BMH Updates

Please follow this link to read The Commons article entitled “Potential of nursing strike looms over BMH” by Joyce Marcel.

Please follow this link to read Commentary entitled “Health is a community effort — How BMH supports our community.” written by Dr. Tony Blofson and Dr. Elizabeth McLarney and published in the Brattleboro Reformer on March 13, 2026.

The following commentary written by Dr. Tony Blofson and Dr. Elizabeth McLarney was released to local and regional media outlets on Tuesday, February 24, 2026. It is the fourth in a series intended to help the community gain a better understanding of the financial and other headwinds faced by BMH and other rural hospital across the U.S.

Beyond the Bedside (Part IV) … The internal pressures shaping BMH

In our last column, we focused on some of the internal pressures shaping Brattleboro Memorial Hospital and rural hospitals across the country.

We discussed the growing difficulty of recruiting healthcare professionals to our region and the urgency created by an approaching wave of retirements.

We also gave a shout out to the incredible team at BMH. They have been inspiring and selfless in their willingness to step up and ensure that we are able to continue providing care for everyone who needs it. But that raises an important question: at what cost? When does constant stress and responsibility slip into feelings of burnout? And how do we prevent that from happening?

As our staff continues to give their all, another challenge looms quietly in the background: much of our physical infrastructure has outlived its original purpose and now requires significant modernization.

The BMH campus reflects more than 120 years of effort to meet the community’s evolving healthcare needs. It is a patchwork of old and new. The Ronald Read Pavilion, which opened in 2023, features state-of-the-art operating rooms and modern clinical and office space. Yet portions of that building share walls with remnants of the original hospital built in 1903.

The Richards Building, home to our laboratory and outpatient treatment services, opened in 2007 and provides modern space for patient care. But it sits directly beside the Medical Office Building, constructed in the 1970s — more than a half century ago.

This mix of aging and modern facilities means BMH is constantly addressing expensive and complex infrastructure challenges. From outdated HVAC systems to slate roofs to pre-WWII sewer lines, the demands on our Plant Services team to keep our hospital safe, compliant, and operational are unrelenting — and costly.

Financial experts use the term “average age of plant” to describe effective age of an organization’s physical assets. Based on depreciation and maintenance costs, it offers a snapshot of how much useful life remains in buildings and equipment.

It is important for our community to know that Vermont hospitals, as a group, rank among the highest in the nation when it comes to “age of plant.” In practical terms, this means there is a pressing need to reinvest in facilities and equipment statewide.

Yet as financial resources steadily erode, hospitals are often forced to defer maintenance needs and postpone capital improvements — despite knowing those costs will only increase over time. At BMH, deferred maintenance and capital totaled approximately $800,000 in FY 2025.

The longer modernization is delayed, the harder it becomes to realize cost-savings through more efficient models of care. Many patient care areas were designed decades ago, limiting our ability to optimize patient flow and implement the efficiencies that patients expect and insurers and regulators increasingly demand.

And just as BMH has a physical backbone, we also have a vast and constantly evolving digital one. Modern healthcare is inseparable from technology, and for a small rural hospital, the cost of keeping pace falls heavily on the bottom line.

Anyone who owns a personal computer understands how quickly technology becomes outdated. Most of us delay upgrading until it is absolutely necessary.

Hospitals simply cannot do that. Even a small hospital like BMH must continually invest in its electronic medical record system, telemedicine platforms, cybersecurity protections, diagnostic imaging, and clinical documentation tools — along with maintaining its website, intranet, and employee computer network.

Our IT staff works continuously to upgrade hardware and software, integrate systems across departments, and protect the organization from cyber threats that can be both operationally disruptive and financially devastating.

The rapid pace of digital technology puts significant internal pressure on BMH to balance innovation with affordability, while ensuring our staff are properly trained and the computer systems we use in patient care areas remain secure and reliable.

As we navigate a period of unprecedented financial pressures, the decisions surrounding infrastructure — both physical and digital — are among the most difficult we face. Every dollar we spend on equipment, repairs, maintenance, or capital investment must be weighed against rising costs, declining reimbursement rates, and the increasingly unpredictable nature of the political and economic environment.

These challenges are not abstract. They directly affect our ability to support our workforce, modernize care, and remain a strong, reliable healthcare provider for the community we serve.

