration efforts to reduce support for people in finding or trying to renew health care insurance policies.

Sanderson asked the organizations represented in the room to "not try to sugarcoat it, but to recognize that we can do something to make a difference here. Help work with us to roll up our sleeves to that work on the ground so that we don't see our insurance [numbers] drop in the ways that folks thought it might. We can make a difference."

She said that many have gotten the impression that health subsidies for insurance will be eliminated, "but that's not true."

If people compare policies, there still are options for insurance, she said. "It may not be what you had, what you are used to, but not having insurance is worse."