March 28, 2023

NEED TO KNOW

Breaking Updates from the Statehouse

• Call to Action on Flavored Tobacco Product Ban, S.18

The flavored tobacco ban bill is up for a final vote in the Senate tomorrow and your Senator needs to hear why banning tobacco flavors will help prevent Vermont youth from starting a dangerous nicotine habit. We know that 80% of 12–18 year old e-cigarette users start with a flavored product. Flavored tobacco products, including menthol cigarettes, are easier to smoke, harder to quit and more likely to addict youth.  Please call 802-828-2228 and ask the Sergeant at Arms to send a message to your Senator asking them to Vote yes! or Click here to email your Senator. 

• House Budget That Includes Increase to Medicaid Rates Advances to the House Floor

Yesterday the House Appropriations Committee voted out their version of the Fiscal Year 2024 House Budget by a vote of 8-4, which includes increasing Medicaid's primary care rates to 110% of Medicare rates and increasing Medicaid's specialty care rates by 3.8%. The House will spend the majority of this week debating and working to pass the FY24 Budget. Click here for the full version of H.494, the House Appropriations Budget bill. The budget bill also includes one-year of funding for a two-year Blueprint for Health Pilot program aimed at providing expanded access to mental health and substance use services for primary care patients, with the intent to maintain the pilot funding in next year's budget. The budget bill also includes funding for H.484, this year's workforce development bill, which includes $1 million for a Vermont Psychiatric Mental Health Nurse Forgivable Loan program and $3.8 million for Critical Occupation Scholarships for mental health counselors and nurses.

VMS will follow up with the outcome of this week's budget work. VMS members and staff will be testifying on H.89, the so-called Shield Law for providers of reproductive health services and transgender care, in the Senate Judiciary Committee this week and on S.36, the workplace violence bill, in the House Judiciary Committee. Next Tuesday, April 4^th you can read a comprehensive description of all action in the 2023 VMS Mid-Session Legislative Bulletin.

Comments Due March 31: DEA Proposed Rules for Permanent Telemedicine Flexibilities for Controlled Substances, Buprenorphine

The Drug Enforcement Administration (FDA) has announced proposed permanent rules for the prescribing of controlled substances via telemedicine beyond the scheduled end of the COVID-19 public health emergency. The public can comment until March 31st. The full text of the proposals with links to submit comments may be found here (non-buprenorphine) and here (buprenorphine induction).  The rules have drawn criticism from specialty societies like the American Psychiatric Association and American Society of Addiction Medicine and telehealth advocates for containing overly restrictive in-person requirements.

The proposed rules do not affect (would continue to allow):

• Telemedicine consultations that do not involve the prescribing of controlled medications.
• Telemedicine consultations by a medical practitioner who has previously conducted an in-person medical examination of a patient.

The proposed rules would address a subset of telemedicine consultations—those telemedicine consultations by a medical practitioner who has: never conducted an in-person evaluation of a patient; AND that result in the prescribing of a controlled medication. For these types of consultations, the proposed telemedicine rules would allow medical practitioners to prescribe:

• a 30-day supply of Schedule III-V non-narcotic controlled medications; or
• a 30-day supply of buprenorphine for the treatment of opioid use disorder
• To issue more than a 30-day supply, you would first have to conduct an in-person medical evaluation of the patient

Additional resources for practitioners can be found here:

• Press Release with Summary
• Proposed Rules Summary Telemedicine Rules Summary.pdf (dea.gov)
• Proposed Rules Highlights for Medical Practitioners Telehealth Highlights Medical Practitioners.pdf (dea.gov)

In parallel efforts, a new proposed rule from the Substance Abuse and Mental Health Services Administration (SAMHSA) proposes to make permanent telehealth flexibilities for hubs (or Opioid Treatment Programs/OTPs).  The rule proposes to allow initiation of buprenorphine via audio-only or audio-visual telehealth technology, and methadone via audio-visual telehealth, if an OTP physician, primary care physician, or an authorized healthcare professional under the supervision of a program physician, determines that an adequate evaluation of the patient can be accomplished via telehealth.

For more information contact jbarnard@vtmd.org. The Vermont Medical Society is working with the legislature and Department of Health to try to ensure that Vermont rules and statutes align with federal changes. 

Vermont Receives Health Center Graduate Medical Education Planning & Development Grant

On Thursday, March 23^rd,  Lamoille Health Partners received a Notice of Award from HRSA for a Teaching Health Center Graduate Medical Education Planning & Development Grant.  This approval paves the way for bringing a new family medicine residency program to Vermont and for Vermont’s FQHCs to play a leadership role in developing a new generation of primary care physicians.  The model’s foundation is rooted in Vermont’s history of collaboration within the healthcare ecosystem.  The consortium model aligns our FQHCs, our hospitals, our medical schools and AHEC partners.  Over the next two years the infrastructure will be developed preparing for the accreditation process and brings Vermont one step closer to bringing in a new class of family medicine residents.  

