M.D.s to Inject Ideas Into State’s Single-Payer System

Physicians in Vermont will have a voice in fleshing out the particulars of the state’s recently enacted health care reform law with the reconvening of a provider bargaining group established in 1994.

The Vermont Medical Society’s Physician Policy Council (PPC) will participate in negotiations with the Green Mountain Care Board, a five-member panel created by the Vermont legislature to over see the design of the state’s new “single-payer” health care system (Psychiatric News, June 3, 2011). Specifically, the PPC will provide input on physician payment rates and methodologies, provider regulation, and the quality of health care provided throughout the state.

The PPC will also address issues such as workforce shortages, administrative simplification, educational debt, and liability reform. The members of the council are expected to be identified by mid-2012.

According to Vermont Psychiatric Association President Alice Hershey Silverman, M.D., a coordinated effort to establish more reasonable reimbursement rates should positively affect both physicians and the patients in need of their services.

“In Vermont, managed care reimbursement rates for psychiatric care have been so low that many private-practice psychiatrists could not sustain their practices and either left the private sector for higher-salaried positions or limited their participation in insurance plans,” Silverman told Psychiatric News. “The impact on psychiatric services in Vermont was significant, as the number of psychiatrists available within the insurance plans dropped precipitously, and access to outpatient care became and remains severely limited. It was very apparent that access to health insurance did not equal access to care.”

Under Vermont’s new health care reform law, the Green Mountain Care Board is charged with transitioning the state’s health care system from a largely fee-for-service model to one that rewards provider performance. As such, the board will oversee pilot projects that test new models of payment, work to design a new health care budgeting system, and recommend the benefits package to be provided under a single-payer system.

Based on the benefits package developed by the board, the state secretary of administration will develop a financing plan for universal health care coverage. The financing plan is due in 2013, but full implementation of the plan requires a federal waiver, which is not available until 2017 under current law.

An article in the November 6 Barre-Montpelier Times Argus noted that the PPC was certified as a provider bargaining group in 1994 as part of former Vermont Gov. Howard Dean’s initial effort to bring universal health care to the state. Last October, the Vermont Medical Society adopted a resolution to reconvene the council.

The Vermont Medical Society’s resolution is posted at www.vtmd.org/sites/default/files/files/2011%20PPC.pdf.