Safety-net hospitals are facing mounting financial and operational pressure, and without congressional action, their ability to sustain quality services could be in jeopardy, according to Mark Gordon, executive vice president and COO of Burlington, Vt.-based UVM Health Network.
Mr. Gordon pointed to looming Medicare sequestration cuts, Medicaid funding reductions and the potential expiration of ACA premium tax credits as factors that could strip hundreds of millions in revenue from UVM Health Network and push thousands of Vermonters and New Yorkers out of coverage. At the same time, the health system is navigating workforce shortages and affordability challenges that threaten access to care across the region.
The six-hospital system, which employs more than 1,000 physicians as well as 2,000 nurses and other clinicians, is bracing for the downstream effects of federal funding cuts, workforce shortages and affordability challenges while also investing in innovation and workforce pipeline programs to sustain its mission.
In a conversation with Becker’s, Mr. Gordon outlined the risks, tradeoffs and opportunities shaping UVM Health Network’s path forward.
Question: What were your top priorities in recent conversations on Capitol Hill, and how do they align with UVM Health Network’s most pressing challenges?
Mark Gordon: Our efforts to keep quality services available is at significant risk as we await the impact of Medicare proposed rules and OBBBA (H.R.1). We know that the 4% sequestration triggered by OBBBA for UVMHN would reduce Medicare revenue by $42M annually, and that our early estimates for the other components of the OBBBA, such as the Medicaid work requirements, increased Medicaid redeterminations and elimination of premium tax credits, could reduce revenue by at least another $100M annually.
Telehealth has become an indispensable part of care delivery and access at UVM Health Network in both northern New York and Vermont, significantly enhancing and connecting patient and provider experiences. Since the onset of the COVID-19 pandemic, telehealth usage has surged, with UVM Health Network leading the way in providing accessible and high-quality care through innovative eHealth services. This includes tele-video, telestroke, tele-ICU, tele-NICU and specialty care eConsult services. Patients across northern New York and Vermont have embraced telehealth, with over 80% reporting high satisfaction levels. Approximately 85% of UVM Health Network physicians currently use telehealth, agreeing that it enables them to provide high-quality care. Moreover, telehealth has improved professional satisfaction for many providers, with a majority indicating that it has enhanced their work experience.
The national workforce shortage has had a massive impact on healthcare organizations across the country, and UVM Health Network is not immune to these challenges. We are taking action to address the workforce shortage by strategically developing, nurturing and retaining new talent throughout Vermont and northern New York. This includes a number of innovative pipeline programs, as well as investments in employee housing and high quality childcare.
Examples of our pipeline programs: UVMHN pathfinder program, licensed practical nursing pathway program, registered nurse program, respiratory therapy program, medical laboratory technician pathway program, licensed nursing assistant program, UVMMC LNA to RN pathway program, clinical assistant program, phlebotomist apprenticeship program, paramedic program.
Q: What would be the downstream effects of federal funding decisions — such as Medicaid DSH cuts or ACA premium tax credit expirations — on workforce strain and patient access for health systems like UVM?
MG: Federal cuts (OBBBA and other): While it will take some time to analyze and fully understand the impact, the nearly $1 trillion in Medicaid cuts that have been announced so far will be estimated to cause 45,000 Vermonters and 1.5 million New Yorkers to lose their healthcare coverage over 10 years (state data). We’re waiting on — and hoping for — actions from our states that will blunt some of the effects of these federal policy changes.
These cuts, and potential ACA premium tax credit expirations, will negatively impact people’s health and put pressure on an already struggling healthcare delivery system, and jeopardize access to care for everybody, regardless of insurance coverage.
We have advocated against this legislation since its inception, and we will continue to work with our partners across New England and New York (including [Lebanon-N.H.-based] Dartmouth Health and [Portland-based] MaineHealth, as well as the Healthcare Association of New York State), and at all levels of government, to advocate for policies that protect patients and ensure the health and dignity of every person we serve.
Q: What tradeoffs are you preparing for amid deepening funding uncertainty?
MG: UVM Health Network provides care to everyone who comes through our doors, regardless of insurance coverage, and we remain committed to that mission.
This summer, in response to Vermont and northern New York’s health care affordability crisis, we announced expense reduction efforts that included layoffs, delayed capital planning, and other initiatives. As we assess the impact of those changes, we expect to need to take further actions to be more effective and efficient in the future, especially as federal funding uncertainty continues.
In this work, the health system is committed to being transparent, staying focused on putting patients and their health first, and continuing to make choices that help the organization effectively and efficiently support them for years to come.
Q: Where do you see the greatest opportunities for growth and innovation across UVM over the next 2-3 years?
MG: In addition to some of the transformational work we’ve talked about regarding our evolution as a health system, we have some great innovation opportunities:
- Technology including eConsults and self-scheduling
- AI, particularly to support providers in documenting visits and reducing burnout
- The pipeline talent/workforce programs we mentioned above are only picking up steam and helping more current and future employees build their skills and move into fulfilling health careers, while addressing workforce shortages.
