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:
- Long-term
care (residents and staff who have patient contact)
- 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)
- Home
health care staff who have contact with multiple patients/vulnerable
people
- 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.
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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
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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: www.ama-assn.org/cpt-office-visits. 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.
Telehealth
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.
Supervision
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.
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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.
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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.
