December 8, 2020


Vermont Prepares for First Doses of COVID-19 Vaccine

Last Friday, Vermont’s COVID Vaccine Implementation Advisory Committee met to discuss how Vermont will prioritize initial doses of the COVID 19 vaccines. Click here to download the meeting slides. Group 1A will be prioritized as follows, within the total of 44,000 healthcare workers in Vermont:

  1. Long-term care (residents and staff who have patient contact)
  2. Clinical and support staff who have patient contact (priority to healthcare and support staff primarily located in the ED, ICU or providing care to COVID patients; EMS with patient contact)
  3. Home health care staff who have contact with multiple patients/vulnerable people
  4. Other healthcare providers/staff who have patient contact

The advisory committee will be meeting weekly to work on implementation of phase 1A as well as prioritization of the subsequent phases.

Last Thursday, during the regularly scheduled VMS call with the Commissioner of the Vermont Department of Health (VDH), Chris Finley, VDH’s Immunization Program Director, presented the additional information on Vermont’s COVID-19 Implementation and Distribution Plan. FDA approval is expected this week for the Pfizer/BioNTech COVID-19 vaccine to be granted under an Emergency Use Authorization (EUA). Once this occurs, Vermont is initially expected to receive 5,850 doses on or around December 15th, with subsequent deliveries of 5,850 doses in each of the following two weeks. The Pfizer vaccine will be delivered to a central location where it can be kept at the required minus 94 F and then will be distributed to the State’s hospitals as it becomes available. Vermont hospitals have agreed to offer vaccinations to all of the phase 1A health care workers in their hospital service area (HSA). Vermont pharmacies through a federal grant program will provide direct vaccination services for the residents and staff at all long term care facilities in the State and will source vaccine separately. The State is also determining how to ensure that the second dose is available for those that receive the vaccine, being mindful that the interim between the first and second doses is 21 days for Pfizer and 28 for Moderna and that the second dose must be from the same manufacturer. Ms. Finley advised practices to schedule both appointments at the same time and to also stagger vaccination of health care workers who provide direct care within each HSA, as fatigue, headache, chills are reported side effects within the first 48 hours of the first dose.


Recent COVID-19 Guidance and Resources:

VDH Begins New Weekly COVID-19 Update Email: Sign Up Here

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


2021 Medicare Physician Payment Schedule Finalized – Contact Congress to Oppose Payment Cuts  

Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2021 Medicare Physician Payment Schedule Final Rule. A detailed CMS summary is available here. AMA staff continue to analyze the rule and VMS will share additional information.  CMS is holding a webinar on Thursday, December 10 from 1:30 to 3 pm ET to better understand key changes of the rule. Register for this Medicare Learning Network event.

Office and Outpatient Evaluation and Management (E/M) Visits

Last year, CMS finalized an important policy change when it adopted CPT guidelines to report office and outpatient E/M visits based on either medical decision making or physician time and reduce unnecessary documentation. These changes become effective on Jan. 1, 2021. January 2021 office visit guidelines and descriptions and educational materials are available at: E/M visits are also seeing an increase in reimbursement rates.

Budget Neutrality Adjustments – Fee Schedule Reductions  

By law, significant increases in Medicare physician payment rates must be offset by across-the-board decreases. This means that increases to office and outpatient E/M visits have led to reductions affecting physicians and other health professionals who do not report office visits. Redistributions will be significant, with family medicine increasing by 13% and many specialties that do not perform office visits decreasing by 8% or more. The AMA is now strongly urging Congress to rescind these cuts as physicians are experiencing substantial economic hardships due to the COVID-19 public health emergency and many of these cuts will directly impact care to COVID-19 patients, including payments for hospital visits, critical care visits, nursing home visits, and home visits.  

Please contact your member of Congress to ask them to support the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act” (H.R. 8702), to avoid these cuts going into effect on January 1, 2020.


CMS is increasing the number of services that can continued to be offered by telehealth to Medicare beneficiaries permanently, beyond the COVID-19 public health emergency, and has also increased the list of services that will be reimbursed during the pandemic. CMS is also establishing payment on an interim final basis for a new HCPCS G-code describing 11-20 minutes of medical discussion to determine the necessity of an in-person visit.


CMS is finalizing that direct supervision may be provided using real-time, interactive audio and video technology through the later of the end of the calendar year in which the PHE ends or December 31, 2021. The rule also allows teaching physicians to use interactive, real-time audio/video to interact with residents in training.

Opioid Use Disorder

CMS is expanding coverage for naloxone and incorporating elements of screening for SUD and opioid prescriptions into the Annual Wellness Visit. CMS is also moving forward with a  requirement that all Schedule II, III, IV or V controlled substances under Medicare Part D be e-prescribed by January 1, 2021 but with an enforcement date of January 1, 2022 to encourage e-prescribing as soon as possible while allowing a transitional period.

