July 6, 2021


State of Vermont Reports Scale Target Performance for Year 3 (2020) of All-Payer Model

Last Wednesday, the Green Mountain Care Board (GMCB), in consultation with Vermont’s Agency of Human Services, submitted the Annual ACO Scale Target and Alignment Report for Performance Year 3 (2020), as required by the Vermont All-Payer Accountable Care Organization Model (“All-Payer ACO Model” or “APM”) Agreement with the federal Center for Medicare and Medicaid Innovation (CMMI).

The 2020 (PY3) scale report demonstrates that Vermont, despite falling short of APM Agreement scale targets, has made strides toward increasing Model scale:

  • All-payer participation grew by over 67,000 lives compared to 2019 (PY2), an increase of over 40%.
  • The number of Medicaid beneficiaries attributed under the Vermont Medicaid Next Generation ACO Program (114,000 in 2020) has grown by 45% since 2020, and by nearly 300% since the program launched in 2017.
  • Commercial participation more than doubled in 2020, from 30,000 in PY2 to 62,500 in PY3.
  • The number of participating Medicare beneficiaries remained static from 2019 to 2020.

Looking ahead, Vermont expects continued improvement in 2021 (PY4; data is preliminary), with the addition of an estimated 40,000 lives, including approximately 8,000 Medicare beneficiaries.  Despite increasing growth in scale year-over-year, it is no surprise that Vermont remains shy of the scale targets set forth in the APM agreement. The Medicare scale targets included in the Agreement are unattainable because some beneficiaries are ineligible to participate or receive the majority of their care out-of-state. All-Payer scale represents a significant stretch goal, and includes populations for which the state has no data or regulatory leverage, for example, self-funded groups that do not report data to the State and Medicare Advantage plans.  Vermont’s Agency of Human Services laid out strategies for improving scale in the Agency’s APM Implementation Improvement Plan published in November 2020.


CMS Releases Surprise Medical Billing Interim Final Rule

Last week, the U.S. Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (Tri-Agencies), along with the Office of Personnel Management (OPM) released an interim final rule with comment period (IFR) entitled the Requirements Related to Surprise Billing; Part I implementing many of the provisions of the No Surprises Act (NSA) signed into law as part of the Consolidated Appropriations Act, 2021 COVID-19 relief bill. The NSA addresses surprise medical billing at the federal level by holding patients harmless from the costs of out-of-network care in certain situations and creating an Independent Dispute Resolution process for determining provider payments. These situations include emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances. The law also addresses price transparency, provider directories, and other patient protections.

The IFR clarifies the Qualified Payment Amount (QPA) by specifying cost sharing calculations for emergency services provided by out-of-network emergency facilities and out-of-network providers, and certain non-emergency services furnished by out-of-network providers at certain in-network facilities. In addition, the IFR clarifies certain notice and consent requirements for health care providers and facilities. The American Medical Association (AMA) is closely reviewing the IFR after submitting comments to the Tri-Agencies on the implementation and calculation of the QPA and the QPA audit process, amongst other provisions, as well as comments on the Independent Dispute Resolution Process and will provide a detailed summary in the coming days. For more information, see CMS’ interim final rule fact sheet.


Drug Utilization Review Board is Currently Seeking Board Members

The Department of Vermont Health Access (DVHA) manages  the publicly-funded benefit programs for the State of Vermont including the pharmacy benefit programs and oversees the activities of the DUR Board.  The DURB is composed of prescribers and pharmacists that meet approximately every six weeks with a total of seven meetings per year. Materials for the meeting are sent via email ahead of time to allow DUR Board members to review before the meeting. The agenda typically consists of:

  • Drug utilization review and analyses
  • Review of new drugs, new indications and dosage forms
  • Therapeutic class review including recently published treatment guidelines and best practices that may influence clinical criteria
  • Safety information
  • Drug information pertinent to managing the drug benefit programs of DVHA

You can find the DURB description, meeting schedule and location, meeting agenda’s, meeting minutes, current members, and contact information on our website at Drug Utilization Review Board | Department of Vermont Health Access

Please reach out to Lisa Hurteau if interested: Lisa.Hurteau@Vermont.gov.


Medicaid COVID-19 Billing Update

Since the announcement that COVID-19 restrictions have been lifted in VT there has been an increase in questions about COVID-19 related billing. Although the state of emergency has been lifted for VT, the federal state of emergency and waivers related to the COVID-19 public health emergency are still in place. Medicaid prior authorizations that are currently waived continue to be waived under the federal public health emergency. The DVHA COVID-19 web page is regularly updated, and DVHA will send additional information when those restrictions will be re-implemented.


