RANDOLPH — A report presented last week to the Green Mountain Care Board makes sweeping recommendations for restructuring Vermont’s health care systems and some communities and hospital leaders fear the loss of emergency rooms and inpatient beds, and the diminishing of other services.

The 144-page report, produced by the New York-based consulting firm Oliver Wyman, called for lowering health care costs, reducing inefficiencies, increasing access to primary care, and improving housing and transportation in an effort to make health care in Vermont more equitable.

The report identified Gifford Medical Center in Randolph as one of four medical centers — along with Springfield Hospital, Grace Cottage Hospital in Brattleboro and North Country Hospital in Newport — that are at risk of insolvency and in need of “major restructuring.”

“Must do” recommendations for Gifford include closing its emergency room and converting all of its inpatient beds into a long-term mental health, geriatric psychiatry, or memory care unit. Inpatient and emergency services can be shifted to “other organizations,” the report states.

Gifford’s leadership, Randolph-area state legislators and community members said that they were disappointed in the report.

“It’s insulting to Gifford, insulting to the community, and it puts Gifford on the defensive,” Randolph’s Economic Development Director Mark Rosalbo said by phone Tuesday.

The report, issued Wednesday, Sept. 18 and commissioned by the Green Mountain Care Board, was set in motion by Act 167 in 2022, which mandated a data-driven study of how to improve Vermont’s health care delivery system.

The board, which regulates the state’s 14 hospitals, hired Oliver Wyman to conduct the year-long analysis of the state’s system along with interviews with health care leaders and community listening sessions throughout the state. The board paid Oliver Wyman $1.05 million for the project.

The report envisions a regionalized health care system, where hospitals drop low-volume procedures and specialize in “areas of excellence.” It recommends moving as much care as possible out of hospitals and professionalizing emergency medical services so that EMTs, nurses and pharmacists can broaden their scopes of practice and provide more community-based care.

The board cannot mandate the closure of hospitals, nor can it force health care providers to alter or reduce their services.

The report’s recommendations are predicated on forecasting that suggests that by 2028, all but one of Vermont’s hospitals will be operating at a loss.

The report states that “hospital transformation” can be expected to yield $400 million in direct savings over five years, which can be invested in community-based care and social needs such as housing and mental health care.

Incoming Gifford CEO Michael Costa, who starts next month, worried about the report’s potential for damage.

“The recommendations in this report have the potential to harm rural communities and some of the most vulnerable Vermonters,” Costa said. “I am particularly concerned that the report could reduce health care choices for Vermont’s women.

Oliver Wyman staff noted that the volume of deliveries at Gifford’s birthing center is “below the minimum threshold” of financial sustainability, but it did not recommend closing or transforming the birthing center. In the Upper Valley, Dartmouth Hitchcock Medical Center in Lebanon is the only hospital other than Gifford that has a birthing center.

Costa also said he didn’t feel as though the institution and its neighbors were heard.

“I am disappointed that the consultant’s report did not reflect the voices of Gifford’s team and our community,” he said.

State Rep. Jay Hooper, D-Randolph, called the report “startling,” and its recommendations “half-baked.” He worried about the implications for Gifford’s workforce.

“There are employees who are immediately apprehensive about their jobs,” he said, “and they have to think about whether they are going to stay.”

Rosalbo said that rather than putting Gifford “on the chopping block,” the state should be working to increase the population of working-age people in Vermont.

Population growth “is the most critical component of health care reform,” Rosalbo said.

Randolph has a population of roughly 4,800 people. Like most of the state, that population is aging out of the workforce. The town, however, has made investments in housing, education and cultural resources that make it attractive to those wishing to move to Vermont, Rosalbo said.

Closing Gifford would be a “catastrophic loss” from which the town would never recover, he said.

“There is fear that this could lead to a dramatic diminishment of services,” state Rep. Larry Satcowitz, D-Randolph, said by phone Tuesday. “Randolph is small and Gifford is critical to our community and our overall economic well-being.”

Transportation is a key component of the report’s regionalized vision of rural health care.

If hospitals scale back their services or close altogether, either through regional mergers or insolvency, connecting people with care could become more difficult. “It would definitely make it more challenging to deliver those services,” Tri-Valley Transit’s Mike Reiderer said by phone Tuesday.

Curtailing services at Gifford “would put pressure on our volunteer drivers, on finding more volunteers to offer more trips, and they’d probably be longer trips,” said Reiderer, the community relations manager for the organization’s Orange and northern Windsor County region, which last year facilitated 25,000 volunteer rides from people’s homes to doctor appointments, dialysis, cancer treatment and other medical services throughout central Vermont.

The Agency of Human Services’ Health Care Reform Office will lead the next phase of “health system transformation,” Green Mountain Care Board spokesperson Kristen LaJeunesse said by email Wednesday.

Should the state signal an intent to enact any of the report’s recommendations, Gifford and members of the Randolph community are ready   to advocate.

“We’re n  ot just going to stand by without making a statement,” Rosalbo said.

Christina Dolan can be reached at cdolan@vnews.com or 603-727-3208.