Call for VMS Leadership Award Nominations & Resolutions For the 208th VMS Annual Meeting - Nov. 5 & 6
Please
join the VMS, in collaboration with the American Academy of Pediatrics Vermont
Chapter, Vermont Academy of Family Physicians and the Vermont Psychiatric
Association for the 2021
VMS Annual & Collaborative Meeting on November 5 and 6th, 2021 at the Topnotch
Resort in Stowe, VT! This year's event will feature both
in-person and virtual options to participate and will pack a lot into a shorter
time span.
Each year the Vermont Medical Society solicits nominations for its
Annual Leadership Awards. There are five award categories to be presented
at the annual awards banquet on Friday, November 5th. Please consider
nominating someone you feel should be recognized this year. To view the
award categories and criteria click here.
VMS is also looking for your input on 2021 Policy Resolutions
to be considered by the membership at the VMS Annual Business Meeting on
November 6th. Submit your resolution idea here.
For more details on the meeting click here. Make sure to save the date and book your room
today with the VMS room block. Call
Topnotch at 1.800.451.8686.
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VMS Members Weigh in Strongly for Parity for Audio-Only Telehealth Services; DFR Sets 2022 Commercial Rate at 75%
Thank you to the nearly 200 VMS and specialty society members who commented last week in response to our survey on reimbursement for audio-only telehealth services starting in 2022. Your comments were thoughtful and made compelling arguments why setting the commercial reimbursement rate for audio-only telehealth services at parity with in-person rates makes sense. Some of your comments include:
- Patients have come to expect this service and will continue to request it. Our payments as primary care providers are already low, and audio only visits take just as long, if not longer often than in person visits, so if this fee is lowered, our revenue will decrease to any even lower level. This might just tip us ‘under’.
- Most of these patients who cannot come in person and do not have video capability are elderly with multiple chronic illnesses who are frequently home-bound and do not have ready transportation to the office. Their visits can be just as complicated and lengthy as the patients who are able to do video or come in person. Because of the limitations of audio-only visits, they are our least preferred form of visit, so we do them only when we have to and have no other viable option under the circumstances. The resources committed to these phone visits involve almost as much work by my clinical staff as an in-person visit such as a pre-visit phone call for information gathering and screening questions, and then phone calls that follow later when the patients call back with questions or concerns, so there is an almost equal amount of staff time as well as provider time involved for these phone visits. As an aside, I also strongly urge funding to support Remote Patient Monitoring (RPM) which is so necessary for all patients who cannot come to the office and require any kind of tele-health visit, whether by audio-only or video chat.
Despite ongoing advocacy from VMS, you individually, and partner organizations such as the Vermont Association for Hospitals and Health Systems and Vermont Care Partners, the Department of Financial Regulation has released guidance (to be posted to their website tomorrow) that will direct commercial insurance companies to set a minimum rate for audio-only visits in 2022 at 75% of in-person visits. Note that this will take effect in January 2022 – rates continue to be at parity for 2021 – and Medicaid and Medicare have not determined which codes or what rates will apply to audio-only services beginning in 2022. DFR staff shared the following reasoning when releasing the draft order:
Many of you, especially on the provider side, are going to be disappointed by this outcome. But, no one is getting everything they wanted—the final draft represents a middle ground that payers have commented is pays too much and providers have commented pays too little. Looking out to see what other states are doing shows that they’re struggling with the same issues that we are. On the federal side, there’s more uncertainty. We don’t know whether Medicare will continue reimbursement of audio only telephone after the COVID-19 public health emergency ends. We also don’t know whether CMS will allow FQHCs and RHCs to bill Medicaid at the prospective payment system (PPS or “encounter”) rate for audio-only telephone services after the COVID-19 public health emergency ends. While we encourage payers to reimburse audio-only services in a way that reflects their clinical value, with all of the near-term uncertainty, some of you or your members understandably can’t accept anything other than parity. And, to the extent that the order creates induced utilization, those additional costs are eventually going to be absorbed by ratepayers or taxpayers. The old adage that there’s no such thing as a free lunch applies doubly to health care. Like we wrote last week, this order by no means represents the final word on how audio-only telephone services will be reimbursed. We’ll make adjustments for plan year 2023—by which time federal telehealth policy should be clearer. The (more normal, post-pandemic) data we gather will provide even more incentive to continue the payment reform work that’s already begun.
VMS will continue advocacy on this issue and will be reaching out to practices for more information about how this will impact their ability to offer telehealth services in 2022. Please contact jbarnard@vtmd.org with any questions or to be involved in further advocacy.
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What Ending the State of Emergency Means for Health Care Practices; Check Status of Telehealth Licensure
The Agency of Human Services and Vermont Department of Health have officially rescinded their Guidance for Licensed Health Care Providers During COVID 19. The AHS statement and VDH statement clarify that licensed professionals are expected to follow current guidance from the Centers for Disease Control and Prevention, as amended, the standard of care, as well as all relevant laws and regulations relevant to the licensees’ practice. Please see the VMS website outlining CDC and new OSHA guidance that health care practices must implement. Please also continue to check the status of licensure required to provide telehealth services to patients located in other states. While New Hampshire has stated that professionals who had emergency licenses can continue to provide services to patients located in New Hampshire until October 20, 2021 under temporary licenses, New York State ended its State of Emergency on June 25th with no continuation of the exception for licensure, so professionals should apply for licensure immediately. Contact Jessa Barnard at jbarnard@vtmd.org with questions or concerns.
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Proposed Medicaid Fee Schedule for Ambulatory Surgical Centers
The Department of Vermont Health Access (DVHA or Vermont Medicaid) is proposing to use the Outpatient Prospective Payment System (often referred to as “OPPS”) methodology that is currently used for hospitals to reimburse Ambulatory Surgical Centers. Currently, Ambulatory Surgical Centers are reimbursed using the Resource-Based Relative Value Scale (RBRVS) physician payment methodology. DVHA states that the Outpatient Prospective Payment System methodology will provide more appropriate reimbursement for Ambulatory Surgical Centers, which are outpatient facilities. The change in fee schedule will result in approximately $226,468 additional payments to ASCs. The proposed policy 21-023: Ambulatory Surgical Centers Reimbursement Change is open for public comment through July 26, 2021.
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Lower Health Insurance Costs for Many Vermonters
The American Rescue Plan Act of 2021 lowers health insurance costs for many individuals and families who buy health insurance through health insurance marketplaces. Vermonters in single plans may now qualify for lower costs with incomes up to $94,500. Those in family plans may qualify with incomes up to $265,000. Learn more at https://info.healthconnect.vermont.gov/ARPAor call 1-855-899-9600.
