Last month, a consultant released a sweeping report that recommended big changes for Vermont’s health care system, including “major restructuring” at four community hospitals.
The 144-page state-commissioned document lays out in detail a series of steps that Vermont’s hospitals should take to stay afloat, including repurposing inpatient units and downgrading emergency departments at some facilities.
State health care officials have said repeatedly that they have no plans to close hospitals or force them to restructure. But the report has nonetheless plunged much of the state’s health care system into anxiety and uncertainty.
Over the past few weeks, moreover, hospital leaders have raised concerns with what they say is inaccurate data in the document — a controversy that has added to the backlash against the recommendations and could complicate efforts to implement them.
Michael Del Trecco, the president and CEO of the Vermont Association of Hospitals and Health Systems, said in an interview Tuesday that the report should be retracted because of faulty data. The hospital association released a detailed press release Tuesday showing discrepancies between its data and the figures used in the report.
“I don’t know how any analytical person or operational person would say, ‘Oh, these recommendations were based on sound footing,’” he said.
‘Not rounding errors’
The report in question stems from Act 167, a 2022 Vermont law that mandated an assessment of the state’s hospitals in an effort to find ways to keep them financially sustainable.
To conduct that assessment, the state commissioned a $1 million study from the international consulting firm Oliver Wyman. Bruce Hamory, a physician and health care consultant there, spent roughly a year collecting data and meeting with Vermont communities and health care organizations before releasing a final report last month.
That report laid out a dire prognosis for Vermont’s health care system. Most of the state’s hospitals are operating at a loss, the consultant found, and would operate more efficiently if they consolidated different categories of medical care at certain hospitals. The report recommended especially extensive changes at four hospitals: North Country Hospital, Gifford Medical Center, Springfield Hospital, and Grace Cottage Hospital.
Those proposals quickly sparked a fierce backlash — one that has only grown now that the consultant has been accused of using inaccurate data.
In its press release Tuesday, the Vermont Association of Hospitals and Health Systems presented a comparison of discrepancies in the final consultant’s report and the hospitals’ own data.
Hospitals’ numbers showing how many patients were discharged from emergency departments and inpatient units in 2022 did not line up with those included in the final report, according to the hospital association.
Hospitals almost uniformly reported higher numbers of discharges — meaning, more patients treated — than the consultants’ report, with differences of up to 83%.
For example, Porter Medical Center, in Middlebury, recorded 21,568 patient discharges from the emergency department in 2022. The consultant’s report, however, recorded only 11,876 discharges for Porter that year.
That same year, Mount Ascutney Hospital and Health Center reported a total of 858 inpatient discharges, according to the hospital organization data. The consultant’s report, meanwhile, recorded only 142.
“These are not rounding errors,” Del Trecco said. “These are major missing components of our services that are delivered to Vermonters.”
‘We stand by it’
Hamory, the Oliver Wyman consultant who led the report, pushed back on those criticisms.
The discharge data in the report was pulled not from the hospitals’ own figures, but from the Vermont Health Care Uniform Reporting and Evaluation System, or VHCURES, according to Hamory. That dataset does not include the complete number of actual discharges from hospitals, but contains claims data: figures showing medical claims paid by private insurance, Medicare and Medicaid.
VHCURES is an incomplete dataset, and includes only 60% of Vermonters who are on private insurance plans. (As of 2021, roughly one half of Vermonters were covered by private insurance.)
Hamory acknowledged the data’s limitations. But, he said, since the report was focused on the financial state of Vermont’s hospitals, examining claims data made the most sense.
“The reason for it is that it is the most reliable data that exists on those numbers for financial purposes,” Hamory said in an interview.
Was it made clear to hospital leaders that the report used VHCURES data? “I think so,” Hamory said, adding that hospitals were presented with the data before the report was published and were given the opportunity to weigh in.
And despite the limitations, the report’s financial modeling — which projects that, without action, Vermont’s hospitals will rack up a combined deficit of $700 million to $2.4 billion below their break-even point by 2028 — is still sound, Hamory said.
“This data gathering and analysis took a year,” he said. “It was not done overnight. It was not done without multiple discussions among various experts and other people doing data analysis. And we stand by it.”
But Del Trecco, of the hospital association, said that those discrepancies invalidated the document’s conclusions.
“If you’re missing a significant amount of utilization (data), how could you move forward with a recommendation to say, ‘Stop doing X service, shift inpatient service, close your emergency department?’” he said. “It seems very flawed to me.”
‘Just a report’
The task now falls to the Agency of Human Services to work with hospitals on the recommendations in the report.
State officials are meeting with hospitals to discuss the report’s proposals, Brendan Krause, the Agency of Human Services’ director of health care reform, said in an interview earlier this month. The state is also seeking a contractor to provide technical assistance to help hospitals with “localized transformation planning,” according to a request for proposals that closed last week.
Krause noted that the path forward for hospitals may not actually look like the recommendations in the report.
“The report was well thought out, and a lot of effort went into it, but it is just a report,” Krause said. The state is not going to force changes on any hospitals, he emphasized.
“I think the important message is that we want to work with hospitals,” he said. “We’re not going to do things to hospitals.”
Even so, the past few weeks since the release of the consultant’s report have been a period of anxiety for Vermont hospitals, particularly the four that were recommended for significant changes.
At North Country Hospital in Newport and Gifford Medical Center in Randolph — both of which, the report said, should halt non-emergency births and replace inpatient units with geriatric or mental health facilities — hospital leaders have raised concerns about the report’s data and its effect on morale in their communities.
Michael Costa, the president and CEO of Gifford, said that the consultant’s proposals are causing anxiety for employees and prospective employees at the Randolph hospital.
Several staff members have resigned because of uncertainty about the hospital’s future, Costa said, and several candidates for open positions have dropped out of the hiring process for the same reasons.
“Excellent staff members are what makes health care go,” Costa said. “And so losing people, or losing recruits, because of the report is a tough blow for the community.”
In Newport, the consultant’s recommendations for North Country Hospital have been met with anger and disbelief.
“It’s been hell,” Tom Frank, the president and CEO of North Country Hospital, said in an interview.
“We have patients calling in tears that they’re afraid we’re going to close the hospital,” he said. “The scuttlebutt in the community is all about, ‘Why are they going to close our hospital?’”
