Health reform means scrapping fee-for-service

By Bea Grause and Judy Tartaglia

Vermonters demand — with good reason — that we continue working toward an affordable healthcare system that meets each of our medical needs and helps our economy grow.

Taxpayer-financed “single payer” is off the table, but our problems remain: lack of universal access to healthcare services, a frustratingly complex system and insufficient coordination among our hospitals, doctors, clinics, agencies and others who interact with patients over months and years.

Health care has to change for the sake of our patients and our economy. Vermont’s not-for-profit hospitals are ready to work with the State of Vermont, the regulators at the Green Mountain Care Board, the federal government and other stakeholders to make the necessary changes. Our shared vision is a bold reform plan that will make sure every Vermonter has access to high quality, affordable care from their doctor and hospital.

The most important first step in this plan requires changing the way hospitals and hospital-employed doctors are paid for the care they deliver.

Currently, hospitals are paid for each service provided, often referred to as a fee-for-service system. In our small rural state, demand for medical services is predicted to increase for a number of reasons, including our aging population and the need for increased mental health and substance abuse services. In the face of growing demand, keeping the current payment model is a recipe for economic disaster.

To achieve our goal of making health care more affordable and accessible for all, payments must be tied to how well we take care of each patient, and our communities’ overall health, rather than the number of procedures provided.

If we proceed with our health reform plan, Vermonters should expect to see many improvements along the way. For example, a person with complex, chronic health problems who goes to the emergency room twice a month would instead have a team of medical and social caregivers prepared to help him or her access primary care, housing and other services he or she may need. Vermonters would also have better access to health care prices and would be better connected to online information about their care.

For Vermont’s hospitals, reforming our health care system isn’t a remote policymaking exercise. It’s about our patients, who depend on hospitals and all other caregivers to ensure they get the care they need, where they need it, every time. We must keep moving ahead toward an affordable, high-quality health care system that supports the economic future of our state.


Bea Grause is president and CEO of the Vermont Association of Hospitals and Health Systems. Judy Tartaglia is President and CEO of Central Vermont Medical Center and Vermont Association of Hospitals and Health Systems board chair.