Vermont, Jack Lyons, Vermont Association Of Hospitals discussed on The Dave Gram Show on WDEV


From radio vermont it's the dave graham show on w._d. It's your show about the people places and the issues that matter the most to you now. Here's your host dave graham good morning. Vermont did is thursday august eighth. Two thousand nineteen and we are so glad to have you listening listening to our program this morning. We're gonna have an interesting show. I think i'm going to hand it off to a guest host <hes> the first half hour of the program this morning our our good friend. Jack lyons the summer internet w._d. E._v. He's been doing a really excellent job here and we decided just to hand him the controls for the next half hour or so he's going to be <hes>. I'll i'll let him introduces guest and <hes> we'll have a good conversation. <hes> there and then later on i'll be coming back in taking over the mike in and i'll be interviewing colonel david smith of the vermont national guard <hes> he's going to be i think talking with us to try to allay some of the concerns we heard about last week <hes> interview you about the f thirty five coming to the vermont national guard base at the burlington international airport and <hes> he <hes> the guard it has wanted a chance to reply some of the criticisms raised about noise about <hes> the possibility that some of these planes may be <hes> armed with nuclear weapons et cetera and <hes> so we'll be hearing from colonel smith in part of this hour <hes> later on believe. We're going to be opening the phones and letting some listeners weigh in on whatever topics are on your mind out there folks course. You're always welcome to call the program. <hes> so nice is easier to take the calls and others because we just have an open phone line etcetera two four four one seven seven seven is the local number here in waterbury one eight seven seven to nine one eight a two five five and with that. I'm gonna hand it off to my good friend. Jack lyons a student at notre dame university. He's from south burlington and he is doing an excellent the job force here as a summer intern w._d. Take it away jack. Well thanks dave our first guest. Today is jeff tieman. He's the president and ceo of the vermont association of hospitals and health systems there in advocacy advocacy group dedicated to representing the state's nonprofit hospitals and we're going to talk to him today about the future of rural hospitals in vermont jeff are you there. I am all right good morning. Good morning. Thanks for having me on so i guess no problem so i i guess our first question would be <hes> can rural hospitals in vermont survive over the for over the coming decades and what some of the changes that take place be to enable able that so i think i it's a great question and it really important one for our state and important jack. I think to acknowledge right off the top. That vermont is really entirely rural. <hes> we think of rural areas and less rural areas or urban areas like burlington but it's really hard in a small state like ours to even separate that out even the teaching hospital in burlington serves rural populations and is actively involved in coordinating care for people in rural areas throughout the state so and all or other hospitals are doing that as well so i think it's important to understand that that we really are <hes> a rural state and <hes> that rural hospitals and all of dr hospitals across the state are vital in their communities <hes> not just as caregivers but also as a big employers often the largest employer in community and as community builders in the work. They're doing <hes> in what we call community benefit and health reform to try to reduce the cost of care and make it better for the patient all of that said real hospitals face big challenges as you probably know <hes> not just here in vermont but across the country we've seen rural royal hospital closures <hes> throughout the country in the past several years <hes> and there's a lot of reasons that happens but certainly cause for concern and the reason reason that we have our our i carefully on this. You know there's even a a task force that was created by the legislature to look into the future of real healthcare in vermont where represented on that task force as are all of the other major stakeholders in our state so this is a conversation that's well underway sure and you mentioned that all hospitals in vermont are auroral hospitals just because our state is in very populated but <hes> what is what is the difference in the challenges that are seen at a small hospital like copley hospital in mooresville bill and the challenges that are seen at medical center in burlington yeah so another good question and when we looked into when we did some research into what can can happen with small rural hospitals understand <hes> particularly in other parts of the country 'cause we haven't had as many closures here in vermont or new england thankfully but in trying to understand dan what can what can precipitate financial problems or or even something as severe as closure. There's a lot of factors that are unique to two smaller. Rural hospitals goes up rating in smaller communities for example <hes> they tend to have <hes> a lot more people on medicare and medicaid and we know that those public payers there's <hes> for hospitals just do not reimbursed at the same level and so hospitals literally receive less income to take care of those patients and that becomes a part of the financial mantra problem. These hospitals are often <hes> typically operating on razor thin margins. That's certainly true here in vermont either either razor thin margins or or as we have right now many with negative margins they face declining volume as population shifts to the city and and in vermont. We have <hes> <hes> an aging population. I think we're second or third in the nation <hes> as far as <hes> the the age of our population <hes> and then i think we're all hospitals are also managing aging the challenges <hes> that are not necessarily unique to rural areas but but can be even more difficult to manage in those places like opioid addiction and and reaching reaching out beyond the hospital walls to to make sure people are healthy. You spoke about razor thin margins at hospitals and i think that <hes> segues well into the conversation about rate rate hikes. <hes> a lot of the hospitals are feeling some pressure from the green mountain care board not to increase their rates a lot but at the same time they're dealing with those razor thin margins you just talk about <hes> how that how that <hes> bargaining works between the green mountain care board in hospitals sure i think i i would point out as you as you did at the top of