January 23, 2019

RehabGym owner cries foul over ACO referrals

Sharon Gutwin, owner of the Rehab Gym. Photo by Mark Johnson/VTDigger

Williston physical therapy business describes growing hospital monopoly

By Mark Johnson

For VTDigger

A Williston-based physical therapy business was denied entry last year to a medical reform group that will cover a large chunk of Vermonters, while physical therapists at the state’s largest hospital were automatically enrolled.

RehabGym owner Sharon Gutwin viewed the rejection by OneCare Vermont, an accountable care organization, as the latest in a pattern of exclusion by the University of Vermont Health Network, which includes the University of Vermont Medical Center and Central Vermont Medical Center. UVM Medical Center co-founded OneCare. The ACO leadership is comprised of higher-ups at the network and the Burlington hospital.

In addition to the ACO rejection, Gutwin recently told the Green Mountain Care Board, the state’s health care regulatory board, that physical therapy referrals from UVM Medical Center and Central Vermont Medical Center have declined significantly in the past several years. She believes the hospitals want to keep their PT business in-house. Hospital referrals to her company were down 27 percent from 2015 through 2017, she said.

A UVM Medical Center spokesperson denied the hospital was steering business to in-house physical therapists and away from outside providers. The spokesperson said the hospital figures showed no change in the number of referrals to RehabGym in the past few years.

Gutwin said she wanted to join the ACO not only for more business. She said physical therapy, particularly preventive care, can lower health care costs by helping clients avoid injuries caused by falls, which can require expensive care.

OneCare is a network of hospitals, doctors, nursing homes, visiting nurses and other providers. The ACO concept is to have providers coordinate care instead of each billing the patient separately for different services.

The ACO has a budget of $620 million and is expected to affect health care for 122,000 Vermonters, about one in five. The plan includes diverting some hospital care funding to support lower-cost preventative care in the community.

In late December, OneCare rejected Gutwin’s request for RehabGym to join the ACO. OneCare account specialist Kelley Beams told Gutwin: “Currently, we have not accepted PT’s in our ACO, but I will forward your message to my director and keep it on file in case this changes.”

Meanwhile, all of the physical therapists at UVMMC were listed as providers in the OneCare network.

Gutwin cried foul, telling Beams: “I feel strongly in patient choice and honest competition. If OneCare promotes exclusion in patient care, I will get involved to change that. Please let me know who I need to talk with.”

Gutwin said she did not receive a reply. A short time later, in early January, Gutwin laid out her concerns to the GMCB — with two of the board members, chair Kevin Mullin and Tom Pelham, asking Gutwin questions. Since she testified, Gutwin was invited to join a GMCB advisory board.

The ACO’s chief operating officer, Vicki Loner, told VTDigger last Thursday that “the door is not closed” on RehabGym joining OneCare, perhaps in 2018, and said that the rejection was not designed to favor hospital PT services over those of independent providers.

Loner said the UVM Medical Center and Central Vermont Medical Center physical therapists were automatically enrolled as members of the ACO when the hospitals became members last year. If the ACO, which just started, is expanded to include outside PT groups, Loner said that all PTs would be welcome.

Communications with Gutwin could have been better, Loner said. For example, she said OneCare should have been clearer that no “private” physical therapists were among the ACO providers.

Loner described OneCare as an evolving organization and said last year’s setup was chaotic, similar to any new business. The ACO officially started Jan. 1. Loner said the ACO will be adding more providers this year, but said including them without a meaningful role would be window dressing and unproductive.

“We want to make sure we’re creating something for (new admitants) to join, to be involved in some of our prevention strategies, to be involved in our care coordination programs. That’s the whole premise behind what we think about what providers we’re going to bring in the following year,” Loner said.

The OneCare chief operating officer said joining the ACO is not automatically a financial boon — the types of contracts between providers and the ACO can range from a straight fee-for-service to a bulk payment to cover a designated group, the latter requiring some providers to take a financial risk, she said.

In her testimony to the GMCB, Gutwin also raised concerns that OneCare is too dominated by UVM Medical Center and UVM Health Network officials. UVMMC and Dartmouth-Hitchcock co-founded the network and provided “substantial financial support and human resources for the establishment of infrastructure and operational support” for OneCare Vermont, according to the ACO website.

“For this ACO to work fairly, there should be people leading it who are not also working for the hospital,” Gutwin said.

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