LEBANON — Service cuts the University of Vermont Health Network announced last week have the potential to affect health care delivery across the region, including in the Upper Valley.

The changes Vermont’s largest hospital system announced last Thursday include decreasing the number of inpatient beds by roughly 50 by limiting transfers from regional hospitals and closing the transplant department at the University of Vermont Medical Center in Burlington.

The UVM network also plans to close an inpatient psychiatric ward at Central Vermont Medical Center in Berlin, end staffing and operation of dialysis programs at several locations and merge multiple family medicine and rehab facilities in the Mad River Valley. The changes will affect about 200 employees, including about 100 temporary or traveling staff.

The cuts at one of only two facilities providing advanced trauma care in the region could increase regional barriers to health care, especially for people in rural areas, and drive more patients to Lebanon’s Dartmouth Hitchcock Medical Center, which already has capacity challenges.

“We don’t have enough beds as it is, so as we see UVM closing beds and Dartmouth struggling to keep beds open, there are enormous concerns,” Anne Sosin, a public health researcher and practitioner at Dartmouth College, said.

UVM Medical Center, the network’s main facility, is Vermont’s only tertiary care provider and academic medical center — meaning it provides advanced and emergency care that other local providers cannot offer — and it is the state’s largest provider by revenue, according to the Green Mountain Care Board, a state regulator.

Meanwhile, DHMC is the only academic medical center and tertiary care hospital in New Hampshire.

It provides a similar level of advanced care as UVM and both accept patients requiring advanced care from around the region.

The timeline of the changes remains unclear. Despite claims to the contrary in the Thursday news release, the health network will not make any “immediate changes to service,” and will “take months to implement” them, Frank Giancamilli, a spokesperson for the health network, said in a Monday email.

It is the decreased number of inpatient beds that could have the most widespread impact on patients, Jessa Barnard, executive director of the Vermont Medical Society, said.

“If the hospitals in the Upper Valley are already referring patients to (DHMC), they may have less of an impact, but our understanding is Dartmouth is often already full or not taking transfers,” Barnard said.

Dartmouth Health did not respond to questions about the impact of decreased inpatient beds and capacity challenges by deadline.

Barnard said the Vermont Medical Society — a Montpelier-based nonprofit that advocates for health care providers in the state — and its members have had ongoing conversations about how the UVM changes will impact health care in Vermont and how to address some of the potential challenges.

In addition to speculation that more patients may be transferred to DHMC or left without care options, UVM has begun discussions with DHMC, the only other facility offering kidney transplants in the region, to give UVM patients access to this care, according to the UVM news release.

UVM provided roughly 12 kidney transplants in 2023, according to the release, while DHMC did 27, according to a Dartmouth Health spokesperson.

The UVM Health Network is making the service cuts to comply with Green Mountain Care Board budget restrictions for 2025, according to the Thursday news release.

The Green Mountain Care Board, or GMCB, ordered the health network to reduce its commercial prices by 1% for fiscal year 2025, while increasing the hospital’s budget by not more than 3.5%.

In its budget order for fiscal year 2025, the GMCB denied UVM Medical Center’s proposed increases in net patient revenue, or income earned from services delivered, and commercial rate requests based on “the hospital’s inefficient operation, unreasonable and unsupported budget assumptions, low provider productivity and clinical efficiency, declining and concerning quality and safety scores, and excessive commercial costs.”

In a Tuesday interview, GMCB Chair Owen Foster maintained that the UVM network could have decreased rates without cutting services.

The network can improve its operating efficiency by investing more in preventative care and reducing some inefficiencies, Foster said.

“We’re certainly not trying to drive care out of Vermont. We want the care to stay in Vermont for sure but we want it at an affordable price,” Foster said when asked about patients being transferred to DHMC.

The UVM network’s decisions come on the heels of a report ordered by the GMCB, under Act 167 of 2022, which assessed Vermont’s hospitals and aims to improve the state’s health care system.

The report, authored by New York City-based consultant Oliver Wyman, ordered widespread changes to the state’s hospitals, including by closing or cutting services at multiple rural facilities. It also inspired an uproar from hospital officials.

The service cuts exacerbate concerns that rural Vermonters already have about their ability to access care locally, Sosin said. They are most likely to affect people living in rural areas, especially low-income residents with existing medical or transportation issues, she said.

“A patient living in Lebanon, New Hampshire or Hanover, New Hampshire will still be accessing care in their backyard at DHMC, so this may have little perceptible impact to them, but patients with first access care at Gifford (Medical Center in Randolph) or North Country (Hospital in Newport, Vt.) and (who) then would be transferred will face the most challenges in getting care they need in a timely way,” Sosin said. “Even though I know Dartmouth works hard to service the region, they have significant constraints in terms of the number of beds and workforce.”

While they are not the only hospitals in the region, Sosin said the region’s academic medical centers play a role that cannot be replaced by smaller critical access hospitals that provide health care to rural communities.

This means that rural providers like Gifford rely on transferring patients to UVM and DHMC, which UVM says it will now limit.

While it is not entirely clear what impact the decreased inpatient beds will have or when the changes will take place, the Medical Society’s Barnard said “how that all plays out and where those patients can be transferred is certainly a concern.”

It may lead to more patients being transferred to facilities farther away than DHMC, for example, to Connecticut, Massachusetts or New York, Barnard said.

According to physicians and hospitals, one of the significant drivers of a lack of inpatient beds in Vermont is an inability to discharge patients to facilities such as nursing homes, Barnard said. This creates a “bottleneck” that leaves patients who could otherwise be discharged in the hospital, taking up beds that could otherwise go to new patients.

In Thursday’s news release, UVM Health Network said it will “achieve this reduction (of 50 inpatient beds) by addressing challenges that prevent patients from being discharged when it is safe for them to leave the hospital or be moved to a more appropriate level of care, such as a rehabilitation facility or nursing home.”

It did not, however, specify how the network would address the ongoing bed crunch.

Providers have been very focused on finding ways to discharge patients who are stuck in the hospital and have made some progress in recent months, but it is a “very complicated problem to solve,” Barnard said.

“I don’t know how much they can do, given Vermont’s limited capacity of post acute beds,” Barnard said.

However, Barnard said it is clear to her that UVM is trying to limit the impact of these changes where possible. For example, by offering impacted providers positions within the network where possible, working with outpatient facilities that provide dialysis treatment to help them find new ways to offer those services and working with Dartmouth Health to plan for future kidney transplants.

“I believe they’re doing what they can to try to mitigate some of the impacts, but that doesn’t mean there won’t be some impacts and hardships because of this,” Barnard said.

Clare Shanahan can be reached at cshanahan@vnews.com or 603-727-3216.