Vermont Health First director: small practices opt out of Blueprint over costs, EHR and admin burden

Susan Ritson, executive director of Vermont Health First, told the House Health Care Committee on April 24 that the majority of independent practices participate in the state’s Blueprint for Health program, but a small subset of very small practices opt out because the per-member-per-month payments and certification requirements do not cover their administrative costs.

For the practices that decline participation, Ritson said common characteristics include having only one or two providers, not having enough attributed patients to justify NCQA certification costs, and in a few cases deliberately not using an electronic health record. “These practices have chosen to keep it simple,” she said, adding that the Blueprint requires an EHR for participation and that can automatically disqualify some small offices.

Ritson told lawmakers that many participating practices value the community health team services Blueprint funds support, but smaller clinics are often asked to absorb the paperwork and reporting without sufficient per-member revenue. She recommended tailoring the program to better serve small practices—by allowing shared access to community clinicians or changing the administrative requirements—so more independent clinics can participate.

During discussion, lawmakers and Rabin suggested pay parity and site-neutral language in the bill could help independent practices compete with hospital-owned clinics. Ritson said administrative burden is a principal driver for some clinicians choosing hospital employment, because hospitals can centralize billing, reporting and other back-office functions.

Chair Black closed the session by asking members to review the bill text and prepare for a scheduled public hearing next Thursday; committee markup will begin after public input, the chair said.

No votes were taken during this hearing.