Editor’s note: This commentary is by Ben Jickling, of Brookfield, an independent state representative for the Orange-Washington-Addison district in the Vermont House.
[T]he recent news surrounding the financial health of Springfield Hospital has generated a lot of buzz in our little state. As news about fiscal difficulties surfaced, the Scott administration quickly intervened, appointing a special liaison and calling for more oversight. The Green Mountain Care Board went further, requesting further information from Springfield, as well as other similar small critical access hospitals and suggesting they may have been misled by executives. Responses have come from outside government as well. Just this week, someone in a VTDigger commentary called for more regulation of hospitals, including subjecting them to the open meeting law.
I am skeptical that the challenges faced by rural hospitals and providers are due to a lack of regulation. Rather, we as policymakers and regulators have not acknowledged or responded effectively to the current environment.
In fact, there has been a steady erosion of support for rural hospitals and medical providers in recent years. The Scott administration has led the way on disproportionate hospital payment cuts, cutting support for uncompensated care by tens of millions of dollars. Similarly, the Scott administration has attempted to remove some of the few supports we provide the medical community, including trying to eliminate the only state program that provides partial loan repayment for primary care providers that chose to practice in our small towns.
To be clear, the challenges faced by rural hospitals are not due entirely to public policy. In Vermont and the greater U.S., these organizations are grappling with changing demographics, rapid urbanization and an increasing complexity of reform efforts. It is critical that these trends are acknowledged by leaders in Montpelier, if we want to ensure a sustainable future for health care in our state.
Such changes threaten our nonprofit Vermont hospitals, which provide some of the best health care in the country. We are lucky in Vermont, because we have spent decades improving access to care in ways that put us ahead of much of the rest of the country. As we embark further into all-payer capitated payment reform, it is as important as ever that we support our health care providers, especially those in rural areas. Reform leaders recognize that successful population health management cannot be limited to Chittenden County. While the Green Mountain Care Board has suggested that consolidation may be the answer for these challenges, it is a misguided assumption. Rural hospitals ensure that all Vermonters, even those that live on our back roads, can access high quality care. With local management and care that is designed for rural communities, there is tangible value in maintaining our cooperative and independent network of hospitals in Vermont.
Any analysis of the budgets of many rural hospitals in the state demonstrate the volatile and challenging environment that they face. Worker recruitment is a persistent challenge, for nurses, providers and support staff. Additional, the chaos in Washington suggests that stability in funding and regulation may be hard to come by. Perhaps in this new year and a new legislative session, policymakers (myself included) can consider these dynamics with open minds and a more discerning approach.
