November 3, 2020


FBI Issues Advisory Regarding Cyberattacks on U.S. Health Systems the Same Day UVM Network is a Target

Last Thursday, the same day that the UVM Health Network was crippled by a cyberattack, the FBI issued a Joint Cybersecurity Advisory with two other federal agencies, warning there is “credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers.” Federal and state officials have not yet confirmed whether the attack on the Network was part of the reported coordinated strike on hospitals around the country using ransomware to hold health care data and systems hostage. The Network IT systems have not been restored, which has caused delays in care and lab results, as they are dependent on paper medical records at this time. To view updates on the status of the Network’s systems and service availability, visit note that clinicians and administrators at the Network are currently unable to receive outside email and must be contacted through alternate means.

OneCare Vermont has also reported service interruption at this time. If you have a question or request for OneCare, you can contact them using the contact form at To protect yourself, review the FBI advisory with your IT professionals. Key points include making sure you have current encrypted backups of all critical data stored off-line or in separated networks, and having a well-rehearsed crisis response plan in case your systems (which may include your email and VOIP-based phone systems) are compromised.


VMS Participates in COVID-19 Vaccination Advisory Committee

Vermont’s COVID-19 Vaccination Advisory Committee held its first meeting today, November 3rd to review the purpose of the Committee, as well as the State’s COVID-19 vaccine plan. The Advisory Committee will provide overall guidance to the planning work of COVID-19 vaccine distribution as well as provide input to the Health Department to ensure the needs of critical populations are fully integrated into planning and allocation of vaccine when the supply is limited. VMS is representing its members on this committee will keep you updated as the committee meets and its work unfolds.


CMS Releases Toolkit on COVID-19 Vaccine Billing, Coding, Reimbursement

CMS has released a set of a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer a COVID-19 vaccine once it is available.  These resources are designed to increase the number of providers that can administer the vaccine, ensure adequate reimbursement for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. Because the initial supply of COVID-19 vaccines will be federally purchased, this toolkit primarily focuses on coverage of vaccine administration. Vaccine doses purchased with U.S. taxpayer dollars will be given to the American people at no cost. Providers that participate in the CDC COVID-19 Vaccination Program contractually agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from a vaccine recipient. People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund.


VMSERF Awards Scholarship to Aspiring Pediatrician

The Vermont Medical Society’s Education and Research Foundation (VMSERF) has selected Adessa Morano as the recipient of the 2020 Mildred Reardon Scholarship. Morano, a student at the Larner College of Medicine at the University of Vermont, will be awarded the $10,000 scholarship at the upcoming Vermont Medical Society Annual and Collaborative Meeting, this Saturday, November 7th. Each year VMSERF awards a scholarship to a medical student committed to practicing medicine in Vermont. The scholarship program was created to encourage young physicians to return to Vermont after completing their residency training and is named in honor of Dr. Mildred Reardon, a faculty member at the Larner College of Medicine at UVM, who was instrumental in forming the Foundation. In applying for the scholarship Morano said, “I plan to share my knowledge and training as a pediatrician, as well as in child development and education, in order to be a resource for children and families in Vermont who need more from our healthcare system than they’re receiving now. Especially in rural areas, physicians with more comprehensive experience and training can fill a critically needed role and have a significant impact on the community they serve.” VMSERF congratulates Morano for standing out among a strong group of candidates for her commitment to serving the families of Vermont.


Information Blocking Rules – Deadline Extended from Nov. 2 to April 5, 2021

Earlier this year, the Office of the National Coordinator for Health Information Technology (ONC) released regulations implementing provisions of the 21st Century Cures Act requiring physicians to comply with new regulations on the access, exchange, and use of patients’ electronic health information (EHI). Information blocking is a large focus of the new regulations and is defined as practices that prevent or materially discourage the access, exchange, or use of EHI. 

