Editor’s note: This commentary is by Steven R. Gordon, president and CEO of Brattleboro Memorial Hospital, and member of the OneCare Vermont board of directors.
As one of Vermont’s 14 non-profit hospitals, Brattleboro Memorial Hospital (BMH) recently completed budget hearings before our state regulatory body, the Green Mountain Care Board (GMCB). The GMCB is charged with reviewing all hospital budgets, rate increase requests, new services and major capital expenditures. Their major focus is to limit hospital rate increases as well as growth in patient revenue. I want to take this opportunity to share some reflections about what’s going on in our region and across the country for many hospitals like ours. The bottom-line is our Vermont hospitals face significant headwinds.
Almost half of the hospitals in Vermont are experiencing negative operating margins for the current fiscal year. For our part, after three consecutive years of negative margins, we are projecting a very small margin of approximately 0.6% of our $87 million budget. To get us to where we are today, we reduced our operating budget by $2 million through careful planning and work to find efficiencies all without impacting patient services.
Hospitals large and small all across the country and even as close to home as Springfield are struggling to adjust and adapt to what is a very challenging environment. More than 100 hospitals have closed in recent years. The reasons vary but many situations begin with an already fragile economic situation. Years of thin margins and years with no margins at all make it difficult, and eventually impossible, to weather reimbursement challenges and workforce shortages among other things. Our aging and declining population combined with the social determinants of health — homelessness, mental health and substance misuse — place additional pressures on all Vermont hospitals.
Springfield Hospital’s bankruptcy is an alarming wakeup call. I know many people have been personally affected by their situation and BMH has been impacted too, having to step in and provide obstetrics services. For too long, too many thought this kind of thing didn’t happen here and that hospital financial woes were overblown. We know that’s not true, and that it is possible if we are not vigilant.
Still, in the face of these challenges, BMH continues to advance initiatives to address our region’s most difficult challenges. This critically important work includes:
- Dental Health: BMH has collaborated with the United Way of Windham County over the past several years to establish a dental center. We recognized the need for accessible, affordable dental care for local patients enrolled in Medicaid or without dental insurance.
- Vulnerable Population Nurse (homeless shelter and respite bed): BMH provides a Vulnerable Population RN embedded at Groundworks Collaborative (a local agency serving the homeless) to provide both health care and case management for homeless and near-homeless individuals in our community.
- LGBTQ+ Initiatives: BMH created the LGBTQ+ Leadership Council with the mission to create a welcoming, affirming, and clinically excellent environment for all employees, patients, families, and friends. We are working with the Fenway Institute to provide LGBTQ+ affirming healthcare.
- Care Coordination: BMH is linking together our clinicians, specialists, and care facilities to provide integrated care for our patients with chronic conditions.
- Embedded Behavioral Health Therapists in Primary Care: Several BMH primary care practices partner with Brattleboro Retreat and Heath Care and Rehabilitation Services (HCRS) to provide behavior health therapy and follow-up services.
- Opioid Reduction Initiatives: BMH is an active member of multiple groups addressing this important issue including the Prescription Abuse Prevention group.
- Health Care Reform: We are engaged in new models for payment for health care services and making the bold move away from fee-for-service care to value-based care where we will no longer be compensated for each test and procedure but instead for prevention and health outcomes.
For 115 years, BMH has proudly served this region with the highest quality, compassionate care delivered by neighbor to neighbor. To remain strong so we are viable for the next 115 years, we will have to continue to operate as efficiently as we can. Our razor-thin margin this year is an indication that we are doing better than in year’s past, but it is also a warning that we have more work to do to be financially secure.
