By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Vermont’s Bold Experiment: A Rebuttal
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Vermont’s Bold Experiment: A Rebuttal
Health ReformPolicy & Law

Vermont’s Bold Experiment: A Rebuttal

Gary Levin MD
Gary Levin MD
Share
3 Min Read
SHARE

As commented on The Health Care Blog

Vermont’s Bold Experiment

As commented on The Health Care Blog

Vermont’s Bold Experiment

More Read

Medicaid Cost-Sharing Disaster Looms Ahead
Health and Wellness Programs: Medicine or Marketing?
Empathy: Beyond a Connection
Spinal Operation Preparation And Recovery Tips To Know
No, This isn’t a Hotel

         

Hsaio 1989                                  Hsaio 2010

Harvard Professor William Hsiao is fond of the phrase “bold experiment’.

In the late 1980s Hsiao supervised and analyzed a study of expenses in medical practice which specifically analyzed services by physicians accounting for physician time, overhead, capital outlays, malpractice and other physician overhead items.

He developed the RBRS scale based upon RVUs (relative value units). The formula was based upon a survey and analysis of practices among different specialties, in different locales in the United States. The current system of fees is based upon these units coded for by the CPT codes (current procedural terminology).

I am very familiar with this since my ophthalmology practice was one of those in the 1989 survey. My opinion is that whatever input was put into that study….the output was pre-determined.. My evaluation of the figures garnered from the study bore little resemblance to what I found in my typical solo ophthalmology practice.

The RVBRS methodology set off a wave of high specialty fees vs primary care physician fees, based upon Hsaio’s flawed methodology Move forward 30 years to 2011 where the disparity between PCP fees and specialty fees is now even greater. For one thing there are many more procedures available to specialists as the explosion in technology took place. By comparison there have been few changes available to PCPs. I am not even sure if the RVUs were adjusted over the past 30 years.

The increasing divide between specialty and PCP reimbursement can be squarely placed at the feet of “Harvard superstars”.

Harvard’s academic staff is always available for another study, or to evaluate and/or pontificate about things surrounding the Boston region. Vermont borders on and touches a good part of Massachussetts.

Vermont may be bold, however it is far different in demographics and/or challenges delivering health care.

Let’s assess the following:

Vermont: Total Population (2010 census) 625,741

New York Total Population (2010)  19,378,102

Texas Total Population (2010)  25,145,561

California Total Population (2010) 37,253,958

Census Map by County– Vermont (pdf)

Using Vermont as a ‘representative’ case for health reform is comparing apple’s to oranges, or at least disingenuous. Any statistician can easily negate the results of this ‘pilot example’.

Other confounding metrics are:

1. Vermont has largely been untouched by multiculturalism

2.It is predominantly a rural state.

3.The population is not mobile, nor immigrant, it is uniform and fairly homogeneous.

4.What is bold about Vermont is that it is highly atypical.except for a few      other states such as Wyoming, Montana, No. & So. Dakota,

 

TAGGED:healthcare policyhealthcare reformVermont
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

contamination
Batch Failures And The Hidden Costs Of Contamination
Health Infographics
October 21, 2025
Medication Management For Seniors
Simplifying Medication Management For Seniors
Infographics Senior Care
October 21, 2025
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Collaboration Is the Prescription for Better Patient Care
Health
October 20, 2025
Epidemiological Health Benefits
Personal and Epidemiological Health Benefits of Blood Pressure Management
Health
October 13, 2025

You Might also Like

Unintended Pregnancy: A Biomarker for Disease and Poverty

February 13, 2012

Is Your Doctor a God or a Guide?

October 4, 2011
HIPAA, content marketing
BusinessHospital AdministrationPolicy & Law

Keeping Your Content Marketing HIPAA-Compliant

October 7, 2014

The Art of Negotiation in Medicine

January 31, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?