After a public fight about payments for primary care doctors, OneCare Vermont and an association of independent doctors have hashed out a compromise.
The agreement settles a conflict that caused 14 primary care practices to say they were dropping out of OneCare, the statewide organization implementing Vermont’s health care reforms.
The conflict arose after OneCare announced that instead of paying a flat $3.25 monthly fee, it would offer a range between $1.75 and $4.75. Primary doctors objected that OneCare was reducing their payment during a pandemic and undercutting primary care.
The deal, which was hashed out on Thursday, split the difference.
Under the deal, practices will have the option to receive the full $3.25 per member per month for each participating patient through 2021. $1.50 of that total is at risk, meaning if OneCare doesn’t meet its goals, the practice will have to give back a portion of that money. If OneCare performs well, practices can earn more.
OneCare CEO Vicki Loner said the agreement showed the company’s support for independent doctors.
“Throughout this pandemic OneCare has demonstrated flexibility for participants to make sure they have the support they need to care for their patients during this difficult time,” she said in an email.
Susan Ridzon, CEO of HealthFirst, an association of independent doctors, was less satisfied. The agreement “fell quite a bit short from what our practices really need,” she said in an email. “For now, we are happy that practices will at least have the option to get the full $3.25 up front,” she said.
OneCare provides the money as a way to encourage doctors to invest in population health initiatives and preventive care. The payments come on top of the approximately $25 per patient that doctors receive for each visit.
Brad Friesen, who wrote a letter to senators, said his practice couldn’t afford to lose money upfront. The losses come during the midst of a pandemic, and doesn’t support OneCare’s mission of improving the health of the population.
OneCare should be increasing pay for primary care doctors, not threatening to reduce it, he wrote.
OneCare, which is responsible for enacting Vermont’s all-payer model, aims to include the majority of Vermonters in its efforts and couldn’t afford to lose practices from its system.
These payments will make primary care doctors more responsible for the care they provide and more integrated into the health care system as a whole, Loner told legislators last week.
The move had sparked questions and criticism from officials. During testimony before the Senate Appropriations and Health & Welfare committees last week, lawmakers quizzed Loner on why OneCare was reducing payments during a pandemic.
After both sides testified before the Green Mountain Care Board on Wednesday, regulators asked Loner and Ridzon to sit down and come to a compromise.
They sent a letter to the Care Board and to lawmakers on Thursday.
Loner said she didn’t know yet whether practices would drop out in spite of the deal; primary care practices had to make their decision by Sept. 11. All independent primary care practices “facing economic stress” can sign on to receive the upfront money by early 2021.
Ridzon objected to the idea that primary care practices should be responsible for more than just the care of their own patients.
“The risk to practices is also tied to things outside of their control, which is difficult to accept,” Ridzon said. “If the ACO is hell bent on holding primary care practices at risk — which we think is inappropriate placement of risk to begin with — the ACO should at least have that risk be associated with the practice’s performance. But these are issues we’ll have to fight another day.”
