• Hospitals ready for new reforms
    May 12,2013

    I spent last Sunday afternoon in the emergency room with my daughter, who learned the hard way what happens when you slam on the front brake of your bike. Three hours and eight stitches later, we left — tired but grateful her injuries weren’t worse.

    As a former ER nurse, I found that the bustling pace, the constant inflow of new patients and the wide range of “chief complaints” — from simple abrasions to complex medical problems — all felt familiar.

    This experience reminded me that while many aspects of health care are complicated, in some ways it’s not. We all want access to health care close to home when we need it. We want our caregivers to be competent, kind and attentive — like the nurse who kept checking on my daughter, even though she was far from his most critical patient.

    What’s complicated is figuring out how to make health care more affordable — otherwise known as “bending the cost curve” — and at the same time preserving access to great care. Vermont hospitals are making progress on all fronts: improving care, maintaining access and restraining cost growth.

    On the cost side, the year-to-year growth in hospital spending is slowing down, despite factors that increase hospital spending, such as our aging population, physician employment (Vermont hospitals now employ 60 percent of physicians) and increases in the provider taxes that hospitals pay to the state of Vermont. Hospitals are working hard to maintain this downward trend for 2013, our current budget year.

    Vermont’s nonprofit hospitals have played a key role in preserving access to great care for years. Our hospitals and physicians are using a teamwork approach to engage and care for patients and have invested millions in health information systems to improve decision-making. Hospitals and community providers, such as nursing homes and home health agencies, are piloting efforts to coordinate services, reduce admissions and improve outcomes for our patients. Under the current fee-for-service payment system, however, this progress can go only so far.

    In February, the federal government provided Vermont and Vermont’s hospitals with a once-in-a-lifetime opportunity to take the progress we’ve made to a new level. The Center for Medicare and Medicaid Innovation awarded Vermont a $45 million four-year state innovation model grant to test strategies for improving how Vermonters receive and pay for health care. If all goes well by 2017, all major payers, including Medicare, Medicaid, Blue Cross and Blue Shield of Vermont and MVP, would make more “global” payments to hospitals, doctors and other providers, such as home health agencies.

    The Center for Medicare and Medicaid Innovation, state policymakers, payers and providers believe the grant could potentially transform the delivery of health care services — an essential, complex undertaking with a simple goal: Provide high-quality, affordable care for Vermonters when and where they need it. Amidst all the differing views around what reform path Vermont should take, this is clearly a step worth taking.

    Bea Grause is president of the Vermont Association of Hospitals and Health Systems.

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