the show so that we are a nonprofit system so i think we just need to always remember that when we talk about margins those are not profit margins but those are the margins funds that enabled the hospital to do things like reinvest facilities and equipment make sure they're always providing the most modern cutting edge care <hes> and that and that they are also also as i said <hes> available to the community that said i think i think jack that are hospitals are proposing budgets to the green mountain care board for twenty twenty the they are proposing the budgets they need to continue meeting patient need and and to continue serving their communities in an effective way while also making sure they are financially healthy and sustainable for the long term so that they can always be there for those communities so the the process with the green mountain care board is for those hospitals for all of our hospitals to to present their proposed budget for next year and to have a dialogue with green mountain care board about why the rates they've asked ask for are necessary to do what i just said to make sure they continue to serve patients effectively be there for their communities and know that there's a sustainable plan for the future sure so. I think you're going to hear that dialogue. Take place with the green mountain care board and and hopefully our hospitals will be able to convey kind of the full set of of challenges changes that they face <hes> from the reimbursement issues. I mentioned with medicare and medicaid <hes> to significant workforce challenges across our state <hes> that make <hes> healthcare both a little more expensive and and challenging to deliver because we don't always have the right people in the right places and can't fill so many open in slots <hes> and also at the same time well hospitals are managing those challenges. They're trying very hard to to stay focused on health reform here you're in vermont which is really to make healthcare better for the patient by focusing on wellness instead of illness and trying to move from a system that now pays for the number of procedures and office visits and and and all of that to assist him that really pays for quality outcomes and and wellness and so i think in trying to do all of those things at once <hes> and keep rates low is is the constant challenge and i think our hospitals have struck the best possible balance they can and you'll not that play out during the budget hearing later this month how much as we're looking forward to these these budget hearings. How much of a dialogue is that. I mean is is there a certain number that <hes> you know the green mountain care board is is not going to allow or is there a certain number that the hospital's not going to go the low. You know what how does that dialogue walk work well. The the agreement and care boy does set in their what they call budget guidance <hes> set a rate for the growth of net patient revenue <hes> and and the hospitals then propose what they think they need for their for their coming budget and those differences or if there is a difference between what the green mountain care board expect and and what <hes> what the hospital <hes> is proposing than than that does become a discussion as part of the hearing so that the hospital hospital has an opportunity to explain the factors that are involved <hes> and to try to persuade the green mountain care boy that the budget they're proposing the one that's really needed <hes> <hes> to to ensure the future of their organization and <hes> and and be able to serve patients the way they want to and what is when we're talking about rate increases. What is a significant rate increase well. I think you know i would probably rather than try to get into numbers. I think we should all acknowledge. That healthcare is expensive. <hes> there's there's no two ways about that and whether we're talking about insurance premiums or <hes> <hes> rate increases that that hospitals <hes> are looking at or we're talking about the cost of pharmaceuticals and supplies all of the stakeholders in our system have a role to play <hes> in in trying to make the system or affordable and i think vermont <hes> yes we are encountering rate increases. <hes> <hes> that you know premiums are expensive for people and that is a challenge. We're all trying to manage together. I think in vermont we're doing that in a way that's <hes> <hes> incredibly compelling and may not produce all the results we want tomorrow but is definitely the direction that the country <hes> that both parties believe we need to move in to to really again focus on keeping people well <hes> addressing the social determinants of health like housing and food security and other things that keep people healthy in the first place and then doing a better job jack on also managing chronic conditions once people are sick. There's a lot of technology and <hes> new patient physician outreach. That's made possible by the work. We're doing here. <hes> to keep people healthier theory prevent emergency room visits all of those things eventually reduced costs while also just making life better for the patients we serve so <hes> you spoken about a wellness as opposed to treating wellness as opposed to illness and more sustainable long-term care provided by hospitals. I <hes> <hes> spoke yesterday with senator richard westman <hes> we try to get him off of the segment. Unfortunately he had a prior commitment but i got some good background information from him. He's a message board member at copley hospital and mooresville and he's also <hes> as a senator on the health and welfare committee and <hes> he spoke about some the things copley hospital has done recently to <hes> to to promote what you're saying that uh a stable long-term wellness care <hes> he talked about community health initiatives serves and also they've <hes> they've now started doing orthopedic surgery. They invested you know in the short term some money on on getting the infrastructure to do orthopedic surgery and they're hoping that by by offering that they can they can <hes> you know bring more patients in the door and help them do that and and stay open. What other initiatives have you seen throughout the state <hes> like that that are focusing on sustainable long term care and how essential are these two to keeping serving rural hospitals open so i think you're seeing a lot of initiatives from one like the one like those you just described to <hes> across our are hospitals. You're seeing a huge focus on expense management and always doing everything possible to to minimize expenses to join purchasing coalitions nations that can bring down the cost of supplies equipment..

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