This commentary is by John Brumsted, M.D., president and CEO of the UVM Health Network.
Rural health care is in peril. It simply is not sustainable in its current form due to financial, demographic and workforce pressures.
So it’s a good time for the health care sustainability discussions now happening in the Vermont Legislature and the Green Mountain Care Board. We at the UVM Health Network have some important lessons to share — examples of how achieving sustainability leads to better health care for the future and for right now.
But we need support to keep this critical work going.
Building a sustainable health care system has been my focus for more than a decade. In many parts of this country, people living in rural areas do not have adequate access to important services, from primary care to the complex and specialized services provided at an academic medical center. Since 2010, 138 rural hospitals have closed nationwide, and today, many more are on the brink of financial collapse.
My colleagues and I launched the UVM Health Network in 2012 to avoid this outcome. We are an integrated academic health system that serves more than 1 million people over a largely rural area in Vermont and northern New York.
Here is an example of what sustainability looks like for our patients: In Ticonderoga, New York, the former Moses Ludington Hospital was a failing, 15-bed critical access hospital with an average of three patients in-house daily. Today, it has been transformed into a medical village offering a variety of complementary health care services that respond to the community’s needs in one convenient location.
The medical village, on our Ticonderoga campus, is a part of the UVM Health Network’s Elizabethtown Community Hospital, a critical access hospital about 30 miles away. In addition to primary, specialty and 24-hour emergency care, patients are able to receive laboratory tests, medical imaging and outpatient physical, occupational and speech therapy in Ticonderoga. This saves some patients from having to drive an hour or more for care they need, and it helps patients avoid the sometimes severe consequences of delaying care.
This transformation didn’t happen by accident, or overnight. It is the result of thoughtful planning, collaboration with many partners and intentional investments. Most importantly, it was driven by a vision for sustainable health care in the rural area around Ticonderoga.
The UVM Health Network is working to preserve and improve access to critical health care services across our region, and we’re doing this through an integrated system of care. It’s about sharing. The organizations that are part of our health system share expertise and resources, which helps us provide the right care, when and where our patients need it, while quickly responding to challenges and crises around us, like Covid-19.
We share support systems (for example, IT, analytics and administration) so we can focus as much of our resources as possible on patient care and on our academic mission of education and research. And we share a commitment to improving the health of our communities, to creating a more equitable and inclusive environment for our patients and our people, and to transforming the way health care is delivered and paid for so we can focus on wellness as much as illness while controlling costs.
With that commitment comes a big challenge: How can we make this work for the long term? This isn’t a theoretical debate. The UVM Health Network is at a financial crossroads amid sharp inflationary cost increases, record-setting patient volumes and more than two years of responding to the pandemic. We are facing difficult decisions about reducing costs or programs in order to live within our means and within the limits imposed on us.
Health care sustainability is a challenge, but it’s not a mystery. There are some essential drivers of sustainability, and I’ll go back to our Ticonderoga campus to illustrate them.
We need progressive health care leadership invested in working together for change, as we saw in the partnership between Elizabethtown Community Hospital and Hudson Headwaters Health Network that brought a primary care center to Ticonderoga. We need engaged communities: In Ticonderoga, community input helped shape the medical village that exists today. We need financial support, especially from governmental partners: The New York State Department of Health funded nearly $15 million of the Ticonderoga project.
We also need caring and committed providers and staff to make sustainability real. To choose just one example from our health system’s 15,000-strong workforce: Gavin Noble, M.D., is a cardiologist at Porter Medical Center in Middlebury, Vermont, but for the last two years, he has also provided care in Ticonderoga, giving patients potentially lifesaving care closer to home.
This is a prime example of how sustainability leads to better health care: By working together and in the best interest of our communities, we can help ensure that all of our patients will get the care they need for many years to come.