Climate and Health Legislative Advocacy Day – April 7^th – Please RSVP

As you know too well, the climate crisis is a huge public health issue. There are solutions to combat it – and we need your help to make them happen.

Please join a few fellow Vermont Climate and Health Alliance and Vermont Medical Society members for a day at the Vermont State House to elevate the public health consequences and benefits of climate action: Friday, April 7th from 8am-12 pm in Montpelier. 

Can you join us – if even for an hour or two – to call on legislators to take bold action to reduce health-harming, planet-warming pollution?  Opportunities include a press event, meetings with legislative leadership, 1-on-1 connections with lawmakers and more. In advance of the day, with support from Vermont Natural Resources Council, we will share information on the big climate policies under consideration and provide talking points, informational materials, and a policy briefing to support you in knowing what bills are on the table for climate and health this session. 

Please let us know by Friday, March 31st if you’re available and interested in joining by completing this Google form

In the meantime, check out the Vermont Conservation Voters 2023 Environmental Common Agenda, supported by 19 groups, which outlines key climate and environmental priorities for the session or register here for a background webinar to update you on priority climate bills currently under consideration by the Legislature being held on Wednesday, April 5, from 12-1:00pm.

2023 VT Educational Loan Repayment Open For Applications - Up to $50,000 

The 2023 Vermont Educational Loan Repayment (Recruitment/Retention) Program for Physicians, Nurse Practitioners, & Physician Assistants application is now available.

Application and corresponding documents can be found here. This year employer matching funds are encouraged but not required.

The 2023 application deadline is Friday, March 31^st, 2023.

View the full flyer here.

MISC.

Baystate Financials' Plan Well Financial Education for Physicians

Vermont Medical Society has partnered with Baystate Financial for The PlanWell™ Series. This is a financial education curriculum geared explicitly towards VMS members. The objective is to help you realize your financial goals, whether it's saving for a house, paying off student debt, or planning for retirement.

There will be multiple webinar offerings in May for early to mid-career physicians and PAs (click here for details) and for late-career to retired physicians and PAs (click here for details).

Learn more and register here.

$28.4 Million USDA Investments Announced for NVRH and Copley

Senator Peter Welch (D-VT) last week held a roundtable discussion on health care challenges in Vermont’s rural communities and announced new funding to support health care facilities in St Johnsbury and Waterbury. United States Department of Agriculture (USDA) Rural Development (RD) Under Secretary Xochitl Torres Small and USDA Rural Development State Director Sarah Waring joined Welch to announce $28.4 million in USDA grants to Northeastern Vermont Regional Hospital (NVRH) and Copley Hospital. The investments are expected to save more than 400 jobs and benefit more than 9,500 rural Vermonters. Read more here.

AHRQ Safety Program for Telemedicine, Improving the Cancer Diagnostic Process – Deadline May 25^th

Is your practice interested in improving the cancer diagnostic process for your patients who receive some or all of their care via telemedicine? The Agency for Healthcare Research and Quality (AHRQ)  is recruiting ambulatory and primary care facilities, including OB/GYN practices for a free 18-month program to improve diagnostic verification, timeliness, and communication with patients diagnosed with breast, colorectal, and lung cancer.  Practices will receive training and one-on-one expert coaching to implement sustainable improvements to effectively close the loop at critical points in the cancer diagnostic process. The application deadline is May 25, 2023 and the program will begin in June. Learn more here. 

Resources on Medicare Fee Schedule, Quality Payments

Last month, the Physician Advocacy Institute released a recorded webinar that breaks down CY 2023 MPFS and QPP Final Rules from CMS and what they mean for physician practices. The webinar can be accessed here. PAI is currently conducting its annual QPP update to reflect reporting changes for the 2024 performance year, and updated resources will be available on the PAI website by early April. 

The data submission window for MIPS-eligible physicians for PY 2022 will close on March 31. Physicians who are unsure about their eligibility to participate in MIPS for the 2022 performance year can check their final eligibility status using the QPP Participation Status Tool.  Additionally, CMS released a 2023 Small Practice Action Planning Tool, a new resource for small practices to plan their participation in MIPS for the 2023 performance year

Department of Health Website Updated

The Vermont Health Department website will soon have a new look and be easier to navigate.  These changes are expected to happen today, Tuesday, March 28, 2023. 

