Editor’s note: This commentary is by John R. Brumsted, MD, who is president and CEO of the University of Vermont Health Network.
Nov. 21 is Rural Health Care Day across the United States. In honor of this day, I want to illustrate the work we are doing locally in northern New York and Vermont, as we adapt to meet the needs of aging populations, changes in how care is paid and reimbursed, and ever-increasing costs of serving every patient who walks into our clinics or emergency rooms.
On one side of the exam table are the patients and their families who are relying on their local, rural community hospitals for primary care, emergency care, and for services ranging from delivering a baby to treating a patient with cancer. On the other side, the same providers delivering those babies and mending broken bones are facing rapidly aging patient populations, increased difficulty attracting doctors, nurses, and other necessary staff, and challenges staying current with the latest technologies absolutely necessary to provide care and run their clinics. Meanwhile, costs to provide this care (from pharmaceutical to utility costs) continue to rise faster than what we are getting reimbursed.
In this environment, it is no wonder rural hospitals all across the country – the anchors for so many of our communities – are closing at an alarming rate (more than 100 over the last decade), leaving many people wondering where they will go for care. And to make a tough situation even harder, with each facility that closes, it becomes more difficult for those who are left to meet the needs of the patients and families coming in the doors.
In our corner of the country, we are not immune from these pressures. The UVM Health Network is our region’s largest provider of rural health care services, and each member of our network, including the UVM Medical Center, is struggling to meet our financial targets. Many ended this past year in the red. Each of us is confronted every day with the reality of diminishing payments for more patients with more complex needs.
What makes us different is that we have come together to pool our expertise, our people, and our resources to set this rural health care system apart from the rest. We have faced head on the hard reality that we need to adapt to survive and preserve health care for this region, and sat across the table from each other to build this network from the ground up. We are a locally led, non-profit network working to preserve access to care, while also changing the way care is delivered to focus on wellness as much as illness and to control costs.
To preserve access to high quality care in our communities across New York, Vermont and beyond, we must continue to transition from totally independent organizations to a system of care where local hospitals and providers continue to exist, but the services provided are the best we can provide, while recognizing the expertise that may be down the road at a different clinic or hospital.
In a coordinated system, if something is not available in one community, it is not up to patients and families to figure out how to access care. Instead, resources within the system can be used to make local care available. For instance, if you cannot afford to build and staff a palliative care program, then partner with one that already exists and bring the service to where and when patients need it. This is what Porter Medical Center did, partnering with the UVM Medical Center to bring this service an hour south on Route 7 to Middlebury.
Other examples include:
- The Emergency Room at the former Moses Ludington hospital in Ticonderoga, New York, is overseen by a physician based at Elizabethtown Community Hospital and is often staffed with other network physicians. If the campus at Ticonderoga had closed completely, patients in need of emergency care would have had to travel nearly an hour to get it.
- Increased use of telemedicine extends the reach of specialists who can provide expert consultations for stroke, ophthalmology and psychiatry patients, among others, without leaving their practice or hospital. By providing tele-stroke services to Central Vermont Medical Center, we are able to keep many patients there to receive their care, saving them and their families the more than 40 miles it takes to get to Burlington from Berlin.
Our network is bringing care where it is needed and reducing duplication to ensure it is more affordable. There is much more work to do.
Maine Health and Dartmouth-Hitchcock Health are other examples of networks coming together in our region around an academic medical center to form a system of care. These organizations have each formed not to dominate, but rather to gather a family of like-minded hospitals and providers around the same table to figure out how to ensure they can continue to provide services their communities need in the future. Meanwhile, areas that have not developed a collaborative system of care are learning the hard way that if providers are left as boats alone in the storm, the risks of closing programs or entire facilities become very real.
The plain truth is that we must innovate to preserve access to high quality, affordable health care delivered as close to home as possible. Rural health care may be at a crossroads, but building a system of care is the road ahead to a healthy future for our patients and our providers, and none of us can afford to not take it.
