BRATTLEBORO-After nearly two hours of conversation with top leadership of Brattleboro Memorial Hospital (BMH) at a July 28 meeting, the Selectboard declined to call a Special Town Meeting to ask residents to help the hospital continue to fund its Birthing Center.
Board members concluded at the special meeting that it would be premature to put the question to taxpayers, and they now await more news from the hospital in September.
The Birthing Center is the maternity and birth services unit at BMH. It has offered care from certified nurse midwives, obstetricians, and nurses, with a focus on low-intervention, individualized birth experiences.
Last month, BMH’s board of directors voted to close the Birthing Center in six to nine months due to unsustainable financial losses.
The board meeting, which ran well over its scheduled time, drew “probably three times the amount of people we normally have here,” Selectboard member Peter Case said.
The decision has triggered a regional coalition — including civic leaders, public officials, business representatives, and community groups — to raise money, advocate for state policy changes, and mobilize public support to prevent closure.
Hospital: ‘We did not ask for a tax increase’
Dr. Tony Blofson, the hospital’s acting co-CEO since October, opened by making clear the institution itself was not behind the tax proposal, nor was Brighter Horizons, a Vermont-based nonprofit that provides family and community services that is part of the broader civic and business coalition working to keep the BMH Birthing Center open.
The request, he said, came from the community.
Instead, Blofson said, the hospital is pursuing several revenue streams simultaneously: a shot at Vermont’s rural health transformation grants, expanded philanthropy, and operational efficiencies.
BMH Board of Directors Chair Chloe Learey echoed that message, framing the hospital’s crisis as symptomatic of a larger, statewide and nationwide problem rather than a Brattleboro-specific failure.
“This is a systemic issue,” she said, warning “there are lots of things that we are not going to be able to solve with one-time payments.”
Blofson cited grim national numbers to underscore the stakes: More than half of rural hospitals nationwide no longer offer birthing services, he said, and roughly 700 of the 1,400 rural hospitals in the U.S. are at risk of closing in the next year or two.
The budget math
Selectboard Chair Oscar Heller pressed for specifics about what it would actually cost to keep the Birthing Center running.
Blofson said keeping the unit open for a full year was projected to cost the hospital $4.5 million to $5 million in losses, but he said that the board had signaled a willingness to absorb roughly $2 million of that, leaving about $3 million that outside funding would need to cover.
As to timing, Blofson said the hospital’s budget was due to the state by Aug. 2, with a hearing before the Green Mountain Care Board scheduled for Friday, Aug. 14.
He said Vermont’s Agency of Human Services was still evaluating rural transformation grant applications, with a decision expected sometime this month, adding that the hospital hoped to “know a whole lot more” by September.
Learey said the hospital has applied for $10 million to $11 million across eight grant requests, only some of which are earmarked specifically for the Birthing Center.
Federal rules mean any money the hospital receives must be spent on the purpose for which it was granted, Blofson noted, warning that misuse could trigger a clawback of the funds.
Critical access status, Medicaid reimbursement, and ‘no silver bullet’
Selectboard member Nell Mayo asked about the possibility of Brattleboro qualifying as a “critical access hospital,” a federal designation that comes with sharply higher Medicaid reimbursement rates.
Under that designation, Medicaid would cover roughly 80% of the costs of the hospital to provide its services. As it stands, BMH receives reimbursement from the federal insurance program under its standard rates that covers about 35% of the cost of providing medical care.
Blofson explained the hospital meets the bed-count requirement but falls short of the mileage rule requiring facilities to be at least 35 miles from another hospital, a threshold Vermont’s governor once had authority to waive.
Learey cautioned against viewing any single fix as a cure-all.
“There is no Hail Mary here,” she said. “No silver bullet, maybe that’s another way to say it.”
The two also described other reimbursement changes under discussion, including “standby cost” payments that would compensate on-call obstetric staff even when no patients are in labor.
Another change could be a shift away from lump-sum “global payment” billing for births toward itemized, per-visit reimbursement.
That measure, Blofson said, could help recapture revenue currently lost when patients receive prenatal care in Brattleboro but deliver elsewhere.
Staff morale and retention
Several board members, including Mayo, questioned the administrators about how current uncertainty is affecting hospital staff members, some of whom have reportedly started looking at jobs at Cheshire Medical Center in Keene, New Hampshire.
