As predicted, 2022 was a challenging fiscal year for Vermont’s 14 community hospitals, which as a group registered almost $62 million operating loss. Hospitals have said that those losses, already creating instability, will only deepen unless regulators change their oversight methods.

That didn’t happen Wednesday as Green Mountain Care Board members voted to set their overall revenue growth target for fiscal year 2024 at 8.6% over the patient revenue recorded in 2022, or 4.3% per year.

For half of the state’s hospitals, that growth target equals less revenue than the board approved last year for their 2023 budgets. That is in part by design since the board voted last year to allow up to an 8.6% increase in the last budget cycle intended to cover the combined upcoming two years.

Telehealth appointments took over during the pandemic, but now in-office is the norm again.

Both Gifford Medical Center and the Rutland Regional Medical Center said telehealth is being used less now than it was three years ago when it began in full force. And a big question for the future of telehealth is insurance reimbursement, and balancing which types of patient care are most suited to the format.

At Gifford Medical Center, Dr. Joshua White said they never went completely virtual at the start of the pandemic but and that creating telehealth options was a massive investment. “We had to make sure that now every provider had access to a Zoom account -- that was what we used initially, a webcam. And then, of course, all of the training and education,” said White.

A major use of telehealth is appointments with a mental health therapist. White said it’s used less in specialty and primary care, but it is still used in some cases.

A record staffing shortage has led the Howard Center to reduce the number of “crisis beds” in Burlington and combine programs in a move some say will leave vulnerable people seeking support for substance use disorder and mental health issues in the lurch.

The Act 1 program — a temporary detox facility on Pearl Street with six beds — will no longer provide beds. Instead, it will only screen walk-in clients and refer them to other programs. Three other Howard Center programs have cut bed capacity in half, according to Bob Bick, the organization's chief executive officer.

“It’s the worst it’s ever been,” said Bick, of the staffing crisis at the state’s largest social services agency.

The organization, which has a staff of 1,600 when fully staffed, is trying to fill 197 full-time and part-time positions and 220 substitute vacancies — the highest since the start of the pandemic.

Vermont state regulators have been treating rule-breaking at residential care homes and assisted living residences with less urgency than is required for skilled nursing homes, according to a report released Wednesday by the Office of the State Auditor.

These generally smaller facilities also aren’t getting annual inspection visits that nursing homes do, and as required by state law, the report said. Plus, the follow-up to ensure problems noted during visits are fixed is also less consistent. That’s true even though a slightly greater number of older Vermonters live in such facilities — around 3,300 versus just under 3,000 in nursing homes.

“I was really struck by the difference in the model,” state Auditor Doug Hoffer said about the findings. “The whole process is so starkly different then what they do for nursing homes.”