Vermont Watchdog | March 31, 2017

Date: 
March 31, 2017

Vermont lawmakers hope to stem ACO abuse of tax dollars seen in other states

Members of the Vermont House on Wednesday reassigned to the Committee on Health care a bill requiring open meetings for accountable care organizations.

The move marked a next step in the debate over balancing the rights of private entities with the need for public accountability.

“This is really important. ACOs are private, but at the same time are involved with individual health records and Medicaid dollars that we need to regulate,” state Sen. Virginia Lyons, D-Chittenden, co-sponsor of S.4 told Vermont Watchdog.

ACOs are private networks of health care providers that cooperate together under a common umbrella administration with the goal of regulating health care expenses.

OneCare, an accountable care organization owned by University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center, is contracted with the state to manage the care of 30,000 Vermont Medicaid patients in what the governor has considers a trial-run of the all payer model.

If the trial is successful, OneCare will morph with other ACOs in the state to form the Vermont Care Organization and manage the entirety of Vermont’s Medicaid, Medicare, and commercial insurance funds. In 2018, VCO will take over complete Medicaid coverage as an initial step. [...]

Does Vermont have the regulations to protect Medicaid dollars?

Mike Fisher, chief health care advocate for Vermont Legal Aid, told Watchdog the Green Mountain Care Board is currently addressing that question.

Act 113, signed by former Gov. Peter Shumlin in May, charges the Green Mountain Care Board with creating rules to prevent the abuse of the cost-saving financial incentive structure.

However, Lyons, along with co-sponsor state Sen. Tim Ashe, D/P-Chittenden, the Senate president pro-tem, believe that Act 113’s language was too vague, and sought in S.4 to clarify what business could be conducted in executive session.

While Act 113 states that all business “not confidential or proprietary” should be conducted in public, S.4 clarifies that executive session is the exception to the rule. The bill lists seven acceptable uses for executive session, including protection of private health care data, litigation and personnel matters.

Todd Moore, chief executive officer for OneCare and Vermont Care Organization, testified against the bill in Senate committee hearings. “It is unclear what problem or anticipated problem this change in language seeks to address. S. 4 changes Act 113 before we even know how well it is working,” he said.

Emanuel said that, in the case of North Carolina, clearly defining what business accountable care organizations could conduct behind closed doors would have protected patients.

“[ACOs] are using exceptions for open meeting requirements in broad, expansionist ways. This information concerns our tax dollars, and the deliberations are important,” she said. [...]

While legislators and the Green Mountain Care Board have work cut out for them, Fisher, who advocates for the rights of consumers in Vermont, says the legislation is “an important first step.”