The web address will stay the same — www.healthvermont.gov — as will most content on the site, including current web pages and links.   The State Office of Rural Health & Primary Care (SORH/PC) have updated and expanded pages including resources for:

• Hospitals, rural health resources (expanded!), hospital sustainability (new!), QI initiatives, patient safety, data interoperability
• Health Professionals, primary and dental care, workforce data, shortage designations, workforce incentives, community health workers,
• Future pages: funding and grant-writing resources, including population data sources

HRSA Organ Procurement and Transplantation Network Modernization Initiative

The Health Resources and Services Administration (HRSA) recently announced the Organ Procurement and Transplantation Network (OPTN) Modernization Initiative to better serve the needs of patients and families. The Initiative is intended to strengthen accountability, equity, and performance in the organ donation and transplantation system through a focus on five key areas: technology; data transparency; governance; operations; and quality improvement and innovation:

1. Data dashboards detailing individual transplant center and organ procurement organization data on organ retrieval, waitlist outcomes, transplants, and demographic data on organ donation and transplant
2. Modernization of the OPTN IT system in line with industry-leading standards, improving OPTN governance and increasing transparency and accountability in the system to better serve the needs of patients and families
3. HRSA’s intent to issue contract solicitations for multiple awards to manage the OPTN in order to foster competition and ensure OPTN Board of Directors’ independence
4. The President’s Fiscal Year 2024 Budget proposal to more than double investment in organ procurement and transplantation with a $36 million increase over Fiscal Year 2023 for a total of $67 million
5. A request to Congress included in the Fiscal Year 2024 Budget to update the nearly 40-year-old National Organ Transplant Act

Read the press release

VMS Policy Resolutions Open for Member Feedback

The VMS Board is seeking member feedback on two policy resolutions related to:

• The Medicare Advantage Program;
• Eliminating Medicare’s Direct Contracting Entity (DCE)/ACO-Reach Programs

All VMS members should have received an email with a link to submit survey feedback on these proposed resolutions between March 14th and April 12, 2023. If you had issues opening up the full resolutions, please try again because the links have since been updated. To read the full resolutions, click here. If you did not receive your survey links or have any questions or concerns with completing the survey please contact bpauley@vtmd.org. The resolutions will then be discussed together with the feedback received from members by the VMS Board at its April 19th Board Meeting.

Resolutions are now considered by the VMS Board on a year-round basis and members can submit resolution topics for consideration at any time. For more information on the resolution adoption process see: https://vtmd.org/vms-resolutions/. Members wishing to listen to the VMS Board discussion or share feedback at the Board meeting can contact bpauley@vtmd.org for zoom log-in information.

Commissioner of Health Public Health Update on April 6th

The next Public Health Update call with Commissioner of Health Mark Levine, MD will be on Thursday, April 6th at 12:30 pm. Hear about the the most pressing public health information affecting the state and nation and have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting. You can view the notes from the March 2, 2023 call here.

You can join the zoom meetings here.

Commissioner of Health Mark Levine, MD, gave a public health update on March 10, 2023 to the Vermont Association of Hospitals and Health Systems. Notes from the call can be found here.

EVENTS

The UVM CORA Clinician Office Hours

Weekly on Thursdays from 12pm to 1pm ET

This program offers free and confidential consultation from addiction medicine-certified physicians focusing on substance use evaluation and management. Information shared will be general in nature and should not be considered as case-specific medical care.

The UVM CORA Clinician Office Hours program is intended only for healthcare providers or others directly serving people with substance use disorders in HRSA-designated rural areas.

Please complete the form here to register for the Clinician Office Hours sessions held weekly on Thursdays, 12:00 -1:00 pm ET.

Registration will close weekly on Wednesdays at noon.

VPQHC Telehealth Q&A: A Discussion with Commercial Payers

March 29, 2023 from 12pm to 1pm ET

Virtual

Do you have questions about telehealth payer policies? Join VPQHC's virtual discussion with Blue Cross and Blue Shield of Vermont, and MVP Healthcare.

Both payers will provide a brief overview of their current telehealth policies, followed by questions and answers.

Register here.

Three years of the COVID-19 Pandemic: What we’ve learned, and how it can make us better at treating rural patients with SUD

March 29, 2023 from 12pm to 1pm ET

Virtual

Join a UVM CORA Community Rounds Workshop Series session titled, “Three years of the COVID-19 Pandemic: What we’ve learned, and how it can make us better at treating rural patients with SUD.” Our speaker is Dr. Sarah Jacobs, MD, MEd. This presentation will explore lessons learned from the COVID-19 pandemic as they relate to rural populations with substance use disorder.

