December 22, 2020

This is the last issue of the Rounds for 2020. Look for your next issue January 5, 2021. The VMS Office will be closed from Thursday, December 24th until Monday, January 4th. 

NEED TO KNOW

VMS Executive Director Holiday Message: With Gratitude

I approach the end of this most unusual year, and my third year as Executive Director of VMS with a profound sense of gratitude. I am grateful for:

  • The opportunity to serve and learn from physicians and PAs who approach every day with a deep sense of commitment to your patients and communities. So many of you are working harder and longer than ever to serve the needs of your patients while also attending to family and personal stresses. I am proud to play a role in supporting you. 
  • Living in a state with a governor and legislature that has navigated this pandemic by listening to physicians, scientists and data - and that have prioritized protecting our vulnerable populations and our children’s education.
  • Working with a smart, dedicated, flexible staff who bring their best to VMS and are always looking for ways to make our organization stronger. They transitioned to remote work with grace and continue to make VMS a team, despite being apart from each other.
  • A healthy family with two young children who teach me daily about finding joy in everyday experiences, appreciating hugs and being resilient in the face of change.

You are all in my heart this holiday season and thank you for allowing me a role in your service to the health of our State. 

Sincerely, 

Jessa Barnard

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COVID-19 Vaccine Distribution Updates

Last week saw progress in addressing COVID-19 as 840 health care workers around the State received the first dose of the Pfizer-BioNTech vaccine and the FDA granted Emergency Use Authorization for the Moderna vaccine. By today, over 3000 health care workers have been vaccinated. The Vermont Department of Health issued a Health Advisory (HAN) on Friday with details regarding the Pfizer vaccine. Among other information shared, the HAN provided some further clarification regarding distribution of vaccine to Vermont’s Health Care Workers (HCW).

The 1A group includes:

  1. Long-term care facility residents and staff who have patient contact (administration by pharmacies began on Monday 12/21)
  2. Clinical and support staff who have patient contact in settings at high risk for COVID-19 patient contact:
    1. HCW (all classes including support personnel) primarily located in the ED, Med-Surg and ICU providing care to COVID patients
    2. HCW (all classes including support personnel) caring for COVID patients in other settings
    3. EMS with patient contact
  3. Home health care clinical staff and caregivers who have contact with multiple patients/vulnerable people
  4. Other health care providers/staff who have patient contact

The HAN offers further guidance for prioritization of “other health care workers” who fall in 4th bullet of 1A: Primary care including OBGYN; community providers who see patients in the hospital setting and dental providers. Hospitals are working hard to get communication, scheduling and other systems in place to vaccinate community health care workers who are not employed by the hospital. There has also been some confusion in that the Department of Health also separately directed hospitals to provide vaccine only to hospital staff, EMS and Home Health staff for weeks 1-2 of vaccine availability, which in some cases can conflict with the HAN. The Department of Health provided hospitals with lists of community HCWs last Friday and the hospital should be reaching out to schedule those individuals for vaccines. You can expect more information from your local hospital by January 4th. Right now, there is no action community HCWs need to take to get scheduled with their hospital. If you have not received any communication from your local hospital by January 4th, you may want to reach out at that time. VMS is also working with the Hospital Association and other organizations to ensure community physicians and other HCWs have access to vaccine as soon as possible.  In the meantime, practices can begin to prioritize staff within your office for vaccine, assuming supply is still limited.  Prioritization should be based on the criteria in Friday’s HAN. Further details are developing daily, and VMS will share ongoing details. We know community health care workers are anxious to receive more information.  

The Department of Health is also beginning planning for 1B – which includes essential workers and older, high-risk individuals. Vermont’s work group on vaccine prioritization is meeting tomorrow (Wednesday 1/23) and more information is expected after that meeting.  At this point, there is no action patients or practices should take to begin to schedule or prioritize patients. 

