November 24, 2020


State Prepares for COVID Spike After the Thanksgiving Holidays

As Vermont continues to see the highest number of coronavirus cases since the pandemic began, the State of Vermont and Scott Administration continue their urgent messaging to Vermonters to stay home and avoid attending or hosting large, multi-household gatherings for this year’s Thanksgiving holidays. Today’s modeling from the Department of Financial Regulation (DFR) forecasts that Vermont could see our positive COVID case rate increase by 41 percent over the next four weeks after Thanksgiving. The DFR slides state that “If Vermonters travel and gather for Thanksgiving consistent with the Ohio State University Medical Center national survey, then in the days following Thanksgiving Vermont could see an additional: 3,200 to 3,800 new infections (detected and undetected), which would result in 40 to 50 new hospitalizations.” These estimates are only accounting for Thanksgiving gatherings and would be in addition to the increase in cases already occurring across the State. The State is working to keep our K-12 schools open and is currently conducting surveillance testing amongst all of our schools. Secretary of Education Dan French said approximately 40-45% of the staff in Vermont schools have been tested for COVID-19 and Commissioner of Health Mark Levine reports there is a very low positivity rate, with around .5% of these tests showing positive. The State is also continuing to expand access to testing click here for the VDH test finder.


VMS Policy Staff Begins Meeting with Newly-Elected 2021-2022 Legislators

With a little over a month before the 2021-2022 Vermont lawmakers will be sworn in, the VMS Policy staff has begun to prepare for the 2021 legislative session and has started meeting with key decisionmakers. The first day of the session is January 6th, and lawmakers need to finalize plans for meeting virtually or some kind of hybrid model. Leadership has changed in both the House and the Senate: Rep. Jill Krowinski, D-Burlington will most likely be the new Speaker, as Rep. Mitzi Johnson, D-Grand Isle, lost her recount last week, and Sen. Becca Balint, D-Windham, has been elected the new Senate President Pro Tem, after Senator Tim Ashe, D-Chittenden, ran for Lieutenant Governor and lost. Legislative leadership has asked for feedback on what worked and what did not work well in holding a virtual session and Jessa Barnard from VMS was asked to be a stakeholder. COVID-19 response remains the number one priority for the Vermont Medical Society, while also working on other public health measures. Click here for the VMS 2021 Policy Priorities.


Vermont Physician Groups Call on Vermonters to Prioritize their Communities and Protect Schools for our Children

VMS joined last week with the American Academy of Pediatrics Vermont Chapter and the Vermont Academy of Family Physicians to call on Vermonters to refrain from any social gathering in order to protect and prioritize essential services like schools, child care, and health care as the rates of community transmission of COVID-19 rise. The statement focuses on the epidemiology of how the virus is spreading in Vermont communities, noting that 71% of cases are linked to a private party or social gatherings, and that we are NOT seeing significant transmission in places where prevention policies are followed like schools and child care. These prevention and mitigation policies worked thanks to the incredible efforts of teachers, school nurses, administrators, and all school staff. Keeping schools open is crucial because children need consistent in-person learning. The statement goes on to urge Vermonters to not gather, and to follow the guidelines set forth by the Vermont Department of Health and our Governor. It is the responsibility of all Vermonters to stop the spread of COVID-19. The full statement can be found here.


Updates on Vermont COVID Vaccine Implementation Advisory Committee

Vermont’s COVID Vaccine Implementation Advisory Committee held its most recent meeting on Nov. 20th. VMS is a member of the Committee. The meeting focused on how to prioritize administration of the vaccine while the supply coming in to the State is limited, click for the presentation. Vermont is expected to receive in the range of 10-20,000 doses in the first round of vaccine distribution compared to a total of 43,977 individuals listed in the target population for phase 1a, including all licensed health care professionals, non-healthcare staff in  healthcare facilities (long-term care facility staff, non-clinical hospital staff), and emergency services (EMS, law enforcement, firefighters, local emergency management, National Guard). The State must be prepared to prioritize within this group while supply is limited. The National Academies of Sciences, John Hopkins and ACIP have put forward models for ethical considerations for prioritization noting that any system must maximize benefit, be fair, be transparent, and mitigate health disparities. At the same time the system must take in to consideration these four criteria:

  1. Risk of exposure
  2. Risk factors of morbidity/mortality
  3. Risk of transmission
  4. Risk of societal collapse and ability to save lives

The committee will continue to discuss and formalize how these guidelines will guide vaccine distribution in Vermont. For a VT Digger COVID-19 Vaccination FAQ with VDH Immunization Specialist, Chris Finley, click here


Agency of Human Services Releases All Payer Model Improvement Plan

Last week, the Agency of Human Services released an Implementation Improvement Plan for the All Payer Model. In response to a warning letter from CMS that Vermont is not meeting its scale targets for the number of patients attributed to the model, the plan looks at how to improve oversight of, and participation in, the model. Among its recommendations, the report outlines how participation can become more meaningful for health care clinicians, from improving the Care Navigator care coordination platform, to improving the data available to clinicians to moving employers towards value-based compensation for employed health care professionals. AHS also states in the report that, over time, participation in OneCare will be required for Blueprint for Health practices.  


