Rural Northeast health system CEOs seek federal support 

Photo: Knaupe/Getty Images

The CEOs of three rural academic health systems in the Northeast want federal lawmakers to provide new policies, programs and payments.

The leaders of Dartmouth Health, which is headquartered in New Hampshire, MaineHealth and the University of Vermont Health Network, told their respective congressional delegations at the end of July that rural hospitals need such support to ensure continued care access.

Their hospitals provide patient services that lose money, such as primary care, behavioral and mental health, ambulance services, long-term care, and dialysis, the CEOs said.

The health systems serve rural communities in northern New England and northern New York. All three are the largest private employers in their respective states. As the primary providers of healthcare in the region, the three health systems are committed to community health, the CEOs said. 

Without change, it will become increasingly difficult for nonprofit safety net hospitals to meet the needs of patients, they said.

Proposals include increased funding from Medicare, a reduction in regulatory burden and allowing more flexibility in providing care. The proposed changes would be measured for success, they said.

Under the current system, efforts to preserve and improve access to care are at odds with the urgent need to hold down the cost of that care. All three systems have strong financial assistance policies to support patients. 

At the same time, they are working to manage expenses in the face of skyrocketing pharmaceutical costs and the escalating cost of recruiting and retaining talented staff during a national workforce shortage, they said.

WHY THIS MATTERS

Rural Americans are more likely to develop chronic illnesses and die compared to their urban counterparts, according to a released statement from the health systems. 

Dartmouth Health, MaineHealth and University of Vermont Health Network share similar academic missions, healthcare service delivery models, support for research and innovation, nonprofit statuses and deep commitments to the communities they serve. The patients in their rural communities face common challenges – growing older, suffering from chronic disease, unmet behavioral and mental health needs, and a lack of affordable housing, among others.

Ongoing workforce shortages and reimbursements from Medicare and Medicaid that do not cover the cost of providing care compound the challenges of preserving access to vital services.

In Vermont, more patients are accessing healthcare services. However, Vermont's largest commercial insurer, Blue Cross Blue Shield of Vermont, blamed increased demand as a reason for their near-record-high premium increases, averaging 24% in 2025, the health system said.

Dartmouth Health is formally designated as an anchor institution. It founded the Center for Connected Care for telehealth in 2012 with a primary objective of helping deliver healthcare to the region independent of patient location. 

Vermont is the lowest-cost provider of care for Medicare in the nation and UVM Medical Center is in the lowest-cost 25% of academic medical centers nationwide, it said. In 2023, UVM Health Network supported more than 8,000 patients by covering the cost of $22 million in care, and helped more than 6,000 patients access free prescription medication, equipment and support, covering $7.5 million that would have come out of the pockets of low- and middle-income patients.

In spite of investing over $500 million last year to subsidize healthcare services that are under-reimbursed by payers, MaineHealth exceeded its $100 million budget savings target through purchasing contracts, improved care delivery models and administrative efficiencies. These efforts support MaineHealth's commitment to maintaining an operating budget target of 3% or less, which supports the system's mission of ensuring high-quality affordable care for its patients.

THE LARGER TREND

The CEOs in New Hampshire, Maine and Vermont are not the only ones sounding the alarm on the rural healthcare crisis.

Other hospital CEOs have warned of service line cuts if federal reimbursement  is not raised.

Over the past decade, more than 100 rural hospitals have closed. As a result, the millions of Americans who live in those communities no longer have access to an emergency room, inpatient care and many other hospital services, according to the Center for Healthcare Quality & Payment Reform.

Over two dozen hospitals eliminated inpatient services in 2023 and 2024 in order to qualify for federal grants that are only available for Rural Emergency Hospitals (REHs), the report said. Every year, more than 7,000 rural residents received inpatient care in those hospitals, but now seriously ill individuals need to be transferred to hospitals far from the community where they live.

ON THE RECORD

"We are bringing the critical needs of our patients and our communities to Washington, D.C., and proposing solutions to ensure that the people of northern New England and northern New York can get the high-quality care they deserve in our region, now and into the future," said Dr. Sunny Eappen, president and CEO of UVM Health Network. "We appreciate our Congressional delegations' willingness to hear about the big challenges uniquely impacting rural communities here and across the nation."

"We know what we must do to take care of our patients and communities," said Dr. Joanne M. Conroy, CEO and president of Dartmouth Health. "We believe that integrated nonprofit medical systems that share a commitment to providing access to high-quality care for our communities, as well as training the healthcare workforce of the future, should have the support they need to remain sustainable. Equitable access to quality healthcare in our rural regions depends upon it."

"As a family physician by training, it has been difficult to watch our rural communities struggle to maintain access to high-quality care for their residents," said Dr. Andrew Mueller, CEO of MaineHealth. "Our proposals align with, and support, our MaineHealth vision of 'Working together so our communities are the healthiest in America.'"

Email the writer: SMorse@himss.org