Devon Green, VP of Government Relations
Last week continued to be a mix of learning, introductions and policy initiatives, so let’s dive right in.
Workforce: VAHHS testified in front of the House Commerce Committee about two workforce initiatives passed last year∏—$5/hour preceptor pay for Critical Access Hospitals and funding for pipeline programs at health care organizations. The Agency of Human Services (AHS) was unable to disburse funding for either program due to federal restrictions and lack of staffing. VAHHS supports the Budget Adjustment Act’s language that would expand the preceptor pay beyond Critical Access Hospitals and provide flexibility for more wraparound services for pipeline programs. Our only concern is that the funding comes from the retention bonus program, and it is unclear how much will be dedicated to preceptor pay and pipeline programs. In addition to retention, Vermont must invest in future health care providers
Health care reform: The Green Mountain Care Board (GMCB) presented an update on health care reform efforts on which they are collaborating with AHS. They hope to announce a consultant for the hospital transformation work by the end of January. Meanwhile, the GMCB and AHS will continue to work with stakeholders and the Centers for Medicare and Medicaid Innovation (CMMI) on payment reform until the end of 2023.
Mental health: The House Health Care committee recommended including $9.25 million in the Budget Adjustment Act to fund inpatient psychiatric beds for adolescents. The Brattleboro Retreat also testified about their latest innovations, including flexible bed designations to respond to emergent needs, their transportation partnership with Rescue Inc. and a telepsych pilot program with Rutland Regional Medical Center. With initial support from AHS, they have also been able to bring on contracted providers that allow the Retreat to reach a census of nearly 100 patients. Hospitals have reported a big improvement to patient flow due to these efforts.
Provider protections: The House Judiciary Committee began hearing testimony on H.89, a “shield bill” that would protect health care providers who offer reproductive and gender affirming care from civil or criminal liability under other state’s laws. VAHHS supports protections for health care providers.
Post-acute and long term care: The Administration is proposing a $3 million increase for home health rates and $17.7 million for nursing home inflation in its FY 2024 budget.
Green Mountain Care Board: Owen Foster, chair of the Green Mountain Care Board, introduced himself to the Senate Health and Welfare Committee. The GMCB’s areas of focus will be hospital sustainability, regulatory process refinement, All-Payer Model negotiations, access to primary care and affordability.
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ICYMI: From Our Latest Annual Meeting |
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Each year, VAHHS brings hospital leaders and other partners together to work on issues facing Vermont's health care system and to hear from experts here in Vermont and often from across the country.
At our last annual meeting, Tracy Dolan, who directs Vermont's State Refugee Office, described the path refugees take to come to Vermont and talked about specific challenges they face when accessing the health care system. She also gave information about what her office and other resources in Vermont are doing to help.
If you missed it or would like a refresher on the content, click below to watch video from her presentation.
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Dousing Vt.'s 'village on fire' |
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Saint Albans Messenger
Vermont’s health care system has been characterized by a legislator, not as a "house on fire," but as a whole village. Our hospitals are operating at maximum capacity. Nine of our 14 hospitals are operating at a deficit. Vacant positions at many of our hospitals are going unfilled. Patients are sent out-of-state for care. These challenges even apply to lower-level care facilities, including our home-health organizations.
The temptation in chaotic times is to focus on something new and shiny as the appropriate way forward. The assumption is that what we have does not work, necessitating a different vision. It’s that perceived weakness that lures advocates into the fray, anxious to take advantage of the disarray to push their own agendas. [Single-payer advocates fit the example.]
It is a temptation that needs a full-court resistance. Vermont’s health care system does not need to be dismantled. What it needs is to be stabilized.
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Grace Cottage emergency dept. expansion underway |
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The Commons
Construction has started on a $650,000 expansion of the Grace Cottage Family Health & Hospital emergency area to enhance patient comfort and privacy and improve patient flow and security.
“This is a very exciting and much-needed renovation, allowing us to efficiently see the increasing number of patients visiting our Emergency Department” says President and CEO Doug DiVello.
“The technology available in our Emergency Department, especially with our recent link to Dartmouth Health’s TeleEd and TeleNeurology service, is, quite frankly, astonishing for a rural hospital of our small size and the support that we’ve received from the community for this project has been overwhelming,” DiVello said.
Work on the historic facility at 185 Grafton Rd. will include building a 250-square-foot canopy and a 1,050-square-foot addition to the emergency area.
