AFAIK including the full VDM wasn't technically possible due to amd64 architecture limitations (no real mode support when in long mode - at least not without use of virtualization but that wasn't a thing at the time). They probably could have implemented partial support but i guess they wanted to keep the full VDM for 32bit versions of Windows (which were the majority for a good number of years anyway and thus more important for backwards compatibility).
OTVDM emulates a 386-ish CPU so it isn't affected by that (i think there is also some code to use virtualization instead but i'm not sure). It is much slower though, but it should still be much faster than the target hardware that 16bit Windows applications had. Perhaps it might be an interesting project to port DOSBox' more advanced JIT CPU emulation code to this.