Rural Vermont hospitals describe local cuts, workforce steps and stronger partnerships to sustain access

CEOs of small and regional hospitals told legislators they are pursuing targeted, local steps to stabilize operations while collaborating with larger centers and regional partners.

Sean Tester, CEO of Northeastern Vermont Regional Hospital in St. Johnsbury, described about $2,500,000 in expense reductions last year at his critical‑access hospital. Tester listed voluntary early retirement for 15 employees, the elimination of an occupational medicine program (with services moved into an Express Care clinic), eight FTE reductions (five administrative, three clinical), nursing‑schedule restructuring to reduce traveler costs, and savings from reduced IT licensing and trimmed benefits. Tester said the hospital is sharing a part‑time pharmacy director with North Country Hospital and is using grant funds to hire transformation consultants and expand NEK Prosper, the region’s accountable community for health, to improve care coordination. Tester also emphasized significant transportation barriers for patients and ongoing EMS staffing challenges.

Michael Acosta, president and CEO of Gifford Healthcare, said Gifford — a 25‑bed critical access hospital with FQHC services and elder care facilities — has doubled its average daily inpatient census from roughly eight to 15–16 and posted a positive operating margin in October. Acosta described joining the New England Collaborative Health Network to benefit from shared purchasing, pooled insurance risk and shared business insurance; those steps, he said, helped Gifford submit a budget 2.7% smaller than the prior year and improve days cash on hand. Acosta said Gifford was cash‑flow positive for seven months and is pursuing shared specialists and group purchasing to keep services local and cost‑effective.

Both leaders said workforce pipeline efforts are central to their plans: NVRH runs a career advancement program that subsidizes time for staff to train toward nursing and allied health roles, and Gifford is exploring residency and nurse‑training partnerships. Legislators asked whether cuts to employee benefits — for example, eliminating coverage for weight‑loss drugs — create longer‑term costs; Tester said the hospital had not completed a deep analysis but noted such benefits often have long‑term horizons that can extend beyond employment. Witnesses called for continued legislative support for transportation, workforce development and regional transformation funding.

The committee did not take formal votes during the captured testimony; members thanked witnesses and signaled ongoing oversight and follow‑up requests for more data on service impacts and workforce pipeline programs.