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Mt. Ascutney hospital projects financial loss



Valley News Staff Writer
Monday, August 12, 2019

WINDSOR — Officials at Mt. Ascutney Hospital and Health Center are projecting to end this fiscal year in September with a slight loss on operations, but they’re looking ahead to better results next year.

The loss, which hospital officials in filings with the Green Mountain Care Board project to be approximately $400,000 on an operating budget of $55.9 million, would follow two years of positive margins for the 25-bed critical care hospital that became a member of Dartmouth-Hitchcock Health in July 2014.

Officials pointed to their participation in contracts with the accountable care organization OneCare Vermont as the primary sources of the deficit and said they aren’t sure whether they will continue in all of them.

Under these contracts, hospitals receive a fixed monthly payment based on the number of patients they care for. They are required to have reserves on hand in case the cost of those patients’ care is higher than expected.

As Mt. Ascutney has increased its participation in such contracts, adding Medicare and Blue Cross Blue Shield to Medicaid for 2019, so has the size of the reserve fund it is required to carry. Participating in all three in 2020 would require that the hospital carry a reserve fund of about $2 million.

“That is a lot for any small hospital to manage,” CEO Joseph Perras said in an interview last week.

Perras, who sits on OneCare’s board, said he believes in the overall aim to move away from a fee-for-service payment model to one that is based on value.

But, the “transition has a lot of uncertainty,” he said.

Despite the uncertainty, Mt. Ascutney officials proposed a budget to the Green Mountain Care Board for the fiscal year beginning Oct. 1 that they expect will produce a surplus of $600,000. The board will hold a hearing on the proposed budget later this month.

To help them get there, Mt. Ascutney officials are requesting the board’s approval to increase the rates they charge commercial insurers. The rates vary based on the type of service, but on average the proposed increase is about 3%.

“The rate increases that we submitted are more than reasonable,” Perras said. “I do think the Green Mountain Care Board understands the position that we’re in.”

The health care reform effort is just one of the challenges facing small hospitals in Vermont and beyond. Others include the high costs of prescription drugs and difficulties recruiting and retaining workers, which have forced them to hire temporary workers at a high cost.

On the latter point, Mt. Ascutney is making progress with its lowest staff vacancy rate in recent years, in part due to investments in housing for workers, Perras said. In the past year, the hospital purchased a condo at the former Ascutney Mountain Resort. The condo acts as short-term housing for permanent employees as they search for other housing in the area, Perras said. If it’s successful and the need warrants, Perras said the hospital would consider another condo purchase.

In addition, the hospital renovated an on-campus building to create a two-bedroom suite with a shared kitchen and living space to accommodate on-call workers who may need to stay close to the hospital for a weekend shift, Perras said.

Perras also credits the improved staffing situation to the hospital’s stability in recent years, which has allowed it to contribute to market and merit raises and retirement funds. He also pointed to uncertainty at other small hospitals in the region, such as Springfield (Vt.) Hospital which is currently going through Chapter 11 bankruptcy.

“Folks want to come work here,” he said.

Though it’s not his goal to poach employees from a nearby struggling hospital, “there are a lot of health care jobs within 30 miles” of Springfield, he said, and potential workers get snapped up.

That said, Mt. Ascutney continues to struggle to recruit and retain primary care physicians, which can have an effect on the number of patients the hospital is able to care for, he said. Perras said he is hopeful that three new hires — two in Windsor and another at the Mt. Ascutney-owned Ottauquechee Health Center in Woodstock — will stay for the long term.

It takes six months to a year for a new provider to begin seeing the same number of patients a seasoned provider would see, Perras said.

In addition to recruiting some former Springfield Hospital employees, Perras said the turmoil in Springfield means that hospital leaders in southern Windsor County and across the Connecticut River in Sullivan County will need to look at how they deliver care. He predicted that the three hospitals will need to collaborate more on specialty care.

The Green Mountain Care Board is slated to review Mt. Ascutney’s 2020 budget proposal at an Aug. 28 hearing. More information is available online at gmcboard.vermont.gov/content/FY2020-Budget.

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.