A sign of support greets health care workers outside Grace Cottage Hospital in Townshend. Photo by Kevin O’Connor/VTDigger Some hospital administrators and elected officials reacted with dismay to a report this week that recommended a significant restructuring of hospitals across Vermont. The sprawling report, released Wednesday by consultancy Oliver Wyman, recommends a slate of reforms to the state’s beleaguered hospitals and health care systems — reforms that are necessary to forestall insolvency at some Vermont hospitals and repair a “badly broken” system, consultants said.But administrators at those hospitals, and political representatives for the communities where they operate, have expressed concern and surprise about the proposals.The report’s recommendations for Randolph’s Gifford Medical Center — which include replacing inpatient beds with a facility dedicated to mental health or geriatric care — were “surprising and deeply disappointing,” said Dan Bennett, the hospital’s president and CEO, in an email.“While we knew this report to the state was coming, its contents are, frankly, shocking,” Bennett said.The report, presented at a lengthy Wednesday meeting of the Green Mountain Care Board, was the culmination of months of work and meetings involving thousands of Vermont health care administrators, providers and residents. The goal is to shore up the state’s struggling health care system and hospitals. Most Vermont hospitals are operating in the red, and if left unchanged, will require hundreds of millions of additional dollars to stay afloat in the next five years, according to the consultant’s projections.The report envisions a dramatically redesigned health care system in Vermont, in which many hospitals focus on specific medical specialties and stop performing procedures outside of those areas. Its proposals include halting some procedures, downgrading emergency departments and finding new uses for inpatient units at four “at-risk” Vermont hospitals: Townshend’s Grace Cottage, Gifford Medical Center, Springfield Hospital and Newport’s North Country Hospital.North Country Hospital in Newport. North Country Hospital photoNorth Country Hospital: ‘A true blessing and asset’But for some, that vision is an unwelcome one. North Country Hospital is a “a true blessing and asset to our region and to those of us who find themselves in this remote and particularly isolated part of Vermont,” Newport Mayor Linda Sullivan said in an email.“I say, ‘leave us alone,’” she said.The hospital serves a largely rural area with a declining population of roughly 27,000 people, according to the report. It sees roughly 30 visits to its emergency department a day, more than a third of which could be addressed at lower-acuity facilities, and admits only about two or three patients a day, the consultant’s analysis found.The report recommends that North Country find a new use for its inpatient unit, consider downgrading its emergency department to an urgent care or “non-physician model” and stop delivering babies except in cases of emergency.North Country Hospital CEO Tom Frank said those proposals could harm local residents. “We cannot support recommendations that will eliminate care in our region and put patient safety in jeopardy by adding more distance between them and the care they need and deserve,” Frank said in an emailed statement.And, if enacted, those cuts would be a significant loss for the sparsely populated Northeast Kingdom — especially as it tries to attract more residents, said Rep. Woodman Page, R-Newport.“If we’re trying to grow our communities, who the devil is going to want to come up here to Newport (if) we don’t have an OB-GYN clinic or have the ability to deliver babies here?” he said in an interview.Gifford Medical Center in Randolph. File photo by Mike Dougherty/VTDiggerGifford Medical Center: ‘That hospital can’t go away’The consultant made similar recommendations for Gifford Medical Center, a 25-bed critical access hospital in Randolph. The hospital serves the smallest service area in the state — 14,000 residents — and with an average of just 14 emergency department visits and two admissions a day, it needs to change to adapt to a shrinking population and low volume,  according to the report.Those conclusions drew disappointment and frustration from some Randolph leaders. “The recommendations in this report have the potential to harm rural communities and some of the most vulnerable Vermonters,” Michael Costa, who will take over as Gifford’s president and CEO next month, said in an emailed statement. “I am disappointed that the consultant’s report did not reflect the voices of Gifford’s team and our community.”Rep. Jay Hooper, D-Randolph, said in an interview that he would strongly oppose any cuts to Gifford.“It’s with no hesitation that I say we need to make sure to defend small hospitals like Gifford, but especially Gifford, as ferociously as we can,” Hooper said. “We have to figure out how to make these hospitals do better on their own. And if Gifford is struggling financially, we have to figure out how to fix that, because that hospital can’t go away.” Hooper compared the consultant’s proposals to a 2020 plan from the former chancellor of the Vermont State Colleges to close an institution of higher education in Randolph. That proposition, which would have closed the former Vermont Technical College, now a Vermont State University campus, drew furious backlash and protests from community members. The plan was later abandoned. “I think maybe we have to scare up that level of resistance and disapproval of that,” Hooper said. Springfield Hospital: ‘Worked so hard’Springfield Hospital, which has been on rocky footing for much of the past five years, should also undergo “major restructuring,” the consultant said.Indebted and struggling to pay bills, Springfield Hospital entered bankruptcy in 2019. It emerged the next year in a new, reorganized structure.The hospital, which has 35 beds including a 10-bed off-site psychiatric unit, was admitting two patients a day and seeing 36 daily visits to the emergency department as of 2022, the consultant found.“I am disappointed Springfield is on this list, because Springfield has worked so hard to turn that hospital around,” Sen. Alison Clarkson, D-Windsor, said in an interview. “They have come up with an effective strategy, they’ve reined so much in, they have really worked very hard to create a new paradigm for their services.”Robert Adcock, the hospital’s CEO, echoed those concerns.“We do not support a path that reduces access to care and requires our patients to travel great distances for critical health care needs,” Adcock said in an emailed statement. Springfield Hospital in June 2019. Photo by Mike Dougherty/VTDiggerGrace Cottage Hospital: ‘Wins and losses’Roughly 20 miles southwest, in Townshend, Grace Cottage Hospital CEO Olivia Sweetnam said in an interview that the consultant’s report contained “wins and losses.”At the 19-bed hospital, some of the report’s recommended actions are, in fact, already underway, such as implementing a “non-physician” emergency department, Sweetnam said. But she worried about converting the hospital’s inpatient beds to a mental health or geriatric care facility, which the report proposed. “My personal feeling is that we know that there’s a need for the service we currently provide,” she said, adding, “We’re full right now.”A loss of services at Grace Cottage would force residents to travel even further — and could harm patients in need of emergency care, Rep. Emily Long, D-Newfane, said in an interview.“Without Grace Cottage providing those services, there are no local services here in our very rural area,” she said. “I think a lot of people don’t realize how rural the West River Valley is.”UVM Medical Center: ‘Inaccurate information’The consultant’s work also drew a rebuke from the University of Vermont Medical Center, the state’s largest hospital. While the final report did not recommend a sweeping reorganization of the Burlington hospital, it did urge leadership there to cut administrative costs, which it said were much higher than other comparable institutions.A UVM Health Network spokesperson said that conclusion relied on faulty data analysis, however. “In fact, when analyzed accurately, UVMMC ranks among the leanest when it comes to administrative costs,” Annie Mackin said in an emailed statement. “We’re disappointed this inaccurate information continues to be perpetuated.”It is not yet clear how many of the report’s recommendations will ultimately be enacted. But key players in the world of Vermont health care said they had no illusions that the process would be without friction. “I want to recognize that there will be — I’m sure already are — really strong pushbacks to many of the details,” Mike Fisher, Vermont’s chief health care advocate, said at Wednesday’s meeting. “And in the world of policy, it is easier to kill an idea than it is to pass a good idea.”But, he said, “the costs of not acting are tremendous.” Read the story on VTDigger here: ‘Leave us alone’: administrators, officials push back on recommendations for hospital restructuring.