Please follow this link to read a reprint of “BMH deficit could take up to three years to fix” This article written by Joyce Marcel. It appeared in the February 24, 2026 edition of the The Commons.

Please follow this link to read a reprint of “Brattleboro Memorial Hospital turnaround could take 2-3 years.” This article written by Chris Mays. It appeared in the February 16, 2026 edition of the Brattleboro Reformer.

Please follow this link to read a Letter to the Editor entitled “Facts and Context are Important” written by Dr. Tony Blofson and Dr. Elizabeth McLarney and published in the Brattleboro Reformer on January 29, 2026.

The following commentary written by Dr. Tony Blofson and Dr. Elizabeth McLarney was released to local and regional media outlets on Thursday, January 22, 2026. It is the third in a series intended to help the community gain a better understanding of the financial and other headwinds faced by BMH and other rural hospital across the U.S.

Beyond the Bedside (Part III) … The internal pressures shaping BMH

In the first two installments of our series on Brattleboro Memorial Hospital (BMH), we focused on the financial pressures facing our hospital and the external forces that disproportionately affect small, independent, rural healthcare providers. We explored the rising cost of delivering care while reimbursement from Medicaid and Medicare has remained stagnant — or declined.

Some may wonder why BMH relies so heavily on Medicaid and Medicare. The answer is straightforward: about 65 percent of our southeastern Vermont community depends on these two government programs for health coverage. In that sense, BMH and the community it serves are deeply interconnected. When reimbursement falls short, the impact is felt not only by the hospital’s balance sheet, but also behind the scenes as we work to preserve access to high-quality, local healthcare for everyone who needs it.

Workforce challenges further complicate this picture. Recruiting and retaining healthcare professionals has been an ongoing issue in rural America since the late 1990s. Today, according to the American Hospital Association, only 10 percent of physicians in the U.S. practice in rural areas. Half of those physicians are age 50 or older, and looming retirements are expected to result in a nearly 23 percent decline in the rural physician workforce by 2030. For BMH specifically, more than 50 percent of our active practicing physicians are 50 or older.

The COVID-19 pandemic intensified these challenges, prompting thousands of highly trained healthcare professionals nationwide to leave the field altogether. This is not to suggest that BMH is understaffed. Rather, it highlights the reality that our staff has had to adapt, improvise, and at times step outside their comfort zones to ensure patients continue to receive responsive, high-quality care — often with fewer resources than would be ideal.

At the same time, we face steep barriers when hiring. We cannot compete with the salaries and signing bonuses offered by larger urban systems, simply because we do not have the patient volumes required to generate that level of revenue. Rising housing costs in and around Brattleboro, coupled with limited professional opportunities for spouses and partners, make recruitment even more challenging.

These pressures inevitably ripple through the organization. For some employees, it means taking on additional roles or shifts. For others, it involves cross-training so they can support colleagues outside their primary specialties. This flexibility helps ensure patient needs are met — but it also adds strain to an already demanding work environment.

BMH is a hospital that never truly sleeps. As a community hospital, we are open 24 hours a day, seven days a week, 365 days a year. Patient volume and medical needs are unpredictable, requiring constant readiness from both clinical and non-clinical staff. Teams must manage emergencies alongside admissions and discharges, balance scheduled and unscheduled surgeries, and coordinate specialist availability — all in real time.

Sustaining this level of complexity is no small task. It depends on seamless coordination and rapid, reliable communication across departments and disciplines. While some might view these conditions as a recipe for burnout, the staff at BMH has demonstrated remarkable resilience.

Even amid profound change and growing uncertainty, our employees continue to show up for this community in meaningful ways — often under pressures that are largely invisible to the public. Their dedication, adaptability, and commitment are a powerful reminder that behind every challenge facing modern healthcare, there are people working tirelessly to ensure care remains close to home.

Brattleboro Memorial Hospital Provides Update on Nursing Union Negotiations

Brattleboro Memorial Hospital (BMH) is providing an update on ongoing collective bargaining negotiations with the Brattleboro Federation of Nurses (BFN). These conversations are taking place during an exceptionally challenging financial period for the hospital, driven by significant and unforeseen changes in financial conditions.

