The Vermont State House, in Montpelier, the nation’s smallest state capital.
VTDigger reports that the federal government and Vermont have drafted a preliminary agreement to implement an “all-payer” healthcare payment system.
Under the model, payments to physicians from commercial insurers, Medicare and Medicaid would be based on monthly fees instead of fee-for-service. Physicians would operate under an Accountable Care Organization — either OneCare Vermont or Vermont Care Organization — which would accept the payments. The ACO would then pay physicians based on quality of care.
The deal would make Vermont the first state to implement an all-payer system for all providers. Maryland now has the only U.S. all-payer system, but just for hospital services.
The Vermont model aims to keep certain costs paid by Medicare, Medicaid and commercial insurance from growing more than 3.5 percent a year for five years, starting in 2018.
The state aims to have about 30 percent of primary-care providers under the model by Jan. 1, 2018, with 80 percent over a five-year period. If OneCare ACO decides to join the all-payer model, the state would reach the initial 30 percent goal.
The Green Mountain Care Board would regulate the ACO. Gov. Peter Shumlin said the all-payer model could save Vermont about $10 billion over 10 years.
To read the VTDigger story, please hit this link.
Rutland (Vt.) Regional Medical Center has told the Green Mountain Care Board that the hospital will reduce reimbursement charges to insurance companies by 3.7 percent starting May 1, reports VT Digger.
The reimbursement cuts are a way for the hospital to rectify insurance overpayments it collected during fiscal 2015.
Under Vermont law, the Green Mountain Care Board is in charge of controlling the rate of growth in healthcare costs, which it tries to curb by limiting the amount of money that hospitals can receive from patient services.
The online publication says that Rutland Regional was among nine hospitals in the state that took in more insurance money for patient care than allowed last year.
The Green Mountain Care Board found that the hospitals took in excess revenue because they had expected to write off $145.3 million in uncompensated care. But instead, the institutions wrote off a combined $98.8 million in bad debt and charity care, a $46.5 million gap.
Main entrance to UVM Medical Center.
The University of Vermont Health Network has offered to spend extra revenue from fiscal 2015 on public-benefit programs, says a VT Digger report.
John Brumsted, M.D., the chief executive of UVM Health Network, appeared before the Green Mountain Care Board and acknowledged that the system’s hospitals exceeded their FY 2015 revenue targets.
The Green Mountain Care Board is in charge of controlling the rate of growth in healthcare costs in the state. The board tries to curb cost growth by limiting the money that hospitals can receive from patient services.
Dr. Brumsted estimated that the hospital network took in $29.1 million more than it should have in FY 2015. He cited higher patient volume in the excess revenue.
“We propose to address this departure from the approved (patient care revenue) levels through reductions as well as investments tied to our network’s commitment to improving people’s lives through population health management,” Dr. Brumsted told the Green Mountain Care Board.
The system proposes that $6 million in excess revenue go to substance-abuse and dental- health initiatives and $3 million to help cover the cost of setting up an “all-payer” model in Vermont.