Vermont providers back S197, saying capitation, site-neutral pay and scholarship fixes could shore up independent primary care
Loading...
Summary
Physicians and practice leaders told the Senate Health & Welfare committee that S197’s mix of capitation, reduced patient cost-sharing and site‑neutral reimbursement reporting could stabilize independent and rural primary care, but they urged careful implementation, resources and voluntary participation.
Vermont clinicians and practice leaders told the Senate Health & Welfare committee on Feb. 5 that S197, a bill to reform primary care payments, could ease financial strain on independent and rural practices but must be rolled out with adequate support and voluntary participation.
Susan Brinson, executive director of Vermont Health First, said the association represents 66 primary and specialty practices in 11 counties and about 235 clinicians who together care for an estimated 90,000 Vermonters. Brinson said she supports S197’s focus on reducing administrative burden, eliminating patient cost-sharing for some primary care services, and introducing capitated payments alongside fee‑for‑service to give practices a predictable revenue stream. "Helping practices to have that predictable income stream and actually paying them for services that they're doing in care of their patients" makes independent practice more sustainable, she said.
Brinson praised language in the bill requiring updated reporting on the clinician landscape and on site‑neutral reimbursements, saying pay disparities for the same service across settings have "hurt the survivability of independent practices." She also welcomed elimination of the sunset for the primary care scholarship program and suggested stronger loan‑forgiveness or other incentives to recruit clinicians to independent practices.
Toby Sadkin, a family physician and chair of Primary Care Health Partners, described his group's experience in a capitated payment reform program through OneCare Vermont. Sadkin said monthly capitated payments allowed his 10‑site, physician‑owned group to expand services such as care coordination and mental‑health supports. "Across our 10 Vermont practice sites, we realized $3,000,000 more than we would have received on a fee for service basis," he said, adding that figure rose to "close to $5,000,000" when factoring in other state and program funding.
Rural clinicians also urged careful calibration. Dr. Will Everett, a family physician and hospitalist at Grace Cottage, said capitation could reduce administrative burden and improve recruitment in remote communities, but cautioned that moving up the capitation scale shifts more risk to payers and requires outcomes assessment. He illustrated patient need with an anecdote about a patient who skips recommended visits because each office visit is a significant financial commitment.
Witnesses offered several implementation recommendations: ensure the primary care steering committee is closely involved in program design, provide ample resources for practice support and data analysis, avoid mandated participation because different models suit different practices, and consider naming the Agency of Human Services (AHS) rather than the currently referenced coordinating entity. Several testified that hybrid payment models—capitation plus fee‑for‑service—can preserve incentives for in‑office procedures while stabilizing practice income.
Committee members asked witnesses to file written testimony and follow up with staff as details are worked out. The hearing produced no formal vote; the committee signaled it will continue to refine S197’s language, including coordination and workforce supports.
