Providers say a change to reimbursements will hit them at a particularly difficult time when the pandemic has increased overhead costs significantly.
A group of private health care providers are threatening to abandon their partnership with OneCare Vermont next year unless the accountable care organization rethinks some changes it plans to make to its reimbursement rates.
Launched in 2018, OneCare offers member groups a fixed payment for patient care, a departure from the traditional fee-for-service model. While initially offering a rate of $3.25 per patient per month, a new proposal will replace that with a range of $1.75 to $4.75 per month, depending on cost and quality metrics. Providers say the change will hit them at a particularly difficult time when the pandemic has increased overhead costs significantly.
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"I understand what OneCare is trying to do to create more financial incentive for doctors to do the things that are necessary to make this work, but this probably wasn't the best timing to do this, in the middle of COVID-19," Kevin Mullin, chairman of the Green Mountain Care Board, told the Burlington Free Press.
Vermont health care regulators are currently facing criticism for not reigning in the state's health care costs, some of the highest in the country. Regulators cite health care consolidation as a main source of increased costs, as well as drug prices and workforce issues.
The disputes like the one between OneCare and its providers could become more common as more independent physicians look to move away from the fee-for-service model, depending on what kind of strategy they take. One issue providers have with the outcome-based rates is that they're dependent on the performance of the overall health care system, not individual practices. Another is the lack of communication between OneCare and its member physicians.
"They essentially are not intending to negotiate whatsoever," Dr. Paul Reiss said in an email to the Free Press. "They are now acting like the insurance companies have always acted with small independent practices which is take it or leave it."
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Emily Payne
Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
