[S]pringfield Hospital’s serious financial trouble has prompted state regulators to consider a host of new disclosure requirements for all Vermont hospitals.

The Green Mountain Care Board, in a new report sent to Gov. Phil Scott, details plans to require disclosure of more information, more frequently, about hospitals’ financial health. The board also is developing standards that could trigger underperforming hospitals to submit a “corrective action plan” to the state.

“Nobody wants to not be able to react in a timely enough manner if a hospital falls into financial distress,” care board Chair Kevin Mullin said. “And I think that Springfield was a wake-up call that we need to be monitoring more closely in this time where all rural hospitals across the United States are really finding intense pressures.”

The regulatory discussion is spurred by last month’s revelations that Springfield Hospital hasn’t been paying its bills. The hospital’s chief executive officer and chief financial officer have resigned, and state officials have said they believe Springfield administrators omitted key information during budget presentations to the care board last year.

In late December, Gov. Phil Scott asked the care board to take a closer look at the financial health of Vermont’s small “critical access hospitals,” including Springfield. The governor also said the board “should make transparent its criteria and metrics for determining the financial viability of critical access hospitals.”

In answering the first of Scott’s requests, the care board on Wednesday sent an “initial reassessment” of critical access hospital finances. The analysis uses actual results from hospital fiscal year 2017 and projected results from fiscal 2018; hospitals don’t have to report 2018 actuals until the end of this month.

All of that data already had been analyzed by the care board during the fiscal 2019 budget review process, and it has been available on the board’s website. So the results were “nothing that we didn’t already know,” Mullin said.

The report does show where each critical access hospital ranks among other hospitals for key measurements like debt service coverage ratio, operating margin and days cash on hand. The results were mixed, but Springfield – not surprisingly – fared poorly in the analysis for fiscal 2017.

A deeper dive into hospital finances is on the way in a few months: Mullin wrote to the governor that the care board “intends to augment this report with additional analysis in April 2019.”

Of more immediate note, the care board has created a detailed list of new financial-reporting requirements.

The board quoted a national study showing that more rural hospitals are closing. “That challenging national landscape … underscores the need for the state to provide enhanced focus on financial health of its critical access hospitals in particular, and all Vermont hospitals more generally,” board members wrote.

“The board is therefore reassessing its metrics and data collection for hospitals to determine if there are additional metrics that might assist the state in monitoring financial health, as well as ensuring that health care costs are contained,” the report says.

New disclosure proposals include:

• The care board has asked critical access hospitals to submit additional financial information based on several federal measurements that aren’t already considered by the care board. By next month, that data will be incorporated into financial “dashboard” summaries for each hospital.

• Officials are considering asking hospitals for “supplemental annual information.” That includes information about credit ratings, parent organizations, affiliated entities and “the hospital’s financial controls, including oversight by the hospital’s board of directors.”

• The board will ask hospitals for more detail in periodic financial reports, “such as balance sheet information and days cash on hand reports.”

• The board also is mandating that hospitals give immediate notice if certain things happen. Examples include changes in management or executive staff; violations of a loan, bond or covenant; and any “significant negative change” in revenues or payments to employees or vendors.

• The board will consult experts to develop new measurements for hospital financial performance. Hospitals that fall “below acceptable performance ranges” would have to “submit a corrective action plan against which the hospital could be monitored.”

As an example of that type of monitoring, care board officials said they’re now requiring that Springfield Hospital submit additional information like weekly cash flow statements, bi-monthly accounts payable reports and monthly accounts receivable reports.

Mullin said the care board still is working through the details of new hospital-monitoring requirements, and the board’s report says it “welcomes feedback.” Some of that feedback will come from the Vermont Association of Hospitals and Health Systems, which is concerned about the administrative burden of additional state reporting.

Mike Del Trecco, the association’s finance and operations senior vice president, noted that the hospital budget regulatory process already takes months.

“We’ll use our standard and long-standing approach to collaborate with the board to make sure there’s a fair balance,” Del Trecco said.