Blofson acknowledged the toll.
“It’s their job. It’s what they do and love, and how they support their families,” he said of the nursing and obstetric staff.
He added that hospital leadership has been sending regular video updates to staff and meeting directly with birthing-center employees to keep them informed.
Longtime Brattleboro nurse Richard Davis, a 47-year veteran of the local health care system, urged the hospital board to formalize that communication.
The former Selectboard member asked for a public update every three months — “no platitudes […] none of that B.S.” — to outline concrete actions taken and plans for the following quarter, arguing it would ease community anxiety fueled by rumor.
Deficits, ‘revenue cycle,’ and a forensic review
Pressed about the hospital’s larger financial picture, Blofson said an outside accountant conducted a review after the scope of the budget problems came into the public sphere last October.
The analysis found no evidence of fraud or embezzlement, he said.
Blofson put last fiscal year’s deficit at roughly $16 million and said this year’s budgeted loss of $14.5 million submitted to the Green Mountain Care Board will likely come in “considerably less” once final numbers are in.
He also acknowledged the hospital has historically failed to bill for services it was entitled to bill for, and said a new finance team has improved billing and reduced insurance claim denials.
Learey added that the scope of the birthing center’s losses became fully clear to hospital leadership only in April.
“We knew it was losing money,” she said. “So until you know the scope of the problem, you can’t fix it.”
Regionalization and what other hospitals have done
Asked whether Brattleboro might be absorbed by a larger system, Blofson said Dartmouth Health has pulled back most of the clinical services it once provided locally and is itself confronting a roughly $60 million loss — leaving it unlikely to take on additional obligations.
He also noted that Baystate Franklin Medical Center, about 30 minutes away in Greenfield, Massachusetts, recently laid off a significant number of employees.
Asked about private equity ownership as an alternative, Blofson said he personally believes it “tends to shove down the quality” of a hospital. He noted that Vermont’s Legislature has moved to restrict that option.
Both Blofson and Learey pointed instead to regional collaboration with Grace Cottage Hospital, 18 miles north of Brattleboro in Townshend, and Springfield Hospital, 40 miles away in Springfield, Vermont, describing regular meetings to determine which services each facility should offer.
Learey said she recently toured Grace Cottage — which closed its own birthing center 25 years ago and pivoted to emergency and primary care — and called it “an amazing facility” with lessons to offer, including about fundraising.
Public comment: gratitude, fear, and a warning about taxes
During public comment, several residents praised the hospital’s transparency while raising concerns of their own.
Jean Marie Davis, CEO of Branches Family Resource Center in Brattleboro, described her organization’s efforts to prepare as a potential emergency backstop if the birthing center closes and pressed the board about whether other regional hospital systems might be positioned to take over BMH’s operations.
Resident Eric Caron delivered one of the evening’s sharpest warnings, telling board members their potential instinct to solve the hospital’s crisis through taxation echoes patterns that have already strained the town’s finances.
“If you follow this pattern […] of taxing us to fix all problems, we’re going to be in horrific trouble very soon,” he said, pointing to deferred maintenance of sidewalks, the town pool, and fire equipment as competing priorities.
Davis urged residents to focus lobbying energy on Gov. Phil Scott’s recent statement supporting higher Medicaid reimbursement for birthing centers, calling it potentially more valuable than any local fundraising effort.
When resident Robert Oeser asked whether Windham County towns could coordinate a letter-writing campaign to the governor, Heller confirmed that outreach is already underway, with several towns having sent letters and passed supportive resolutions.
Elizabeth Crow, joining remotely, argued that maintaining local birthing services is essential to keeping young families in the region, saying the hospital’s emergency room “is not suitable or equipped” to handle birth complications on its own.
No motion, no vote — for now
With Heller stating it “feels a little premature to move forward at this time,” no board member offered a motion to call a special town meeting on hospital funding.
Case, who had originally requested the topic be placed on the agenda, said his goal had never necessarily been to secure a “yes” vote but rather to make sure the community understood what losing the hospital would mean.
“Whether you are for or against it is inconsequential,” he said. “You are in the conversation.”
The board voted 5-0 to adjourn after roughly 2½ hours, with hospital officials promising more clarity on the birthing center’s fate by early September, when decisions on state and federal grant funding are expected.
This News item by Virginia Ray was written for The Commons.