Vermont hospital report sparks furor amid allegations of inaccurate data

Last month, a consultant released a wide-ranging report recommending big changes to Vermont’s health care system, including “major restructuring” at four community hospitals.

144-page government contract document sets out in detail a number of steps Vermont hospitals must take to stay afloat, including repurposing inpatient units and downgrading emergency departments at some facilities.

State health officials have repeatedly said they have no plans to close hospitals or force them to restructure. But the report nonetheless plunged much of the state’s health care system into a state of anxiety and uncertainty.

Moreover, in the past few weeks, hospital leaders have raised concerns about what they say are inaccurate data in the document, a controversy that has fueled backlash against the recommendations 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 be retracted because of faulty data. The Hospital Association published detailed press release Tuesday showed discrepancies between his data and the figures used in the report.

“I don’t know how any analyst or operational person could say, ‘Oh, these recommendations had a solid basis,'” he said.

“No rounding errors”

The report in question comes from Law 167A 2022 Vermont law that mandates an assessment of the state’s hospitals in an attempt to find ways to keep them financially sound.

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

This report outlined gloomy forecast for the Vermont Health System. The consultant found that most of the state’s hospitals were operating at a loss and could operate more efficiently if they consolidated different categories of care at certain hospitals. The report recommended particularly sweeping changes at four hospitals: North Country Hospital, Gifford Medical Centre, Springfield Hospital and Grace Cottage Hospital.

These proposals quickly caused violent reaction – one that has only increased now that the consultant has been accused of using inaccurate data.

In a news release Tuesday, the Vermont Hospital and Health System Association provided a comparison of discrepancies in the consultant’s final report and the hospitals’ own data.

Hospital data showing how many patients were discharged from emergency departments and inpatient units in 2022 did not match the data included in the final report, according to the hospital association.

Hospitals almost always reported more discharges (i.e. more patients treated) than consultant reports, with differences of up to 83%.

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

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

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

“We support this”

Hamory, the Oliver Wyman consultant who prepared the report, rejected the criticism.

The discharge data in the report was not taken from the hospitals’ own data, but from the Vermont Uniform Health Reporting and Evaluation System, or VHKURESAccording to Hamory. This data set does not include the full number of actual hospital discharges, but does contain claims data: numbers showing medical claims paid by private insurance, Medicare, and Medicaid.

VHCURES is an incomplete data set and only includes the 60% of Vermonters with private insurance plans. (As of 2021, approximately half of Vermonters were covered by private insurance.)

Hamory acknowledged the limitations of the data. But because the report focused on the financial health of Vermont hospitals, examining claims data made the most sense, he said.

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

Was it clear to hospital leaders that the report used VHCURES data? “I think so,” Hamory said, adding that hospitals were presented with the data before the report was released and were given the opportunity to voice their opinions.

And despite the limitations, the report’s financial modeling, which estimates that without action, Vermont hospitals would face cumulative shortfalls of between $700 million and $2.4 billion below the breakeven point by 2028, is still sound, Hamory said.

“The data collection and analysis took a year,” he said. “This was not done overnight. This was not without numerous discussions between various experts and other people involved in data analysis. And we support this.”

But the hospital association’s Del Trecco said those inconsistencies invalidated the paper’s conclusions.

“If you’re missing a significant amount of utilization (data), how could you make a recommendation: ‘Stop providing service X, move inpatient care, close the emergency department?’ – he said. “That seems very misguided to me.”

“Just a report”

Now it’s up to the Human Services Agency to work with hospitals on the report’s recommendations.

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

Krause noted that future hospital developments may not actually meet the report’s recommendations.

“The report was well thought out and a lot of effort went into it, but it’s just a report,” Krause said. The state is not going to force changes on any hospitals, he stressed.

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

Even so, the past few weeks since the release of the consultant’s report have been a period of concern for Vermont hospitals, particularly four that were recommended to make significant changes.

At North Country Hospital in Newport and Gifford Medical Center in Randolph—both of which the report said should halt non-emergency deliveries and replace inpatient units with geriatric or psychiatric facilities—hospital leaders expressed concerns about the report’s findings and its implications. on morale in their communities.

Michael CostaPresident and CEO of Gifford, said the consultant’s proposals are causing concern among Randolph Hospital employees and potential employees.

Several employees have resigned due to uncertainty about the hospital’s future, and several candidates for vacant positions have dropped out of the hiring process for the same reasons, Costa said.

“Great employees are what makes healthcare successful,” Costa said. “And so losing people or recruits because of the report is a huge blow to the community.”

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

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

“We have patients calling in tears and saying they’re afraid we’re going to close the hospital,” he said. “In the community, everyone is fussing about, ‘Why are they going to close our hospital?'”