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New numbers highlight Covid-19's impact on inpatient mental health care and emergency departments |
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VTDigger
New numbers reported this week suggest that inpatient psychiatric care capacity in Vermont slowly started to rebound last year, but still remains significantly below pre-pandemic levels.
Meanwhile, the total number of days that patients seeking mental health care spent in emergency departments statewide reached new heights. That number, over 10,500 days, now appears to be more than triple what a similar analysis found as a baseline in 2015.
That result is not surprising to Ben Smith, medical director of the emergency department at Central Vermont Medical Center in Berlin. His department’s internal numbers show at least a doubling of inpatient days waiting for crisis mental health care over the last five years. The impacts on patients of all kinds seeking care and on his staff are profound, he said.
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High school partnership puts nursing degrees in adults’ hands |
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WCAX
It’s never too late to learn something new. You could become a dental assistant, get your CDL or even just learn how to make pasta as part of St. Johnsbury Academy’s Adult Education Program.
Now, a new skill is being offered and it could come with a new career.
Vermont has needed nurses for years. Sen. Bernie Sanders highlighted the problem and now thanks to money secured in part by Sen. Sanders, the St. Johnsbury Academy and the Northeastern Vermont Regional Hospital and other NEK organizations are partnering to get nurses in the classroom and into scrubs faster than ever.
The St. Johnsbury Academy isn’t just for high schoolers, it’s for adults trying to bolster their education, too. Come this spring, a new partnership will allow those learners to get licensed in nursing to the degree of their choosing.
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The Promise of Workplace Violence Legislation |
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HEALTHeCAREERS
With the legislators back in session, there are promises of Workplace Violence legislation on the docket. This session there will be proposed legislation to permit law enforcement to immediately remove those individuals that threaten or commit violence that impedes with providing medical care.
At first blush this seems like a win for healthcare workers – those that are causing violence and interfering with the provision of medical care will be removed from our care environments. But under further inspection, this solution may be inhibited by other Vermont legislation in meeting its desired intent.
The proposed legislation authorizes law enforcement to remove a violent person from the care environment, but there is no expectation in the language that allows or requires law enforcement or a judge to detain the person beyond removal from the hospital.
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Looking to cut $120M in its budget, Dartmouth Health plans hiring freeze, job reviews |
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VTDigger
Dartmouth Health, New Hampshire’s largest private employer, has implemented performance improvement plans and a “position review process” at some of its member organizations as it seeks to close a $120 million budget gap by the end of September, according to an email sent to employees.
After an initial hiring freeze, DH officials have determined that all open positions at Dartmouth Hitchcock Medical Center and the Dartmouth Hitchcock Clinics are subject to a hiring review by the Position Control Review and Clinical Workforce Committees, according to the Jan. 17 email obtained by the Valley News. This review also will be required of job changes such as employee transfers, adjustments, promotions and filling positions after an employee leaves “for the foreseeable future.”
The Lebanon-based health system will continue to actively recruit for some key “Tier 1” positions that “are essential to keeping patients safe and providing high-quality care.” Such positions include those that would allow DH to replace those currently filled by a staffing agency; positions that are currently understaffed and have a direct impact on clinical care; research positions that have a full two years of grant funding available; and positions required to meet regulatory requirements, according to the Tuesday message.
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Brattleboro Retreat | Kurt L White: More than winter blues? |
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It’s the time of the winter blues, the darkest days of the year, which many of us can find so jarring and difficult to manage. But when is this “normal,” and when is this something to be concerned about?
What makes depression an issue that needs attention? The word “depression” is now a part of our everyday language, and we might ask who hasn’t felt down at times, after all? In the mental health field, we look for some specific indicators.
Depression is a physical, cognitive, emotional state that affects all aspects of a person’s life. Physical symptoms, including pain, can be notably worse in a person experiencing depression, and even more so in older adults. One of my first jobs in the field was working nights in a psychiatric hospital in Chicago, and my last task of my shift was to get some of the patients ready for their early morning treatments. I would come in, and it might take a half an hour to assist someone to the bathroom, who seemed unable to move or speak, and could hardly interact with me at all. A few weeks later, I would be back on the unit, and some of the same patients would wake up and not need my assistance at all, and would greet me robustly. In other words, what I had naively ascribed to aging were actually symptoms of depression.
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