Last month, a consultant released a comprehensive report recommending major changes for Vermont’s health care system, including “major restructuring” at four public hospitals.

144-page government-commissioned document reveals in detail There are a number of steps hospitals in Vermont must take to stay afloat; These include repurposing inpatient units and downgrading emergency rooms in some facilities.

State health officials have repeatedly said they have no plans to close hospitals or force them to restructure. But the report still threw much of the state’s healthcare system into concern and uncertainty.

Moreover, over the past few weeks, hospital leaders have expressed concern about what they say is inaccurate data in the document; It’s a debate that has fueled backlash against the proposals and could complicate efforts to implement them.

Michael Del Trecco, president and CEO of the Vermont Association of Hospitals and Health Systems, said in an interview Tuesday that the report should have been retracted because of inaccurate data. The hospital association issued a statement detailed press release It shows discrepancies between Tuesday’s data and the figures used in the report.

“I don’t know how any analytical or operational person would say, ‘Oh, those recommendations were well-founded,'” he said.

‘Not rolling errors’

The report in question stems from Law 167A 2022 Vermont law mandated that the state’s hospitals be evaluated to find ways to remain financially sustainable.

To carry out this assessment, the state commissioned a $1 million study from international consulting firm Oliver Wyman. Bruce Hamory, a physician and health consultant there, spent nearly a year collecting data and meeting with Vermont communities and health organizations before releasing a final report last month.

In this report a dire prediction For Vermont’s healthcare system. The consultant found that most of the state’s hospitals were operating at a loss and that certain hospitals would operate more efficiently if they combined different categories of medical care. The report recommended sweeping changes at four hospitals in particular: North Country Hospital, Gifford Medical Center, Springfield Hospital and Grace Cottage Hospital.

These offers quickly ignited a spark violent reaction — this was compounded when the consultant was accused of using incorrect data.

In a press release Tuesday, the Vermont Association of Hospitals and Health Systems offered a comparison of discrepancies between the latest consultant’s report and the hospitals’ own data.

According to the hospital association, hospital numbers showing how many patients were discharged from emergency rooms and inpatient units in 2022 do not match the figures in the final report.

Hospitals almost uniformly reported higher numbers of discharges, meaning more patients were treated, the consultants reported, by margins of up to 83%.

For example, Porter Medical Center in Middlebury recorded 21,568 patient discharges from the emergency department in 2022. But the consultant’s report noted only 11,876 discharges for Porter that year.

That same year, Mount Ascutney Hospital and Health Center reported a total of 858 inpatient discharges, according to hospital organization data. Meanwhile, the consultant’s report contained only 142 entries.

“These are not rounding errors,” Del Trecco said. “These are important missing components of our services to Vermonters.”

‘We stand behind this’

Oliver Wyman consultant Hamory, who led the report, disputed these criticisms.

Discharge data in the report are from the Vermont Healthcare Uniform Reporting and Evaluation System, not from hospitals’ own figures; or VHCURESAccording to Hamory. This data set does not include the exact number of hospital discharges, but it does include claims data: figures showing medical claims paid by private insurance, Medicare, and Medicaid.

VHCURES is an incomplete dataset and includes only 60% of Vermonters with private insurance plans. (As of 2021, about half of Vermonters had private insurance coverage.)

Hamory acknowledged the limitations of the data. But because the report focuses on the finances of hospitals in Vermont, he said it makes the most sense to examine claims data.

“The reason for this is that for fiscal purposes it is the most reliable data available on these numbers,” Hamory said in an interview.

Has it been made clear to hospital leaders that the report uses VHCURES data? “I think so,” said Hamory, adding that the data was presented to hospitals before the report was published and they were given the opportunity to evaluate it.

Despite the limitations, Hamory said the report’s financial modeling — which predicts that without action, hospitals in Vermont will run a total deficit of $700 million to $2.4 billion below break-even by 2028 — is still solid.

“This data collection and analysis took a year,” he said. “This wasn’t done overnight. This wasn’t done without a lot of discussion among various experts and others doing data analysis. And we stand behind it.”

But Del Trecco of the hospital association said those inconsistencies invalidate the document’s conclusions.

“If you have a significant underutilization (data) gap, how do you move forward with the recommendation, ‘Stop doing X service, change inpatient service, close your emergency room’?” he said. “It seems very flawed to me.”

‘Just a report’

It now falls to the Department of Human Services to work with hospitals on the report’s recommendations.

State officials are meeting with hospitals to discuss the report’s recommendations, Brendan Krause, the Human Services Agency’s director of health care reform, said in an interview earlier this month. The state is also seeking a contractor to provide technical assistance to help hospitals with “localized transformation planning,” according to a request for proposals that closed last week.

Krause noted that the path ahead for hospitals may not actually resemble the recommendations in the report.

“The report was well thought out and a lot of effort went into it, but it’s just a report,” Krause said. He emphasized that the state will not force any hospital to make changes.

“I think the important message is that we want to work with hospitals,” he said. “We will not do anything to hospitals.”

Even so, the past few weeks since the consultant’s report was released have been a period of anxiety for Vermont hospitals, particularly the four hospitals that recommended significant changes.

At North Country Hospital in Newport and Gifford Medical Center in Randolph (both of which the report says should stop non-emergency deliveries and replace inpatient units with geriatric or mental health facilities), hospital leaders expressed concern about the report’s data and its impact on morale in their communities. about.

Michael KostaGifford’s president and CEO said the consultant’s recommendations caused concern for employees and potential employees at the Randolph hospital.

Costa said many staff resigned due to uncertainty about the hospital’s future, and many candidates for open positions withdrew from the recruitment process for the same reasons.

“Great staff is what keeps healthcare moving forward,” Costa said. “And so losing people or losing hires because of the report is a heavy blow to the community.”

In Newport, the consultant’s recommendations for North Country Hospital were met with anger and disbelief.

“It was like hell,” Tom Frank, president and CEO of North Country Hospital, said in an interview.

“We have patients calling in tears because they are afraid we are going to close the hospital,” he said. “The debate in society is all about ‘Why are they going to close our hospital?’ “It’s about.”