Vermont Public is independent, community-supported media, serving Vermont with trusted, relevant and essential information. We share stories that bring people together, from every corner of our region. New to Vermont Public? Start here.

© 2024 Vermont Public | 365 Troy Ave. Colchester, VT 05446

Public Files:
WVTI · WOXM · WVBA · WVNK · WVTQ · WVTX
WVPR · WRVT · WOXR · WNCH · WVPA
WVPS · WVXR · WETK · WVTB · WVER
WVER-FM · WVLR-FM · WBTN-FM

For assistance accessing our public files, please contact hello@vermontpublic.org or call 802-655-9451.
Play Live Radio
Next Up:
0:00
0:00
0:00 0:00
Available On Air Stations

The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Study That Shows Disparity In Physician Pay Could Boost Reform Efforts

A new study shows a wide variation in how much Vermont's primary care physicians are paid for basic service. The information could play a key role in the development of a comprehensive payment reform system in the future.  

Last session, lawmakers asked for this report to find out if independent physicians are being reimbursed by private health insurance companies at a lower rate than doctors who work for one of the state's 14 hospitals.

Robin Lunge is the state's director of health care reform. She says the report shows that the answer is both yes and no.

Yes, because doctors who work for an academic hospital, meaning the University of Vermont Medical Center, or Dartmouth Hitchcock, are reimbursed at a higher rate for the 10 most common office procedures.

But no, because the report also shows that independent physicians are reimbursed at a slightly higher rate for these services than doctors at Vermont's 13 non-academic hospitals.

"I was actually surprised to see that, given the anecdotal evidence and suggestions that we've been hearing from different places,” Lunge said.

Lunge says the academic hospitals have higher reimbursement rates, in part, because some of their teaching expenses are folded into the primary care rates. She thinks these hospitals play an important role in the state's health care system.

"Why would you want to pay doctors a different amount for the same service? As we move toward a more unified system we would want to do that if it was based in value, quality and outcomes." - Green Mountain Care Board Chairman Al Gobeille

"So having that academic medical center in Vermont means that we've become a more attractive place for doctors to settle, and certainly as work force is a big issue that people are concerned about, we would want to continue to support developing our health care workforce,” said Lunge. “Whether or not rates are the right way to do that is, I think, the debate."  

Dr. Ira Bernstein is the chairman of Women's Health Care Services at the UVM Medical Center. He says his hospital provides special services that are reimbursed through primary care rates. Services like a 24-hour neo-natal intensive care center, a trauma center, a large emergency room and some of the expenses related to the teaching program.

"It's pretty clear that we are as an institution providing services that are unique in the community,” said Bernstein. “And that we have the opportunity to figure out ways to make those work through the system of reimbursement that ... exists."

Al Gobeille, the chairman of the Green Mountain Care Board, is not a fan of the current payment system. 

"So orthopedics may be funding the emergency room, or the neo natal intensive care unit may be funded by an enhanced primary care code for an academic medical center,” said Gobeille. “It's very opaque and it doesn't mean it's evil or bad or there's bad people doing it. It's grown to this over the years."  

Gobeille wants to move to a system where hospitals clearly identify the costs associated with providing various services.

"Increasing rates on other services to allow the emergency room to continue that is a very opaque way of doing this, and I think as we move forward we need to get away from that,” said Gobeille. “That doesn't mean we need to get rid of emergency rooms. That means we need to, in a transparent way, fund them."

Gobeille says his board is working on a comprehensive payment reform plan. It's a plan that would move the state away from the current "fee for service" model and allow providers to be reimbursed for keeping people healthy. Under that system, Gobeille thinks physicians should be reimbursed at a higher rate if it can be shown that they provide a high quality of care to their patients.

"Why would you want to pay doctors a different amount for the same service?” said Gobeille. “As we move toward a more unified system we would want to do that if it was based in value, quality and outcomes."

Dr. Bernstein at the UVM Medical Center is very supportive of these payment reform efforts.

"Where we get reimbursed for the health of a population, incentivizing providers to maintain people's health makes a lot of sense, rather than reimbursing us on an interaction by interaction basis," said Bernstein.

The Green Mountain Care Board hopes to implement the first phase of its payment reform plan during 2015.

Bob Kinzel has been covering the Vermont Statehouse since 1981 — longer than any continuously serving member of the Legislature. With his wealth of institutional knowledge, he answers your questions on our series, "Ask Bob."
Latest Stories