Vermont Medicaid Proposes Coverage for Percutaneous Transcatheter Closure

Effective August 1, 2021, the Vermont Medicaid program proposes to add coverage for CPT Code 33340 - Percutaneous transcatheter closure of the left atrial appendage for physician reimbursement. Atrial fibrillation is a common condition associated with an increased risk of stroke. Percutaneous closure of the left atrial appendage is considered an alternative treatment to traditional treatments that rely on anticoagulation, which carries a small risk of serious bleeding.  Please send any comments or questions to Jill Sudhoff Guerin at jsudhoffguerin@vtmd.org.


Hospitals and Corporations Own Nearly Half of U.S. Physician Practices

Nearly 70% of U.S. physicians are now employed by hospital systems and corporate entities like private equity firms and health insurers according to new data by Avalere for the Physicians Advocacy Institute (PAI) examining the period between January 1, 2019 and January 1, 2021.  The research found that the COVID-19 pandemic accelerated a long-term national trend of hospitals and corporate entities acquiring physician practices and employing physicians. During the two-year period, these entities acquired 20,900 additional physician practices. Forty-eight thousand additional physicians left independent practice for employment by hospital systems or other corporate entities.


HHS Opens Provider Relief Fund Reporting Portal

The Provider Relief Fund (PRF) Reporting Portal is now open for providers who need to report on the use of funds in Reporting Period 1. All recipients of PRF payments must comply with the reporting requirements described in the Terms and Conditions. Providers who received funds between April 10, 2020 and June 30, 2020 are required to report during Reporting Period 1 and have until September 30, 2021 to submit their information via the Portal. HRSA is committed to supporting the providers who have received PRF payments in completing their reporting requirements successfully.

Providers can review the updated Reporting Requirements Notice (June 11) to enter the PRF Reporting Portal. Portal registration is the first required step (if not already completed).


New Summer Schedule! Commissioner Call Update | VMS calls with Vermont Department of Health Commissioner, Mark Levine, M.D. will be held on specific Thursdays from 12:30-1:00 p.m. throughout the summer. These calls are on ZOOM - click below for the virtual meeting address that will remain constant each week.

Summer dates will be: July 22nd; August 5 & 19th; September 2 & 16th.  
Click here for an online schedule.

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

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. 

The Vermont Medical Society is currently seeking nominations for its Annual Leadership Awards and will be accepting nominations until July 30, 2021. To view the award categories and criteria click hereVMS 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

24th Women’s Health and Cancer Conference: Friday, October 1, 2021 – Save the date: the UVM Cancer Center will once again bring together health care professionals, patients, survivors, caregivers and the general public for this event which is aimed at empowering and supporting individuals and communities with knowledge about cancer prevention, detection, treatment and survivorship. Registration will be available in June. For more information click here. 

Sponsored jointly bythe Mayo Clinic,
Stanford University and the American Medical Association

American Conference
on Physician Health
October 7- 9, 2021

Achieving the quadruple aim: Resilient systems in times of crisis.” Joint scientific conference that promotes scientific research and discourse on health system infrastructure, and the actionable steps organizations like yours can take to improve physician well-being.

  • Registration rates: Available through Thursday, Sept. 23.
  • To register for conference and view agenda, visit the ACPH 2021 homepage.

AMA STEPS Forward offers a collection of engaging and interactive educational toolkits that are practical, actionable “how-to” guides to transform and improve your practice.

AMA Steps Forward Webinar Series

July 15 (12:30 - 1:30)
Integrating organizational actions toward patient safety and clinician well-being. Register Here

July 20 (12:00 - 1:00)
Promising practices to support physician well-being during COVID-19: A case study from EvergreenHealth. Register Here

VPQHC Expands Health Equity Training Offerings Due to High Demand!

The Vermont Program for Quality Health Care (VPQHC) has expanded the free health equity training offerings that qualify health care professionals for 3 CME credits, entitled, "Structural Competence and Cultural Humility to Address Disparities and Inequities." This training is being provided by Dr. Maria Mercedes Avila, PhD, MSW, MED and is currently waitlisted through May. Register here.

Special Enrollment Period Now Until August 15th, 2021

Due to the COVID-19 emergency, Vermont Health Connect has opened a Special Enrollment Period through August 15, 2021. During this time, any uninsured Vermonter can sign up for a qualified health plan through Vermont Health Connect. Qualified families can also get financial help paying for coverage. Please call us 1-855-899-9600 to learn more.


Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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