See more vaccine resources, including a recording of the VMS Webinar held this afternoon on COVID-19 Vaccine Safety, Distribution, and Considerations for Patients, here: https://vtmd.org/covid-19-vaccine-information

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GMCB Considers Primary Care Payments, Provider Reimbursement

Last Wednesday, two Green Mountain Care Board meetings considered clinician payments and reimbursement. In the morning, the Board heard an update of efforts to quantify and compare primary care payments between the New England states. Across the region, only 5.5% of total claims payments went to primary care using a narrower definition and 8.2% of total payments went to primary care using a broader definition of primary care services.  Compared to other states, Vermont was at the lowest percent spent on primary care by commercial payers, the highest by Medicare Advantage and Medicaid, and second highest for Medicare fee for service.  Overall, the report concludes that investment in primary care was relatively low compared to total healthcare expenditures and varied significantly by payer, geography, age group and other factors.   In the afternoon, the Board convened a panel to consider the mechanisms and regulation of provider reimbursement. Independent practices represented by Health First presented their concern that each year the Board approves increases to insurance rates yet those rates have not translated into increases to independent practice fee schedules.  Several Board members argued that if the Board was to require increases in provider rates they would need much more information about independent practice budgets, such as payer mix, days cash on hand and profitability. Board member Jessica Holmes suggested that the Board could request more information from the payers regarding where the increases in rates were ultimately allocated. 

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Governor Announces Updated Guidance on Gathering, Outdoor Recreation

At his press conference today, Dec. 22nd, Governor Phil Scott announced that between Dec. 23rd and Jan. 2nd, gatherings between two households will be allowed for the holiday season. He clarified that gathering with more than one household over that time period, even on different days, is not allowed.  Commissioner Mark Levine added that those over 65, with high-risk health conditions or who work in high risk settings are discouraged from gathering and all who have gathered should get a COVID-19 test 7 days later. In addition, Vermont’s travel policy is not changing – everyone coming into the state must follow quarantine guidance.  Gatherings will be prohibited again beginning January 3rd to allow the State to gather data regarding the impact of the change. Other changes Governor Scott announced include:

  • Outside recreation, such as hiking, sledding, skiing and ice fishing, is now allowed between multiple households if you can physically distance and wear a mask. No gathering with other households before or after the activity is allowed. See Section 4.1 of ACCD Guidance for further details.
  • A phased restart of youth sports is beginning on Dec. 26th.  School based and youth recreation leagues can start training if physically distanced and wearing masks, with no contact. Adult recreation leagues and all spectators are still prohibited.
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Recent COVID-19 Guidance and Resources:

VMS Weekly Zoom with Commissioner of Health, Thursdays at 12:30 pm

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VMS Prepares for Virtual 2021 Legislative Session

The 2021 Legislative session begins Wednesday, January 6th, 2021 and the VMS policy team has been busy preparing. We have met with newly-elected legislators, chairs and members of various Health Care and Human Services' Committees, Governor Scott's policy staff, Lt. Gov. Molly Gray and others who will determine health care policy in Vermont in 2021. Click to read the 2021 VMS Policy Priorities. With the rise in prevalence of COVID-19 cases, the Vermont House and Senate have decided they will convene the legislature via virtual sessions through at least the months of January and February and will decide if they return in March at a later date. To read more click here. 2021 will come with significant changes, as both the House and Senate will have new leadership. The House has elected Rep. Jill Krowinski, D-Burlington, as the new House Speaker after Rep. Mitzi Johnson, D-Grand Isle, lost her re-election by a slim margin. Rep. Krowinski has served in the Vermont legislature since 2012 and has been the House Democratic Majority Leader for the last 4 years. Sen. Becca Balint, D-Windham, was elected as the new Senate President Pro Tem after Sen. Tim Ashe, D-Chittenden, lost his bid for Lt. Governor to newcomer Molly Gray. Senator Balint has served in the Vermont legislature since 2015 and has been the Senate Democratic Majority Leader for the last 3 years. Committee membership will also change as key positions are open on the House Health Care, Human Services and Appropriations Committees and the Senate Health and Welfare Committees. One of the first priorities the legislature will need to tackle is whether they will reallocate approximately $20 million in CRF funds. After Congress passed the most recent pandemic relief bill, they extended the December 30, 2020 deadline to use the CRF funds from the CARES Act to next December 31, 2021. 

Let 2021 Bring Hope

With vaccine now entering the state, many clinicians may be feeling a ray of hope for 2021. At the same time, for many of us, this time of year is challenging. Many of us are lonely, sad, stressed, and anxious. 

If you feel like this message is directed at you, please understand that you are not alone. Others feel the same way, and there are resources that can help. Asking for help is okay – and healthy!

Here is a list of resources. DO NOT HESITATE!

