[P]rimary care providers in Vermont could decide within the next week whether to endorse the state’s draft agreement with the federal government for an all-payer model of health care payment.
Todd Moore, who as CEO of Vermont’s largest doctor group is one of the most influential health care executives in the state, said he is asking his and two other groups to hold advisory votes on the deal.
The draft deal proposes to put almost all of Vermont’s doctors and hospitals into a giant organization. The state says this will allow doctors to coordinate patient care and lower growth in health care costs.
If any one of the three groups of doctors endorses the deal, the Green Mountain Care Board and the Shumlin administration will have support from enough doctors to sign the agreement.
Moore is the CEO of OneCare Vermont, the accountable care organization that represents about 30 percent of primary care providers in the state. His other title is senior vice president of accountable care for the University of Vermont Medical Center.
Moore said he wants the boards of directors for OneCare (which represents doctors working for hospitals), Community Health Accountable Care (which represents doctors at community health centers) and the new Vermont Care Organization (an administrative company created to bridge the other two) to vote on whether to endorse the deal.
Each entity has its own board of directors. Moore said he wants all three boards to vote before the Green Mountain Care Board decides whether to sign the agreement.
Al Gobeille, the chair of the Green Mountain Care Board, said Wednesday the outcome of the all-payer agreement would depend on the views of doctors.
What laws would be waived?
Doctors participating in the all-payer model’s accountable care organization would enjoy a series of waivers of federal Medicare laws. The waivers would not reduce coverage for Medicare beneficiaries, but doctors argue they would improve the quality of care while lowering costs.
One of those waivers addresses what is commonly called the three-day nursing home rule. Currently, if a Medicare patient spends the night at a hospital for a surgery or other illness, Medicare will not always pay for the patient to transfer to a nursing home.
Under Medicare rules, the federal insurer will pay for the patient to stay in a nursing home only if the person has already spent three nights in a hospital. That means some patients stay too long in the hospital before transferring to nursing homes, and some go to nursing homes and find out Medicare won’t pay the bill.
Another of the waivers to Medicare law would allow patients who stayed in a hospital to get treatment at home once they leave the hospital. Currently, Medicare has significant restrictions on when it will pay health care providers for home visits, according to Moore.
Under the deal, any Medicare patient would be allowed to have up to two visits from a home health agency — such as a visiting nurse association — or a nurse. Moore said the change would allow more patients to have follow-up visits after they’ve been in the hospital.
A third waiver would make it easier for doctors to make video calls to check on their Medicare patients. Medicare’s so-called telemedicine rule allows doctors to get paid for follow-ups via videoconference only if the patient lives in a very rural place and the doctor follows certain rules, Moore said.
“Now, doctor visits via video are going to be much more flexible,” he said. “Now, we can really innovate in telemedicine any place it makes sense (and) get to the patient sooner before the issue becomes worse.”
Those three rules are being waived for organizations all over the country that are similar to OneCare. The federal government essentially dislikes the rules and wants to experiment with waiving them for different organizations before eliminating them completely, Moore said.
Views of the three boards
Tom Huebner, the CEO of Rutland Regional Medical Center, is the chair of the board of the Vermont Care Organization. That’s the umbrella organization that was created in July to merge OneCare with the group representing community health centers.
“I think it’s a good draft agreement,” Huebner said. “Everybody will be interested in hearing the comments that people make over the course of the next couple weeks, but it’s terms that are not surprising to us, frankly, at this point.”
Huebner said Friday that he has not officially scheduled a vote, and he said any vote would not have veto power over the deal. He said the board of the Vermont Care Organization is scheduled to meet next on Oct. 10.
Huebner said members of the public should not be worried because “providers take very seriously their commitment and mission to care for their community.”
Moore said OneCare’s position on the deal is “cautiously optimistic.” He said there was nothing in the draft agreement that was “hugely unexpected” and the draft looked “fairly familiar” to information available in the past.
Community Health Accountable Care said in a statement: “Like everyone else, we are studying the specifics embedded in the new materials made available this past week, before making an official endorsement.”
Remaining public hearings
The Green Mountain Care Board and the Shumlin administration are holding a series of hearings on all-payer.
- Monday, Oct. 3, 5:30-7:30 p.m., Montshire Museum of Science, Norwich.
- Wednesday, Oct. 5, 9 a.m., Green Mountain Care Board meeting room, Montpelier.
- Thursday, Oct. 6, 4-6 p.m., Chittenden County, University of Vermont Dudley H. Davis Center, 590 Main St., Burlington.
- Tuesday, Oct. 11, 2 p.m., Green Mountain Care Board meeting room, Montpelier.
- Thursday, Oct. 13, 1 p.m., CVPS/Leahy Community Health Education Center, Rutland Regional Medical Center.
(Correction: An earlier version of this story had the wrong day and time for the Oct. 13 hearing in Rutland.)
