Independent physicians say Vermont's all-payer system could force early retirements: 6 thoughts

Some independent physicians in Vermont fear the implementation of the state's all-payer system at the turn of the year, Watchdog.org reports.

Here's what you should know.

1. Dermatologist at Rutland Skin Center Daniel McAuliffe, MD, and private psychiatrist Robert Emmons, MD, are both opposed to joining an ACO.

"ACOs fundamentally are organized for rationing care. That does not compute with my code of ethics," Dr. Emmons said.

2. Dr. McCauliffe said if doctors are forced to ration care, it would affect the physician-patient relationship negatively.

3. Vermont's governor Peter Shumlin is not forcing practices into the all-payer system, but the state is allowed to issue Medicare payment waivers "to implement a discount on Medicare fee-for-service payments to Vermont providers and/or suppliers not participating in an ACO.”

4. Dr. McCauliffe is increasingly worried the new system will limit providers from referring cases to independent physicians, in efforts to keep care in-network.

5. The author argues if regulators impose fees or equalize patient referrals, independent physicians not joining the all-payer model will be driven out of business.

6. Dr. McCauliffe believes the impending changes will be crippling, and that ending his practice is a "foreseeable option."

“If Vermont becomes an untenable place for private practice,” McCauliffe said, “the patients will be the ones who suffer.”

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