Senate Health & Welfare weighs S.190 on reference‑based pricing and hospital outsourcing

The Senate Health & Welfare committee heard hours of testimony on S.190, a bill that would require hospitals to report certain prices as a percentage of Medicare and tighten oversight of clinical services outsourced to independent provider groups.

Debbie Green, representing the Vermont Association of Hospital and Health Systems, told the committee that "Conceptually, we do not have a problem with that" when describing the bill’s reporting requirement for reference‑based pricing, but she urged clearer standards and a single source of truth so hospitals report consistently. Green said detailed, standardized guidance from the Green Mountain Care Board could avoid inconsistent postings and protect the transparency goals of the bill.

Green also challenged parts of the bill that deal with outsourced clinical services. She said hospitals have been "very upfront" about outsourcing arrangements and warned that folding independent groups’ revenue into hospital budgets or capping those companies could make Vermont less attractive to partner organizations. "We want to make sure there's a good balance between the ability for good companies to come in, help hospitals save money, help increase quality versus... making Vermont not attractive to those companies," she said.

The bill’s provisions on administrative process and oversight drew separate scrutiny. Green criticized the removal of an internal appeals process in section 9, saying an internal mechanism helps create a record that can avoid later litigation. On audit authority in section 10, she called the phrase "reasonably necessary or helpful" overly broad and warned that additional investigatory obligations would be disruptive, given existing oversight by state hospital licensure, Medicaid fraud investigators and federal inspectors.

Owen Foster, chair of the Green Mountain Care Board, responded that the board already holds subpoena and observer authorities and has used them sparingly. "In the history of the Care Board, my understanding is we've issued exactly 1 subpoena ever," Foster said, arguing the chair‑level authority mirrors current subpoena practice and that the board would use audits judiciously.

Care‑board staff told the committee they had submitted suggested language to clarify key definitions and urged the board to issue guidance so hospitals report data consistently. Staff discussed possible approaches to price limits — including a 500%‑of‑Medicare cap previously considered and alternatives that target service lines or out‑of‑network prices — and said modeling is needed to estimate budget impacts before setting a concrete cap.

Physician leaders and rural hospital officials emphasized how independent groups and partnerships preserve essential services in lower‑volume hospitals. Dr. Ade Abdi, chief medical officer at Brattleboro Memorial Hospital, warned that the bill "will unintentionally harm rural hospitals' ability to secure adequate and high quality staff for critical 24/7 services," describing existing partnerships for pathology, radiology and anesthesia that allow small hospitals to deliver care they could not otherwise staff.

Jay Mullin, president and CEO of Bluewater Health and an emergency physician, opposed the bill as written, arguing independent, physician‑led groups are not the cost drivers S.190 aims to regulate. Mullin said the No Surprises Act already protects emergency patients from balance billing and suggested narrower steps — such as requiring disclosure of outsourced contracts — instead of redefining independent groups as hospital departments. "Independent physician‑led groups deliver high quality, cost effective community based care," he told the committee, and he warned that merging independent group revenue into hospital budgets could drive physicians out of the state and increase long‑term costs.

No formal votes were taken. Committee members asked for additional modeling and clearer statutory language, signaled they would mark up the bill in a future session, and requested follow‑up materials from hospitals and the Care Board on how proposed changes would affect budgets and staffing.

What happens next: committee staff will circulate suggested language and fiscal modeling; members said they expect to continue work on S.190 in a future markup session before advancing any formal recommendation.