Medicare Shared Savings Program

CMS is finalizing changes to the Medicare Shared Savings Program (Shared Savings Program) quality performance standard and quality reporting requirements for performance years beginning on January 1, 2021. For performance year 2020, CMS is finalizing to provide automatic full credit for CAHPS® patient experience of care surveys. For more information, please see the Quality Payment Program fact sheet. 


GMCB Receives Reports on 2019 ACO Results

At the December 2nd Green Mountain Care Board meeting, Medicare, Vermont Medicaid and BlueCross BlueShield provided financial results for the 2019 year of participating in Vermont’s ACO. 

  • Costs of care for Medicare-covered patients were $11.1 million under the 2019 financial target set for the year. $6.3 million of this savings was reinvested to fund Medicare participation in Vermont programs such as Community Health Teams and SASH. 
  • For Medicaid, spending for ACO-attributed members was approximately $13.5 million more than expected. After adjustments, OneCare will pay approximately $6.7 million back to DVHA. ACO-participating providers who were paid prospectively spent $8.2M less than expected on the services within their control. Conversely, providers who were paid fee-for-service (both within and outside of OneCare’s network) spent $13.5M more than expected, highlighting how different financial incentives might impact the delivery and cost of health care.   
  • For BlueCross BlueShield, costs exceeded the target by about $6.5 million or 6.6%, net of member cost share. Three factors were found to drive the costs for attributed patients: significantly more E&M and professional mental health/SUD visits; higher use of urgent care visits without a corresponding reduction in ER visits; and more costly and/or intense PT services.

OneCare concluded with some high level comments that adjusting for shared savings and shared losses is the mechanism by which Vermont is staying on a predicable health care budget. GMCB staff also presented preliminary results on meeting 2019 goals for meeting the All Payer Model total cost of care, quality and scale results. Per person, from 2017 to 2019, the total cost of care for Vermont residents has increased 4.2%, within the 3.5% -4.3% target set in the All Payer Model Agreement. 


HHS Amends PREP Act Declaration, Including to Expand Access to COVID-19 Countermeasures Via Telehealth

On Friday, the U.S. Department of Health and Human Services (HHS) issued a fourth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to increase access to countermeasures against COVID-19. Among other things, the amendment authorizes healthcare personnel using telehealth to order or administer Covered Countermeasures, such as a diagnostic test that has received an Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA), for patients in a state other than the state where the healthcare personnel are already permitted to practice. (While many states including Vermont have decided to permit healthcare personnel in other states to provide telehealth services to patients within their borders, not all states have done so.)  “Covered Countermeasures” include any antiviral, drug, biologic, diagnostic or other device, or any vaccine manufactured, used, designed, developed, modified, licensed, or procured to diagnose, mitigate, prevent, treat, or cure COVID–19.

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

Are Your Patients Covered for 2021? Open Enrollment Ends December 15th! 

The Department of Vermont Health Access (DVHA) has joined 15 other states and the District of Columbia in a national #GetCovered2021 campaign to encourage Vermonters to enroll for health insurance coverage for 2021 before December 15, 2020. The partnership between these states and providers, individuals, and consumer advocacy organizations is focused on promoting the Get Covered 2021 campaign to help people stay safe during the pandemic and to ensure access to quality health care when people need it.  Please find more information about this national effort here. Please go to VT Health Connect here.


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  


      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. Rebecca Bell, M.D., Pediatric Critical Care physician at UVMMC and President of the American Academy of Pediatrics Vermont Chapter, and Thomas Delaney, PhD, UVM Larner College of Medicine Assistant Professor, will discuss firearm violence and suicide rates and the work that’s being done to positively impact Vermont's trends. According to a report that Delaney presented in 2018, Vermont’s suicide rate increased 30 percent more rapidly than the rest of the country between 2004 and 2017 and firearms are involved in approximately 59 percent of suicide deaths in the State. 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. 

      Unmasking Health Disparities through a Health Equity Lens

      December 16th, 12:30 – 2:30 PM

      Join Northern Vermont AHEC for the first of a 5-segment virtual series targeting VT health care practitioners and partners, Quality Care is Equitable Care:  The Case for Culturally and Linguistically Responsive Health Care

      To register for Session 1 and/or learn more about each monthly activity click here.

      AMA Release the Pressure: RTP Wellness Wednesday

      Dec. 9th & Dec. 16th

      8 PM EST

      AMA's Release the Pressure (RTP) coalition, which includes the AMA, AMA Foundation, Association of Black Cardiologists, American Heart Association, Minority Health Institute and National Medical Association, is launching an extension to their RTP initiative entitled, RTP Wellness Wednesday. To kick-off the launch, radio talk show icon, Tom Joyner talks with the AMA immediate-past president, Patrice A. Harris, MD for a special 2-Part interview. 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. 


      Vermont Medical Society

      134 Main Street

      PO Box 1457

      Montpelier, VT 05601

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