Vermont health network accused of ACO exclusion and biased referrals: 4 things to know

Sharon Gutwin, practicing physical therapist and owner of the Williston, Vt.-based physical therapy office RehabGym, is accusing the University of Vermont Health Network of excluding her practice from its ACO — called OneCare Vermont — and being biased in its referrals, according to VT Digger.

Here are four things to know about the accusations.

1. The University of Vermont Health Network includes Burlington-based University of Vermont Medical Center and Berlin-based Central Vermont Medical Center, among other organizations. The ACO leadership is made up mostly of network and hospital executives.

2. OneCare Vermont covers 122,000 Vermont residents — nearly one fifth of the state's population. Ms. Gutwin argues RehabGym's denied entry to the ACO is an effort by hospital leadership to divert more business to in-house physical therapy practices.

3. She also points to a 27 percent reduction in referrals from the hospitals since 2015 as evidence they are purposefully implementing an exclusionary strategy.

4. Representatives from OneCare Vermont say the hospital's physical therapy practices were automatically enrolled in the ACO, and the only reason RehabGym was denied is because the newly created organization is not yet considering outside providers.

"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," Vicki Loner, COO of OneCare Vermont, told VT Digger.

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