A dermatology visit in Vermont tends to arrive loaded. Patients drive in from two or three counties over, so one appointment becomes a full skin exam, several biopsies, lesion destruction, and pathology to track back, carrying modifiers and specimen counts that have to be right on the first submission. Most of the state's specialty capacity sits in Chittenden County around Burlington, South Burlington, and Essex Junction, while a practice in Rutland, Bennington, or St. Johnsbury is the referral endpoint for everyone around it.
Consolidation reaches Vermont owners as a back-office argument. Sell to a platform or a larger system, the reasoning goes, and billing, credentialing, and payer contracting stop being your problem. The infrastructure behind that offer is real, and so is what it costs: decisions about staffing, about which plans you participate in, and eventually about the practice itself move to people who do not sit in Montpelier or Middlebury.
An owner can hire that infrastructure rather than sell for it. Volume is what pays for a dedicated dermatology coding bench, a denials team that already knows how these payers behave, and reporting a physician can act on, and 1,246+ providers across 200+ practices is what funds ours. A practice in Barre or Brattleboro reaches all of that inside the software it already licenses, and holds a 98% net collection rate doing it. Hiring, payer contracts, and any decision about selling stay with the physician who owns the place.