Primary‑care clinicians tell committee S126 must give them more authority, funding and data access to rein in costs

A group of primary‑care clinicians and advisory‑group members told a legislative committee on April 25 that S126 and related policy work should give primary care a stronger, better‑resourced voice and concrete authority to change system behavior.

A physician participating in the Green Mountain Care Board Primary Care Advisory Group (PCAG) told the committee the group represents clinicians from federally qualified health centers (FQHCs), hospital‑affiliated practices, private and direct‑primary‑care practices, nurse practitioners and physician assistants. The speaker said the advisory group has advised state officials since 2018 but lacks the ability to drive implementation: "I don't think we have any teeth," said Faye Homan, a family physician who practices at an FQHC.

Clinicians urged several near‑term priorities: raise the primary‑care spend rate from historically low levels, expand residency training slots and pipeline supports for rural primary care, improve data‑sharing between electronic health records and the state health information exchange, and redesign payment so providers are rewarded for keeping care in primary care settings.

Testimony and discussion included these specifics and examples:

- Primary‑care spend rate: multiple speakers cited a rough long‑running primary‑care share of health spending of about 4–5%, a figure they said is low given primary care’s role in population health and cost containment.

- Panel sizes: clinicians said a full‑time primary‑care provider in rural Vermont typically manages a panel of roughly 1,500 patients and bears substantial unpaid panel‑management work (referrals, record follow‑up, medication authorizations and discharge‑summary reconciliation).

- Workforce and GME: clinicians said the state needs more residency slots and cited the Maple Mountain residency proposal as an example of an unopposed, community‑based program that would expose trainees to broad scope primary care; speakers said Medicare GME caps limit the number of residency slots available and that additional state support or incentives are needed.

- Data and interoperability: multiple clinicians described time‑consuming work to gather records across different hospital electronic‑health‑record systems and the state exchange (referred to in testimony as the health‑information exchange or "Bridal"). They said better, more automatic access to shared patient records would reduce redundant testing and administrative burden.

- Specialist follow‑up: clinicians urged payment or quality changes to discourage long‑term specialist follow‑up for stable conditions that primary care could manage, a practice that both fragments care and increases cost. Suggested fixes included clearer discharge instructions and an explicit specialist checkbox indicating whether a patient is stable to return to primary care.

Nurse practitioner Michelle Wade, president of the Vermont Nurse Practitioners Association and a PCAG member, pressed for payment and implementation language in the bill that recognize nurse practitioners’ role in primary care and asked that advisory language avoid physician‑centric phrasing.

Several speakers recommended greater, routine connection between PCAG and the Green Mountain Care Board (GMCB) or statute‑based authority so primary‑care voices are not only consultative but can help hold implementation bodies to account.

Ending: Committee members thanked clinicians for the testimony and indicated S126 markup would begin the following week. Clinicians asked lawmakers to consider modest increases in primary‑care spending, targeted investments in residency training, improved health‑information exchange integration and statutory mechanisms that give primary‑care advisory input practical effect in implementation.