Initiatives underway across Vermont will reduce wait times, address critical staffing shortage, improve services for patients in aging and rural Vermont; leaders say regulatory flexibility is also needed
Vermont Business Magazine The Vermont Association of Hospitals and Health Systems (VAHHS) responded today to the Vermont Agency of Human Service’s health care access report on wait times for certain medical specialties. The assessment has been underway since the fall of 2021. The report itself uses various methodologies to compare services and wait times for medical appointments. It also makes regional, national and global comparisons. Hospital leaders welcomed the review but cautioned that it should be used to reveal opportunities for improvement and not to confuse or mislead from the challenges—some very unique to Vermont and some global—facing health care today.
Leaders expressed concern over the following:
- Comparisons that can be inappropriate or confusing. Comparing a 25-bed critical access hospital to a 500-bed Academic Medical Center is misleading. Similarly, comparing Vermont’s hospitals to those in large urban settings, for-profit systems, states with little regulation and countries with completely different health care systems can distract from real and tangible progress we have made and can make here in Vermont.
- Lack of acknowledgement of constraints placed on hospitals by our regulatory construct. We have the most rigorous regulatory framework in the country, both in terms of hospital budgets and oversight of hospital facilities and equipment expansion.
- “Secret Shopper” exercise took place during Delta/Omicron COVID-19 surge and at peak of staff shortages. The State revealed that they placed 1,000 calls to schedule theoretical specialist appointments in December of 2021 and January 2022. These calls consumed precious staff time while hospitals were inundated with patients, reducing services and experiencing historic staff shortages due to COVID infections and quarantines.
“The State is a critical partner with hospitals, and COVID-19 made it clear that when we work together, there is nothing we cannot do for Vermonters. We must continue that partnership to make progress on the challenges we face as a rural aging health care system to ensure Vermonters get the care they need as close to home as possible,” said VAHHS President and CEO Jeff Tieman. “While there are findings in this assessment we wish were different, the fact is we must reduce wait times. To succeed, we need to work with the State and others to make progress on our staffing shortage. The good news is that hospitals have a number of initiatives well underway to help us get there. We also need regulators to understand the situation and provide necessary flexibility.”
Hospitals have long pressed for greater regulatory flexibility from the Green Mountain Care Board (GMCB) in the form of more predictable budget processes and a streamlined Certificate of Need process so that new and broadened health care services can be more quickly activated. For years, the GMCB has attempted to balance affordability with hospital growth rates, which has not always recognized the rate of medical inflation. This has contributed to the shortage of resources needed for hospitals to hire staff, invest in facilities and equipment and meet growing patient need.
According to a recent study, nearly 20 percent of the health care workforce has quit their job since the start of the pandemic and Vermont ranks highest among states for the percentage of hospitals routinely experiencing a critical staff shortage.
“We are so fortunate in Vermont to have a system that is entirely not-for-profit. Revenues that exceed cost are reinvested in our mission, which is to care for our patients and communities,” said Claudio Fort, president and CEO of Rutland Regional Medical Center and chair of the VAHHS Board of Trustees.
“We have smart, dedicated doctors, nurses and other providers working hard every day to help solve these challenges. Even as we emerge from the disruptive pandemic, there is an opportunity to make progress by working together as a system. In order to do that, we have to acknowledge the barriers we face in Vermont are particularly difficult and diligently work through them. That is what we intend to do,” he added.
Hospitals are leading with hundreds of efforts underway to address staffing shortages, improve care and reduce wait times.
Some examples include:
- UVM Health Network’s comprehensive multi-year Access Action Plan
- Brattleboro Memorial Hospital’s accelerated certified medical assistant partnership with CCV
- Central Vermont Medical Center’s plans for new inpatient psychiatric care services to address delays in care
- SVMC loan forgiveness up to $60,000 for new nurse graduates
State releases critical medical wait times report
Interim AHS Secretary Jenney Samuelson said in the state report that wait times preceded the COVID pandemic and were then exacerbated by them. Wait times were experienced regardless of health insurance type. She said that the pandemic also exacerbated chronic conditions, which will have a long-term effect on the health care system.
Wait times were longest for Endocrinology (average 113 days), Neurology (114 days) and Dermatology (140 days). A dermatology appointment could be secured within 11 days or 410 days depending on the practice.
The waits were shortest for General Surgery (29 days), Orthopedic Surgery (35 days) and Gynecology (35 days).
The median medical wait time for specialists across hospital providers was 48 days, but varied significantly by location. The report says it is important to note that hospitals offer different mix of specialties, and some offer more of the specialties with longer wait times.
With the system-wide average (including Dartmouth) at 48 days, UVMMC (87 days) had the longest median waits, with SVMC (82) and RRMC (69) next. Springfield (21), Gifford (29) and CVMC (41) had the shortest.
You can learn more about workforce access initiatives at Vermont’s hospitals here.
Montpelier, VT – The Vermont Association of Hospitals and Health Systems. Learn more at VAHHS.org