On December 3, 2025, BMH submitted a revised fiscal year 2026 budget to the Green Mountain Care Board (GMCB) showing a projected loss of approximately $14.5 million. Following the original submission in August, the GMCB directed BMH to conduct a deeper review of its budget.  As a result, several inaccuracies were corrected, including some of which resulted from aspirational assumptions no longer realistic under current financial conditions. BMH has been operating at a loss since 2017, and the challenges ahead continue to compound this long‑standing negative financial trend.

BMH recognizes the importance of its nursing workforce and values the critical role nurses play in delivering high-quality patient care. The hospital remains committed to bargaining in good faith and working collaboratively with BFN to reach an agreement that supports employees while ensuring the organization’s long-term financial stability.

Negotiations include discussions about wages, employee retirement benefits, medical benefits coverage offerings, and shift/specialty differentials—premium payments provided to employees for working specific shifts, performing specialized duties, or working under particularly challenging conditions. BMH’s current offerings in these areas are more generous than prevailing industry standards and the proposed adjustments are intended to align more closely with similar organizations and the regional market.  These changes reflect the hospital’s financial reality and its responsibility to maintain a balanced, sustainable budget while continuing to provide essential healthcare services to the community.

In recognition of the impact of these proposals, BMH has also indicated a willingness to reopen negotiations on specific economic issues during the term of the agreement with BFN.

“We are at a point where hard financial decisions must be made,” Acting Co-CEO Dr. Tony Blofson said. “The truth is, we cannot continue operating at status quo—it’s simply not sustainable.  Our shared goal is to ensure the long-term health of BMH, the jobs of all of us here, and to preserve the care our community depends on.”

Negotiations are ongoing, and BMH will continue to provide updates as appropriate.

Follow this link to read the January 22, 2026, Brattleboro Reformer article entitled “BMH Outlines Financial Improvement Projects” by Chris Mays.

Follow this link to read the Vermont Digger article entitled “State issues warning but won’t intervene in Brattleboro hospital budget saga” by Kevin O’Connor

Follow this link to read The Commons article entitled “Stabilizing the Patient” by Joyce Marcel.

The following commentary written by Dr. Tony Blofson and Dr. Elizabeth McLarney was released to local and regional media outlets this afternoon. It is the second in a series intended to help the community gain a better understanding of the financial and other headwinds faced by BMH and other rural hospital across the U.S.

Beyond the Bedside (Part II): The External Pressures Impacting Brattleboro Memorial Hospital

By Acting Co-CEOs Dr. Tony Blofson and Dr. Elizabeth McLarney

We hope you had a chance to read Part 1 in our series about the mounting external pressures that have generated a tidal wave of financial distress at Brattleboro Memorial Hospital and rural hospitals across the U.S.

If so, you have a better understanding of how the soaring costs of hospital overhead combined with shrinking payments from government health insurance programs like Medicaid and Medicare have been devastating for rural hospitals—especially those like BMH that have worked hard to remain independent and part of the community we serve. Unfortunately, our challenges don’t end there.

While workforce shortages have affected every hospital in the country, falling numbers of available clinicians, nurses, medical technologists, and emergency medicine specialists have hit small rural hospitals the hardest.

That’s because BMH and hospitals like BMH are forced to compete in a shrinking labor market with larger hospitals and health systems that are better positioned to offer higher salaries, and generous signing bonuses. We are fortunate that BMH has a great team, but the competition for talent is ongoing and intense.

The downstream effect on existing staff and patients is felt in a variety of ways.  When open positions remain unfilled, patients experience delays and longer wait times for primary, emergency, and specialty care. Existing staff members are under pressure to take on heavier workloads, making the risk of burn-out-driven turnover very real.

This plays out on a daily basis as surging numbers of people with substance use and mental health disorders turn to BMH’s emergency room as a first point of care. The added workload on staff is very real and often heartbreaking as mental health patients typically wait for hours and sometimes days for placement in an appropriate psychiatric facility.

The difficulties we face in recruiting and retaining healthcare workers often means rural hospitals are forced to hire contract labor to fill the gap. These healthcare professionals, known commonly as “travelers,” are incredibly expensive. Depending on their specialty, we pay double what we pay our own staff. And with contracts that typically run 13 weeks, they represent a short-lived solution to a long-term problem.

Healthcare worker burnout is not restricted to a hospital’s clinical operations. It’s also a huge and ever-growing challenge for employees on the administrative side of a hospital. Few people realize how expensive and time-consuming it is to interpret and fulfill the growing mountain of regulatory and reporting requirements imposed on hospitals.