High-risk info blocking actions include interfering with:

  • Patients who seek to access their own EHI (for example delaying patient access to lab results for a certain amount of time);
  • Providers who seek EHI for treatment or quality improvement;
  • Payers who seek EHI to confirm a clinical value; or
  • Patient safety and public health.

For nearly all EHI requests, physicians must respond and release patients’ medical records unless an appropriate exception can be identified and used. Responding to the AMA’s advocacy efforts requesting additional time and flexibility due to the COVID-19 pandemic, ONC’s interim final rule now pushes the information blocking compliance date from November 2, 2020 to April 5, 2021. Practices should take advantage of this time to educate themselves about what the rule requires. The AMA has created a two-part educational resource to help physicians and their medical practices understand the requirements: Part 1: What is Information Blocking and Part 2: How do I comply with Information Blocking and where do I start?______________________________________________________________

Affordable Care Act: California v. Texas

On November 10, the United States Supreme Court will convene at 10:00 am (EST) to hear the oral argument for the California v. Texas (Dkt. No. 19-840) case, which addresses the constitutionality of the Affordable Care Act. The Supreme Court will announce which media services will be providing live audio stream for the oral argument in a press release closer to the date of the hearing. Access the audio recording within a week after the session. 


Medicaid Proposes 2021 Physician Fee Schedule – Open for Comments

Vermont Medicaid has just released its proposed 2021 Resource-Based Relative Value Scale (RBRVS) fee schedule. The payments are being updated to align with Medicare’s 2020 relative value units (RVUs), and the primary care conversion factor is increasing from $36.04 to $36.09. This keeps the primary care conversation factor at 100% of Medicare rates, however when taking into account decreases in other elements of the Medicare payment formula (Geographic Indices for Practice Expense and Malpractice) this does result in a net .2% decease in reimbursement for all codes and a .5% decrease for primary care physicians (about $200,000). The changes are proposed to go into effect 1/1/21 and last until 7/1/21, when the fee schedule will be updated again. A summary of the changes can be found here. Please send comments or feedback to


GMCB Holds OneCare Vermont 2021 Budget Hearing

OneCare Vermont recently submitted its 2021 Budget to the Green Mountain Care Board and presented at a budget hearing last Wednesday. Highlights include that the ACO will be accountable in 2021 for $1,412,000,000 in spending on health care services. An additional $30,558,970 will be spent on population health management investments and $16,132,547 on the OneCare Vermont operating budget. The population health management investments include payments to primary care practices, care coordination, Blueprint Programs and RiseVT. From 2020 to 2021 there has been a 9.4% increase in patient attribution, largely due to a 17.8% increase in Medicare attribution due to new participation by the Rutland health service area. OneCare leadership also discussed how the Vermont ACO model is evolving how it distributes risk and risk is now based more on statewide performance of the OneCare network versus health service area performance; for the first time in 2021, primary care practices will have some of their payments based on performance by the network. 


AMA Releases COVID-19 Physician Practice Survey Results

In July and August, the AMA conducted a nationwide on-line survey of 3,500 physicians to better quantify the impact of the COVID-19 pandemic on physician practices. The survey asked about issues including income, use of telemedicine, availability and cost of personal protective equipment (PPE), and usefulness of the various federal financial relief programs available to physicians. Key findings:

  • 81% of physicians said that their income this summer was still lower than it was in February, before the pandemic began to escalate. The average revenue drop was 32%.
  • The use of telehealth expanded significantly with eased coverage restrictions, although this revenue stream did not completely offset the decline in in-office visits.
  • Spending on PPE is up, with physician-owned practices having the most difficult time acquiring these supplies.
  • Most physicians who applied for federal relief funds were successful and found it helpful.

Click here for the full results.

