Vermont does many things well. Maple syrup, fall foliage, covered bridges, getting confused with New Hampshire on a map. They are also good at slow driving. That’s not a criticism, just an observation from my three years living in Norwich, VT during med school. They drive noticeably slower than the rest of New England. I just don’t think Vermonters are in much of a hurry. I can appreciate that. It’s a rural state and the maple tree sap buckets fill very slowly. What’s the rush?
Another thing we can add to the “Vermont does well” list is their Corporate Practice of Medicine (CPOM) law. On June 15th, 2026, Governor Phil Scott signed House Bill 583 establishing strict boundaries on corporate medicine in the Green Mountain State. They join 32 other states with CPOM legislation. For more on that, I talked about another CPOM law passing in my current green and mountainous home, Oregon, on the podcast last year.
A quick list of things this law prevents corporate entities from doing:
- Influence provider judgement, referrals and treatment plans
- Setting productivity expectations like patient volume and work schedules
- Hiring and firing
- Setting prices or rates for provider services
- Making coding or billing decisions
All big happy faces from me. But, there’s a lot more within this bill, and I have thoughts about all of it. The version that passed is far weaker than the version initially introduced. Initially, the bill completely outlawed private equity ownership in any healthcare entity, period. Hospital associations and some physician groups threw a fit about that, and successfully lobbied it down to its current version. Frowny face.
Actually, I guess I’ll just explain all my thoughts on things the bill does or doesn’t do through the universal frowny face-to-happy face scale.
Does NOT restrict private equity firms or hedge fund ownership of clinical entities.
This gets a big ole frowny face from me. However, it specifically restricts the ability of private equity groups to influence clinical and operational decisions. Happy face for this.
Does NOT prohibit management service organizations (MSO).
Another big frowny face. MSOs are how big private equity-owned healthcare corporations get around these CPOM laws. In short, the private equity-owned MSO establishes a new company in the state of interest and hand selects a friendly physician, also referred to (by me) as a patsy, to run that new company. This allows the MSO to say, “No, no, look! There’s a doctor in charge!” when people accuse them of practicing medicine as a corporation, but in reality, the MSO is pulling the strings. Oregon’s CPOM law specifically prohibits this MSO structure, making it one of the strongest CPOM laws in the country.
DOES increase ownership transparency, sort of.
Healthcare entities (including MSOs) in which a PE firm is invested must publicly report ownership structure as well as organizational charts identifying all entities within the larger corporation. This gets a happy face followed by a crying laughing face from me. When Eugene Emergency Physicians sued ApolloMD (an MSO), ApolloMD was forced to reveal its corporate structure. It was a clown car of LLCs and PCs. Even the CEO had no idea who was in charge of what. The preposterous complexity really showed the lengths these PE-backed MSOs will go to obfuscate who is actually in charge. Transparency is a great thing. Unfortunately, Vermont’s bill stops short of requiring public disclosure of profit and loss statements. Frowny face.
DOES impose penalties.
With each violation of the law, the offending corporation is fined 25k, which is a happy face until you remember that’s also known as the cost of doing business as a billion-dollar private equity firm. At least the offender is also not permitted to enjoy any apple cider donuts from a roadside mom & pop farm for a whole year.
As I said, the version that was signed into law last month is a watered-down version of the original bill. Nevertheless, it establishes corporate restrictions that did not previously exist. Hopefully, more states take notice and enact their own CPOM legislation. Good job, Vermont. Take a bow, and a slow, nonchalant drive along Lake Champlain.
P.S. – If you read this and thought, “wow, I wish med school had taught me more about all this business stuff”, you’re definitely not alone. ICYMI, the theme of this month’s programming in the Humor & Humanity in Medicine membership is, well, that.
We’ve got some really cool events coming up that cover those topics, including a talk/workshop I’ll be doing on July 21st all about fighting back against private equity in medicine. More details still to come, but you can check out what we’re doing and join us here. We’ve got events like these all year long, and our members are seriously awesome folks who are really passionate about these topics. If curated, educational, and (imo) soul-restoring community events and content are your thing, I’d love to see you inside.