By law, BMH must comply with hundreds of state and federal requirements while also meeting a host of oversight guidelines and accreditation standards. We are not implying that rules are unimportant. We are simply pointing out that the expanding scope and complexity of regulations associated with things like patient and staff safety, quality reporting, billing, staffing ratios, emergency preparedness, licensing, accreditation, and protecting patient information is enormous and increases expenses.

This is further complicated by the fact that the electronic medical record platforms across the regulatory landscape of U.S. healthcare are fragmented. They follow different formatting and compliance standards. The result? We have no choice but to enter the same information multiple times in order to meet the disparate documentation requirements of Medicaid, Medicare, commercial insurers, and regulatory bodies.

Brattleboro has supported BMH for more than 120 years. That support is the reason we are able to meet these pressures head-on and continue delivering high-quality care to the people who depend on us. We are proud to be part of this community, and we know we can get through these challenges by working together.

The following commentary written by Dr. Tony Blofson and Dr. Elizabeth McLarney was released to local and regional media outlets this afternoon. It is the first in a series intended to help the community gain a better understanding of the financial and other headwinds faced by BMH and other rural hospital across the U.S.

Beyond the Bedside: The External Pressures Shaping Brattleboro Memorial Hospital

By Acting Co-CEOs Dr. Tony Blofson and Dr. Elizabeth McLarney

When news about Brattleboro Memorial Hospital’s recent budget woes and leadership changes became public last October, we were deeply moved by the unhesitating and heartfelt messages of support we received from our community.

BMH is so much more than a collection of buildings. It’s home to a network of skilled healthcare professionals who have the best interests of the community at heart. That’s clearly obvious to so many people.

But what’s less obvious is the ways in which steadily mounting financial and other pressures from outside the organization have grown over the past decade. That’s why we’d like to share a bit about these pressures and explain some of the complexities they add to running a rural community hospital like BMH.

Imagine owning a business that begins the year in a financial deficit.  Unfortunately, this is the annual reality for BMH and all Vermont hospitals due to the state provider tax.  The tax is calculated at 6 percent of revenues, which means the amount can vary year to year.  In fiscal year 2025, BMH paid over $6 million in provider tax, underscoring the significant financial burden this places on healthcare institutions.

As a business owner you might respond by raising your prices. But hospitals like BMH that care for a large percentage of people who receive Medicaid and Medicare are required to accept reimbursement rates that often do not cover the full cost of services. Add to this recent federal legislation that cuts Medicaid funding by $1 trillion over the next ten years, and you understand the scope of the challenges we face.

BMH has been and always will be committed to meeting and exceeding modern standards of care. But the perfect storm has arrived for hospitals in rural America in the form of dwindling financial resources coupled with soaring costs not just for leading edge medical technology, but for basic equipment, medications, staffing, insurance, and compliance with regulatory requirements.

In the U.S. between 2017 and 2024, sixty-two rural hospitals closed while only 10 opened. And rural hospitals that can produce positive margins and remain open tend to be those that have more beds, higher occupancy, and are affiliated with a health system. Like other industries in our country, healthcare appears to be moving toward survival of the biggest. But is bigger always better?

It’s not if you have to drive 50 minutes to deliver a baby or reach an emergency room. What do you do if you’re unable to drive, or you lack an internet connection that will allow you to reach a provider online?

These are just some of the reasons why BMH has remained fiercely independent for more than 120 years. We’ve followed this course because it gives us the ability to remain deeply rooted in the needs of the community. Independence has allowed us to remain responsive and personal—but it comes at a cost.

We lack the economies of scale that help give large health systems an advantage—shared resources, centralized purchasing, and broader networks of specialists. These things mean BMH is more vulnerable to economic downturns, rising prices, and unexpected crises like the Covid-19 pandemic.

But they don’t mean we can’t come up with innovative ways to survive and even thrive in the 21^st century. For example, we are a founding member of the New England Collaborative Health Network giving smaller hospitals, like BMH, stronger purchasing power.  BMH’s strongest asset is our community, and with your help and understanding we will make it through these difficult times.

In Part 2 of this mini-series, we will talk about how staffing shortages, regulatory requirements, and the rising demand for mental health services have added to the complexity of BMH’s challenges.