A 144-page report released last month describes a dire near-future for Vermont’s hospitals, which are some of the most expensive in the country.
To keep health care affordable and accessible, the report — paid for by the Vermont Legislature and commissioned by the Green Mountain Care Board — recommends taking drastic action. Such as: reconfiguring some emergency departments to urgent care, converting inpatient units to mental health care, and shifting birthing outside of hospitals.
That has some rural hospitals and their communities worried — like North Country Hospital in Newport.
Earlier this month, about 200 local residents and physicians attended a meeting to discuss the recommendations. Many people questioned whether they could be trusted when there were factual errors in the report.
Vermont Public’s Elodie Reed was there and picks up the story.
This interview was produced for the ear. We highly recommend listening to the audio. We’ve also provided a transcript, which has been edited for length and clarity.
Tom Frank: There were many discrepancies in that report that we attempted to address, and unfortunately, they did not make it into the final version.
Elodie Reed: This is Tom Frank, the president and CEO of North Country Hospital, speaking at the Oct. 10 forum.
Tom Frank: One example is the report we received in July said 200 births per year, which is accurate. What the final report said was 200 births in two years.
Elodie Reed: Essentially, Frank is saying that the hospital’s number of deliveries was erroneously stretched out not over one year, but two. That made it look like the hospital served fewer people.
Bruce Hamory led the work on this report. He’s a medical doctor and consultant specializing in redesigning health care delivery with the firm Oliver Wyman.
He spent a year gathering feedback from thousands of Vermonters including patients, health care workers, hospital leaders and advocates — as well as data provided by hospitals.
And Hamory says: North Country Hospital CEO Tom Frank is right. The birth numbers were wrong in the final report.
Bruce Hamory: The physician is correct. That number 200 is not over two years. It's a one-year number.
Elodie Reed: But Hamory says, while unfortunate, he stands by the overall findings. That Vermont’s vital statistics show birth numbers going down at North Country Hospital, and that obstetrics are costly for hospitals.
Bruce Hamory: And so it's basically, get ready for the future, right? Don't — don't act like what is now there, will always be there.
Elodie Reed: The head of North Country Hospital also took issue with a second data point in the report — annual emergency department visits. The number is listed as just under 11,000 in the report. But Tom Frank said the hospital sees closer to 16,000 people in the emergency department each year.
According to Hamory, the numbers that were supposed to appear in the report came directly from the hospitals themselves.
Bruce Hamory: We asked the Vermont Association of Hospitals and Health Systems to do a survey for us. And the number of emergency room visits that North Country Hospital reported to them was 14,188. So you know, he's right, but it's more, it's around 14,000 … and I, you know, messed up in the report.
Elodie Reed: But Hamory says he used the correct number to calculate how many costly emergency department visits at North Country Hospital could have instead been handled by a primary care doctor.
Bruce Hamory: So again, doesn't really affect the financial analyses.
Elodie Reed: Being a reporter, I know small details get — we make mistakes, right, and then we correct them. That happens all the time in my work as well. At least in my work, though, it really does impact trust when we do make mistakes like that.
Bruce Hamory: No and I understand, and that's why I'm upset about it too, because I had lots of eyes on these slides, including mine. We all missed that two-year thing. OK? And I agree with that. But my point is, it's a forward-looking report. The data that are used were vetted by the hospitals and reported by the hospitals.
I'll bottom-line this: the health care expenses in Vermont are out of control. The question is, what do you do? OK. If there's disagreement about the health care costs being out of control, that would be an important data element to have missed.
Elodie Reed: You know Tom Frank opened that meeting essentially by saying, you know, "They took, like" — they being Oliver Wyman — "took the two worst years we've had and extrapolated that out to paint a picture of our financial sustainability. And from where I'm sitting" — this is him saying this — "you know, we have," he said, "221 days of cash in the bank. Like we are — we are strong."
How do you square his sort of presentation of the hospital's financial health with — with what you've put in this report?
Bruce Hamory: I take Mr. Frank's point. And yes, I mean, he's got a lot of days cash on hand, and he's a very prudent hospital administrator, a good, good administrator. But they're still requesting price increases.
Again, the question is, how do you address increasing costs?
Elodie Reed: Because there are these questions coming from the community about, you know, the accuracy of some of the numbers in the report — is that standing in the way of taking the next step in this conversation?
Bruce Hamory: No, no. And let me look at it this way — in every conversation that I had in the state of Vermont, everyone — these were not new problems. People said this has been going on for years. Now, you can argue with the data and — and I'm certain, because they've done it with every prior report, right? That yes, there will be a problem here or there. Nothing's perfect, OK?
You can take that as an excuse to do nothing, all right. If you do nothing, best projections are that in the next three to five years, you're going to have a bunch of folks bankrupt. They will either be hospitals, or they will be citizens, or they will be both. That's the bottom line.
Elodie Reed: Hamory and the Green Mountain Care Board say they will correct the information for North Country Hospital in the Oliver Wyman report.
Vermont Public reached out to the Green Mountain Care Board to ask about whether it plans to fact-check the rest of the numbers for other hospitals. The board said it would make any other corrections brought to its attention.
The board also said it was glad to see communities like Newport engaging with the report — and hoped this would help generate solutions for how to fix the problem of health care affordability in Vermont.
The Green Mountain Care Board has a public meeting to discuss next steps with the Agency of Human Services and lawmakers at 1 p.m. on Wednesday, Oct. 30.
Have questions, comments or tips? Send us a message.
_
