USDA Rural Development’s Vermont director Sarah Waring, left, and federal director Xochitl Torres Small, right, laugh with U.S. Sen. Peter Welch, D-Vt., at the Northeastern Vermont Regional Hospital in St. Johnsbury. Photo by Kristen Fountain/VTDigger

ST. JOHNSBURY — The CEOs of two northern Vermont hospitals spoke soberly with U.S. Sen. Peter Welch, D-Vt., and federal and state administrators Friday morning about their concerns for the future at a roundtable discussion that also celebrated the awards of two long-term, low-interest federal loans.

Shawn Tester, of Northeastern Vermont Regional Hospital in St. Johnsbury, and Joe Woodin, of Copley Hospital in Morrisville, shared their sense that ongoing economic and social stressors will make coming years the most difficult yet faced by their institutions.

“We got through the pandemic and it was incredibly challenging,” said Tester, lauding his staff’s creativity in responding to the threat of Covid-19. “I think the next five years are going to be much more challenging of an environment than the last three years.”

The region’s population is aging, which means more complex and chronic illnesses to treat and retirements among longtime core nursing staff, Tester told them.

Meanwhile, the St. Johnsbury hospital — and, even more so, the systems it relies on, such as emergency transport, home health care and pharmacies — are struggling to continue to provide care amidst rising costs and burned-out staff. 

“All of those other systems that we count on are literally houses on fire, and all that backs up on the hospitals,” Tester said. 

Copley Hospital CEO Joe Woodin and Northeastern Vermont Regional Hospital CEOs Shawn Tester listen during a health care roundtable with Sen. Peter Welch, D-Vt., and USDA staff. Photo by Kristen Fountain/VTDigger

Copley’s Woodin agreed, saying the heartbreaking scenes his staff experienced during the pandemic understandably led many to choose other career options. But the open positions and rotating temporary hires required to keep services available make meeting today’s needs even more difficult for those who remain.

Local investments in housing and child care are needed to draw new skilled local workers, Woodin added. But even with that, he predicted that the demand for clinical staff will be impossible to meet without new routes for training that are exponentially faster than what currently exists. 

“Nobody has ever seen it like this. Nobody has ever seen this level of intensity,” Woodin said.

Along with Welch, the two men spoke with Under Secretary Xochitl Torres Small and Sarah Waring, who respectively head the federal and state offices of the U.S. Department of Agriculture’s Rural Development division, which is providing the loans.

Welch called the money a sign of the federal government’s commitment to supporting rural hospitals. “You can’t have rural America without rural hospitals,”he said. “They have gone way beyond just providing medical care. They are really a social and economic hub in our community.”

Northeastern Vermont hospital received a $16.5 million low-interest loan that, along with local contributions, will pay for a $22 million expansion for its cramped emergency department, as well as to its laboratory, pharmacy and mental health support area. Four new beds in the emergency room will be opening this summer, but the full project will take around two years to complete, Tester said.

Copley Hospital’s $9.9 million loan will help construct a new, almost 10,000-square-foot building for its existing outpatient orthopedic clinic, which also involves the purchase or property along Route 100 in Waterbury. The project has already received approval via a certificate of need from the Green Mountain Care Board. Plans have it opening early next year, Woodin said.

USDA Rural Development gives preference in most of its grants and loans to projects in smaller, lower-income communities, making it an important and frequent funding source for projects throughout Vermont’s rural areas. The federal spending in these programs are a small part of what is allocated every five years by what’s known as the Farm Bill, which will be up for reconsideration this fall.

Municipalities and community-based nonprofit organizations are eligible for these “community facilities” loans. The money can be used for a wide variety of projects — health care facilities, child care centers, fire stations and airports. Rutland Regional Medical Center received a $28.2 million loan, also through Rural Development, for construction of a new office building in 2018.

Both the St. Johnsbury and Morrisville hospitals also received $1 million Emergency Rural Health Care grants, available as economic relief through the American Rescue Plan Act. A similar event was held last summer in Springfield to announce the same kind of emergency grants to Springfield Hospital, Brattleboro Memorial Hospital and Little Rivers Health Care, a federally qualified health center in and around Bradford.   

Torres Small said similar challenges are facing rural hospitals across the country, and many of the most promising solutions arise when hospitals and other health service providers work together to share resources regionally. 

Friday’s event also included Green Mountain Care Board chair Owen Foster and staffers from the offices of all three members of the state’s congressional delegation.

Jenney Samuelson, head of the Vermont Agency of Human Services, was also in attendance and said the loans “are critical investments” in two important rural communities.

Keeping acute health care available locally is a priority because then Vermonters are more likely to seek care for problems when they arise, she said. 

“If it’s not close to home, then what we see is people don’t get the care at all,” Samuelson said. “Particularly those who are our most vulnerable forgo what is necessary until it is either too late or it is catastrophic.”

Read the story on VTDigger here: Hospital heads, Peter Welch discuss rural health care challenges.

As Reported by VTDigger

Owen Foster, chair of the Green Mountain Care Board. The board’s decision gives the Department of Mental Health the lead in setting spending priorities. File photo by Riley Robinson/VTDigger

The Vermont Department of Mental Health will have a say in how the University of Vermont Health Network spends excess earnings that were earmarked in 2018 for expanding inpatient psychiatric capacity in the state. 

After several weeks of deliberation, the Green Mountain Care Board, which regulates hospital budgets, unanimously voted Wednesday to give the health network greater flexibility in spending the roughly $18 million that remains from the $21 million initially allocated. 

The funds can now be spent more broadly “to increase capacity of mental health services in the state,” the approved order said. But a proposal for spending, due to the board by May 31, must reflect and incorporate priorities from the Department of Mental Health.

“For me, the really important thing is we’re not the experts,” care board member Jessica Holmes said. “DMH are the experts here with a full view of the system and how best to create impact with these dollars.”

The health network — which includes University of Vermont Medical Center in Burlington, Central Vermont Medical Center in Berlin and Porter Medical Center in Middlebury — initially agreed to use the funds to construct a new psychiatric wing at the Berlin hospital that would have added 25 inpatient beds. 

But network leaders dropped the project, citing ongoing operating losses that were forcing them to scale back capital investments. They anticipated a $20 million loss stemming from the operation of the proposed facility due to lower-than-cost reimbursements for mental health care. 

The care board is requiring that the health network’s new proposal show how the investment could be expected to reduce the frequency and length of stays in emergency departments for adults, adolescents and children experiencing a mental health crisis. 

The order also requires that, going forward, all interest earned on the funds be put toward implementing the network’s proposal. 

Projects already mentioned by the health network in statements to the board include the opening of a second outpatient therapeutic program and working with the Howard Center to establish a mental health urgent care location in South Burlington.

Read the story on VTDigger here: Board allows broader use of UVM Health Network funds.

As Reported by VTDigger