Mental Health needs and sustainable funding for hospitals to continue the transformation of the healthcare system were among the top priorities addressed in a discussion last week between members of the Franklin & Grand Isle counties’ legislative delegation, the NMC Board, our Leadership Team, and our Medical Staff leaders.  We had strong attendance, insightful questions, and good discussion on how to move forward together for a healthier community.

I reviewed the recent improvements NMC made in our approach to caring for patients who are suicidal or dealing with severe mental health issues and the role of law enforcement. As I have discussed in prior columns, we have strengthened our policies, documentation, training, and partnerships and are making renovations to our Emergency Department (ED). Even with this, a community hospital ED is not the right care setting for many of these patients. The state hospital which specialized in the inpatient care of patients with these challenging needs was destroyed in a flood a few years ago and has never been adequately replaced within Vermont’s system of care. John Casavant of our Board made the point that we do not ask Vermont’s community hospitals to go beyond their expertise for matters of physical health, we should not be pressing our community hospitals to serve as unofficial psychiatric facilities when we lack the infrastructure, staffing, and training to do so.  We appreciate the strong collaboration between NMC and Northwestern Counseling & Support Services and other community partners to wrap around individuals and prevent their situations from spiraling to emergent levels. Still, despite this excellent work, Vermont needs to build and staff the proper care environments for those patients who do need inpatient psychiatric care. Timely access to the right care in the right setting is ultimately key to the quality of the patient’s care, the safety of patients and staff, and appropriate cost containment within the overall system. We asked for our legislators’ assistance in pursuing improvement in Mental Health care for all of Vermont.

Chris Hickey, NMC’s Chief Financial Officer, provided our legislators with insight into NMC’s financial situation. Medical inflation nationally is driving hospital costs beyond the cap on revenues which is set by the Green Mountain Care Board. Short term, this prompts the need for continued emphasis on efficiency and cost cutting. It was good to remind our legislators that hospitals have to pay a provider tax (NMC’s share is $6 million per year) and that the funds designed to help hospitals survive the significant underfunding of Medicaid have been reduced by more than 30% in recent years. Long term, these are unsustainable trends as more money is  going out to meet the community’s need for care than regulators allow to come in. Ultimately, this threatens access and services. At the same time, hospitals are being asked to fund the transformation of the healthcare system from fee-for-service to population health to bend the cost curve through care management and prevention by focusing more on keeping people healthy. NMC is a leader in that work locally and at the state level.  NMC’s financial situation is challenging and changes to the system need to be made before the health of all Vermont’s community hospitals worsens.  Locally, we are actively working to reduce expenses while maintaining our investments in our future through access, quality, wellness, and prevention. We asked our legislators to help at the State level by providing fair funding for Medicaid and not cutting reimbursements to hospitals any further.

I greatly appreciate the opportunity to have these frank discussions with our elected officials. It is not easy work to balance all of the needs within our State’s resources. One of the wonderful things about our community is the ability we have to engage in discussion, listen to one another’s perspectives, and work together for a better future for all. I look forward to working with our delegation and others on these important priorities.

— Jill Berry Bowen, NMC’s Chief Executive Officer