Dept. of Financial Regulation Recommends Continued Coverage of Audio-Only Telehealth Services

The Vermont Department of Financial Regulation – responsible for overseeing Vermont’s private insurance companies – convened a work group this fall to consider whether insurance companies should continue to cover audio-only telehealth services after the end of the COVID-19 public health emergency. The report has been finalized and will be submitted to the legislature by Dec. 1.  The report concludes that coverage should continue after the emergency when medically necessary and clinically appropriate.  In addition, clinicians should obtain informed patient consent before delivering audio-only services (as with other telehealth services) and should complete training as needed to ensure they can meet the same standard of care as when delivering services in-person.  VMS was an active participant in the work group that informed the report and will continue to advocate in the legislature for ongoing coverage of audio-only services. 

Making Sense of Pandemic Restrictions

(Or Why Thanksgiving Dinner is Cancelled But Schools Are Not)

WRITTEN BY Rebecca Bell Pediatric Critical Care | Associate Professor of Pediatrics | AAP Vermont Chapter President 

Last week the Governor of Vermont announced a ban on multi-household gatherings and other temporary mitigation measures in response to a rise in community transmission of COVID-19 and a surge in case numbers. These restrictions are intended to limit activities that are known to lead to viral transmission in order to preserve essential services, like in-person learning. For many Vermonters, this was a much-appreciated measure. For others, this led to confusion, resentment, and fear. How is it not ok to have family or friends over for dinner but ok for kids to still go to school? Is that safe? Is it fair?

So here we go — a quick look at epidemiology, risk perception, and equity to make sense of the new guidelines. Click here to read the full Medium article. 

Commissioner Call Update - THERE IS NO CALL ON Thanksgiving!

VMS weekly calls with Vermont Department of Health Commissioner, Mark Levine, M.D. are held each Thursday from 12:30-1:00 p.m. on ZOOM - click below for the virtual meeting address that will remain constant each week. 

Once a month, VMS will feature a guest speaker during this call time, as the Commissioner has a conflict. The speaker will discuss clinical protocols and best practices during the State of Emergency.

Join Zoom Meeting -

Meeting ID: 867 2625 3105 / Password: 540684

Dial In: 1 646 876 9923 / Meeting ID: 867 2625 3105 / Password: 540684


CMS Reminder: December 31, 2020 Deadline for MIPS Exception Applications

Due to the impact of COVID-19 pandemic, CMS will be using its Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% for the 2020 performance year. There are two exception applications available to clinicians in PY2020:


Home Health Services – Ordering Providers

Vermont Medicaid is making changes to allow additional provider types to order Home Health Services. These changes are a result of the Federal CARES Act in response to the COVID-19 Public Health Emergency. These are permanent changes that are not limited to the duration of the public health emergency. The change would allow physician assistants, nurse practitioners, and clinical nurse specialists to order home health services in addition to physicians. This change applies to the following services provided by a home health agency: part time or intermittent nursing services; home health aide services; and physical therapy, occupational therapy, or speech language pathology services. Global Commitment Register (GCR) proposed policy 20-063: Home Health Services - Ordering Providers is open for public comment through December 18, 2020. Comments or questions can be sent to  


AHS Extends Application Deadline for Stabilization Grants to November 24th!

The Agency of Human Services (AHS) announced the extension of the application deadline for Round 2 of the Health Care Provider Stabilization grant program. The Stabilization application portal was reopened in response to requests from health care providers and applications can now be amended or completed until Tuesday, November 24th at 11:59 PM ESTTo apply, go to this website and log in to the portal and complete the application as soon as possible. New users can apply here. Returning users can access the application here. 


E/M Office Visit Changes Effective Jan 2021

Effective January 1, 2021, CMS has adopted major modifications to coding, documentation, and payment of evaluation and management (E/M) services for office visit CPT codes (99201-99215). This includes the elimination of code 99201. We encourage you to read about the changes and what they mean for your practice. The American Medical Association (AMA) has developed an extensive online library of resources to assist with the transition, which includes the following titles:


      VMS December Webinar: A Crisis in Vermont: Gun Violence and Suicide

      Please join us on Thursday, December 17, 2020 from 12:00 pm to 1:00 pm for our VMS December webinar. Please join Rebecca Bell, M.D. and Thomas Delaney, PhD, for a relevant discussion on firearm violence, suicide rates, and the work that’s being done in Vermont to positively impact these trends.To register click here. To see the entire VMS Thursday Webinar series for 2020/2021 click here. 

      Registration Open: Bi-State’s Clinical Quality Symposium

      Bi-State Primary Care Association’s 2020 Clinical Quality Symposium, “Interprofessional Collaboration for Better Clinical Outcomes,” connects the three pillars of health - primary medical, mental health, and oral health care services. The Symposium’s keynote speaker, Benjamin Anderson, will walk us through the myriad ways health care systems can and do break down in siloed systems, with a harrowing example from his own life. For the agenda and registration click here. 

      The Impact of Telehealth on Health Equity from the Perspective of Large Healthcare Systems during the COVID-19 Pandemic

      Tuesday, December 08, 2020

      2:00–3:00 P.M. ET

      Please click on the Zoom link below to join:


      Vermont Medical Society

      134 Main Street

      PO Box 1457

      Montpelier, VT 05601

      -- Unsubscribe --