CME/CE Credits are available for this live webinar.​

Register here

Future Health Best: Practices for Advancing Care

March 31, 2023

Virtual and In-person at Waltham, MA

Join physician leaders and health care experts from the Northeast for a signature event to share knowledge and research that advances equitable, sustainable, patient-centered, and best-in-class health care.

You can view the full flyer here.

For more information about the speakers, program, CME accreditation and to register please visit here.

Note: You can use the discount code of FHB23NE when registering for this event 

UVM Medical Center Cardiovascular / Vascular Forum

April 3, 2023

In-person

This course will provide primary care, internal medicine and urgent care providers education about cardiovascular and vascular disease, including additional POCUS skills for evaluation. The objective is to improve accuracy of appropriate and timely cardiovascular disease treatment, and efficiently use expert consultation in a value-based environment.

For more information about our speakers, sessions, accreditation and to register, visit here.

Save the Dates - Preparing for and Delivering Value-Based Care in Rural Communities

April 4th, May 2nd, June 6th, and June 27th, 2023

View the topics of the webinar series here.

Look for more information and registration details in February 2023 

Division Of Substance Use Programs

April 5, 2023, 11:30am-1:00pm and

April 6, 2023, 1:30-3:00pm

Virtual

In honor of Alcohol Awareness Month, the Division Of Substance Use Programs is hosting 2 webinars to discuss treatment access for alcohol use disorder (AUD). Each webinar will focus on a specific audience, one for emergency department providers and one for community-based practitioners. All are welcome to register for one or both webinars.

Please see the flyers in registration link here for more information.

Emergency Department Providers

April 5, 2023, 11:30am-1:00pm

Community-Based Practitioners

April 6, 2023, 1:30-3:00pm

Howard Center Annual Conference: Breaking Barriers: Finding Purpose & Possibilities Together

April 19, 2023

In-person and Virtual

The 6th Annual Howard Center Spring Conference is taking place on April 19th from 8:30am to 4:30pm with featured speakers including Dr. Nadine Burke Harris, Dr. Dacher Keltner, Dr. BJ Miller, Dr. Jeffrey Swanson, and Dr. Anna Malaika Tubbs.

For more information about the speakers, sponsors, and to register, visit here. 

Vermont Geriatrics Conference

April 20, 2023

In-person

The 17th Annual Vermont Geriatrics Conference is designed to equip physicians, advance practice providers, nurses, pharmacists, social workers and other healthcare professionals with practical and innovative approaches to the medical care of older adults.

For more information about our speakers, sessions, accreditation and to register, visit here. 

Integrative Pain Management Conference

May 5, 2023

In-person

This conference will meet the needs of an interdisciplinary healthcare community in the following ways:

1. Learn about integrative therapies and share best practices, research, and innovations in integrative approaches for chronic pain management.
2. Understand national initiatives and innovative policies that increase access to high-quality, evidence-based, comprehensive pain treatments in the context of an opioid epidemic and a mental health crisis.
3. Explore ways to provide integrative treatment of chronic pain to medically underserved populations.
4. Provide attendees with information and techniques which can be effectively integrated into day-to-day clinical practice to enhance patient engagement.
5. Demonstrate ways healthcare systems can support clinicians to prevent provider burnout and promote resiliency when working with the chronic pain population.

Learn more and register here.

Diabetes 2023: Updates on Management and Treatment

May 12, 2023

In-person

This conference is designed to equip primary care clinicians and other professionals, including dietitians, with updated knowledge on issues related to outpatient management of patients with diabetes.

For more information about our speakers, sessions, accreditation and to register, visit here.

49th Annual Family Medicine Course

June 6-9, 2023

In-person and Virtual

This intensive four-day program (with optional pre-conference full-day workshop taking place June 5, 2023) for family physicians, advance practice providers, nurses, and other primary care professionals will focus on current issues in the practice of Family Medicine, with special attention to new contributions. Emphasis is on practical, clinically-applicable diagnostic and management issues in primary care.

The conference dates will overlap with the Burlington Discover Jazz Festival, and all ages, live-music event on four stages in downtown Burlington that brings the community to life! 

The pre-conference workshop titled Mastering Early Goals of Care Conversations will take place on June 5, 2023

Empathic, honest conversations are cornerstones of patient- and family-centered care. Research shows that patients who speak with their clinicians about their goals and values are more likely to receive the care they want, have fewer non-beneficial medical treatments, spend fewer days in hospitals and intensive care units, and report a better quality of life. Take part in this safe, small group pre-conference workshop.

For more information about our speakers, sessions, accreditation and to register, visit here.

For more information about offerings from UVM CMIE, visit here.

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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