VMS Deputy Director Recognized for Outstanding Advocacy

Last week, the American Academy of Ophthalmology released their 2020 awards recognizing outstanding work by state societies and staff. VMS Deputy Director Stephanie Winters was recognized as a 2020 Outstanding Executive Director in Political Action for her work as the Executive Director of the Vermont Ophthalmological Society (VOS) during their efforts this past year to prevent non-physicians from performing eye surgery. In typical fashion, Ms. Winters pointed to the collective efforts of the VOS, the ophthalmologists of Vermont and VMS in preserving safe surgery in Vermont, however this is a well deserved award for Ms. Winters who spent countless hours in the 2019 and 2020 legislative sessions coordinating the state and national response. 

Bidding for the VMSERF Benefit Auction Closes Tomorrow!

Looking for a way to support fellow VMS members in need during this challenging year? Bidding closes tomorrow, November 4th, for the Vermont Medical Society Education and Research Foundation (VMSERF) Online Benefit Auction. Your generous bids will be donated to VMSERF, a 501(c)(3) nonprofit sponsored by the Vermont Medical Society, and organized to support charitable, educational and scientific activities in the field of health. START BIDDINGContact Elizabeth at

Commissioner Call Update

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


Please Respond – Seeking Feedback on Appointment Wait Times

The Scott Administration and Department of Financial Regulation (DFR) have received anecdotal reports that some patients are seeing delayed wait times for medical appointments, especially specialty care. DFR would like to better understand if wait times are longer than normal or are being exacerbated due to COVID-19 restrictions. Please take a moment to fill out this brief survey, that should take no more than 2-3 minutes to complete. 


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:


Health Care Provider Stabilization Grant Program Application Deadline This Friday

Reminder that the deadline to apply for the Agency of Human Services’ Health Care Provider Stabilization Grant Program is this Friday, November 6th at 11:59 PM. If you plan to apply but have not yet begun the application, AHS encourages you to start immediately. To apply, please log in to the portal and complete the application. New users can apply here. Returning users can access the application here. For application assistance and program guidance, please visit the website for more information.


      Please Join Us This Saturday, November 7th the 207th VMS Annual & Collaborative Meeting and the FIRST virtual Annual Meeting! Register here

      Held In collaboration with the American Academy of Pediatrics Vermont Chapter, the Vermont Academy of Family Physicians and the Vermont Psychiatric Association, the 2020 VMS Collaborative Meeting will provide ample opportunities for meaningful policy work, engaging CME sessions, and spontaneous laughter and fun.

      Click here for the full Agenda

      Register here

      VMS November Webinar: Let’s Take a Moment for YOUR Wellness!

      Please join us on Thursday, November 19, 2020 from 12:00 pm to 1:00 pm for our VMS November webinar. During this noontime wellness focused webinar, speakers Joe Lasek, M.D., and Doug Wysockey-Johson, M.Div., local leading experts on mental health and wellness will be exploring the value and strategies behind maintaining wellness as a medical professional. To register click here. To see the entire VMS Thursday Webinar series for 2020/2021 click here. 

      Osteoporosis Update for Primary Care

      Friday, November 6, 2020

      7:30 a.m. - 12:45 p.m.

      This half-day virtual conference features course Director Jennifer Kelly, DO and other UVM Health Network faculty, who will present on topics designed to improve the skills of the primary care team when they encounter patients who have, or who are at risk of developing, osteoporosis. Register. See the full 2020/2021 Continuing Medical Education schedule here. 

      Seeking Palliative Care CME credits for relicensure? VEN's Fall Palliative Care VIRTUAL Conference, "Informed Consent: More Than A Piece of Paper"

      Monday, Nov. 9, 2020

      8:15 a.m. - 4:15pm EST

      Unpacking the ethical, legal and practical considerations of obtaining informed consent in complex clinical situations and at end-of-life with plenary talks by Thaddeus Mason Pope, JD, PhD and Guy Matal, MD. Click to register here

      RME Collaborative’s 2020 Rural Health Clinical Congress

      Saturday, Nov. 21, 2020

      9 a.m. EST

      An interactive, multi-topic, complimentary CME/CE conference held in conjunction with National Rural Health Day, designed for primary care providers who care for patients in rural and underserved areas. Click here to learn more and register 


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