Ho! Ho! Ho! There will be NO Commissioner Calls on

Christmas Eve, 12.24 or New Year's Eve, 12.31

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 -https://us02web.zoom.us/j/86726253105?pwd=VkVuNTJ1ZFQ2R3diSVdqdlJ2ZG4yQT09

Meeting ID: 867 2625 3105 / Password: 540684

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

MISC.

Reminder – E/M Office Visit Code Changes Coming Jan. 1


Effective Jan. 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is adopting updated Current Procedural Terminology (CPT®) Evaluation and Management (E/M) codes.

  • The revisions only apply to office visits
  • Code 99201 has been eliminated
  • Codes 99202, 99203, 99204, 99205, 99206, 99207, 99208, 99209, 99210, 99211, 99212, 99213, 99214 and 99215 descriptors and documentation standards have been revised

The AMA offers a wide variety of free tools and resources to keep you informed on critical updates such as the E/M office visit code changes. These resources include:

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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:

      EVENTS

      VMS January 2021 Webinar: Emerging Information on COVID-19

      Please join us on Thursday, January 21, 2020 from 12:00 pm to 1:00 pm for our VMS January webinar, "Emerging Information on COVID-19." Patsy Tassler Kelso, PhD, the State Epidemiologist for Infectious Disease at the Vermont Department of Health (VDH) will discuss how COVID-19 has developed, spread, and led to necessary public health changes in Vermont. To register click here. To see the entire VMS Thursday Webinar series for 2020/2021 click here. 

      Center on Rural Addiction (CORA) Best Practices Scholarship Program

      Deadline: April 30, 2021


      UVM CORA leverages innovative technology and telehealth strategies to deliver support to providers in rural counties. Their patient-focused approaches are sensitive to the demographics and needs of rural populations, which have been disproportionately impacted by Substance Use Disorder (SUD). This scholarship program offers an opportunity for two days of in-person comprehensive training and consultation at the University of Vermont with Center on Rural Addiction (UVM CORA) faculty and staff experts. Click here to learn more. 


      Someone You Love: The HPV Epidemic Documentary

      Friday, January 8, 2020

      11:30 AM – 1:30 PM EST

      Earn 2.0 CME Credits for participating in this free virtual showing of the HPV Documentary, "Someone You Love." Following the film screening, participants can choose to attend two breakout session discussions focused on cancer prevention and the HPV vaccine. This event is sponsored by Bi-State Primary Care Association, the Norris Cotton Cancer Center, the American Cancer Society, Southern NH Area Health Education Center, and the Vermont Department of Health. Register here. 

      IN THE NEWS 


      NATIONAL NEWS

      Becker's Hospital Review: Nursing Homes Struggle to Obtain Resident Vaccine Consent  More than 3 million long-term care facility and nursing home residents could face delays receiving the COVID-19 vaccine as facilities struggle to obtain consent, The Washington Post reports. Read more. 

      Bloomberg: Moderna Shot Cleared in U.S., Ready for Delivery Starting Sunday

      Moderna Inc.’s Covid-19 vaccine was cleared by U.S. regulators, the second vaccine to gain emergency authorization this month as a historic mass immunization effort ramps up across the country. Read more. 


      USA Today: States Were Left Scrambling After Finding Out They'd Get 20-40% Less Vaccine Than They Expected  States were given estimates that turned out to be based on vaccine doses produced, not those that had completed quality control and were releasable. Only on Wednesday and later were states informed of the actual numbers. Read more. 


      Politico: CDC panel: Frontline Workers, 75-plus Seniors Should Get Covid Shots Next

      People 75 and older and essential frontline workers should be the next in line for limited supplies of Covid-19 vaccines, an expert group advising the Centers for Disease Control and Prevention recommended Sunday. Read more. 


      National Law Review: HHS Proposes Changes To HIPAA Including Access To Protected Health Information On Dec. 10, 2020, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) issued a notice proposing a number of significant changes to the HIPAA Privacy Rule. The public has 60 days to comment on these proposed changes. Read more.


      Politico: Congress Strikes Stimulus Deal After Days of Frantic Talks

      The crux of the package remains the same: a $300 boost in weekly unemployment benefits for 11 weeks through March 14, $600 relief checks for adults and children, more than $300 billion for small business aid and huge pots of money for schools, hospitals and vaccine distribution. Read more


      Politico: 'Surprise' Billing Fix To Be Included in Spending Package

      Congress is set to include a long-elusive ban on “surprise” medical bills as part of a major spending deal lawmakers were working to finalize Sunday evening. Read more.

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