January 30, 2024

NEED TO KNOW

The Vermont Legislature is Full of Action as January Comes to a Close

With more bills introduced this session than any other session before, and the second year of the legislative biennium, lawmakers are working at a full sprint to get their bills in play. The VMS team has been in a number of committees testifying on bills that would streamline prior authorization, enact car seat requirements for children, require insurance coverage forobesity treatment, and prohibit the sale of flavored tobacco sales. Now that the House has passed the FY24 Budget Adjustment Act, which increases State spending by roughly $56 million, the House is beginning to take testimony on the FY25 Budget. The Department of Vermont Health Access provided the House Appropriations Committee with these asks for 2025 that include a 4.6% increase in payments to FQHCs for the Medicare Economic Index (MEI) adjustment. Here is a quick summary of action on other priority bills: 

• H.766 - A priority bill for the VMS, this bill includes improvements to insurance claims processing and also provides strategies to reduce and streamline prior authorization. The House Health Care Committee took testimony on a provision that requiring payers to direct bill patients and is taking testimony this Tuesday on the step therapy section of the bill. This week they will be wrapping up testimony and beginning to mark up the bill;
• H.721 - The House Health Care Committee continues to take testimony on a bill to gradually expand the income eligibility for Medicaid to 312% of the Federal Poverty Level by 2030 and to increase the age of eligibility for Dr. Dynasaur up to age 26. The bill includes an increase in Medicaid reimbursement for primary care, with a floor of 125% of Medicare. The bill also includes an expansion of eligibility for the Medicare Savings Program (MSP), which helps low-income Vermonters afford Medicare premiums and out of pocket costs. This week they will also hear testimony on a provision that would expand eligibility for mental health coverage for youth under the age of 26; 
• H.151 - This week, the Senate Health and Welfare Committee will be taking up this health reform bill, a VMS priority from last session, to decide which pieces to advance. VMS supports all sections of the bill, including allowing minors to consent to prevention services for sexually transmitted diseases and to increase commercial payers spend on primary care;
• S.164 - The Senate Finance Committee took testimony on a bill to provide coverage for obesity medication and treatment and heard excellent testimony from Dr. Kimberley Sampson and Dr. Ashley Miller. The Committee is expected to take this up next week; and 
• S.18 - The House Human Services Committee voted out S.18, the bill to end the sale of all flavored tobacco products in Vermont. The bill, as passed, includes prohibiting the sale of flavored e-cigarettes and menthol cigarettes, but exempts flavored cigars, cigarellos, shisha and dip/chew. The VMS does not support the exemptions but will work to improve the bill in the House Ways and Means Committee next week. 
• Feedback Sought: PFAS Registry:  S. 197 is being taken up in the Senate Health & Welfare Committee this week.  Among other provisions, including banning the procurement of certain products containing PFAS by school districts and municipal and State government, the bill creates a PFAS registry in the Department of Health and would require “a health care provider that screens for, diagnoses, or provides therapeutic services to patients with adverse health conditions and diseases that may be  attributable to PFAS exposure to report to the Department all individuals diagnosed as having such a disease or condition not later than six months from the date of diagnosis.”  VMS has concerns that it is difficult to link any one health condition to PFAS exposure.  A recent CDC PFAS Information for Clinicians Guide highlights that while there may be benefit to PFAS testing to discuss sources and ways to reduce exposure, “research has not yet confirmed mechanisms for each health effect” and ” results do not indicate whether a current illness can be attributed to PFAS exposure.”  Please contact jbarnard@vtmd.org to share your feedback on the concept of a registry for PFAS exposure.

VMS Kicks off Successful Legislative Breakfast Series

VMS launched the legislative session with an all-specialty legislative breakfast on January 18^th.  Last week, the OBGYN Residency program (pictured above) visited the Statehouse, chatted with lawmakers over coffee, sat in on several legislative hearings, and offered testimony in favor of S.109, which would require Medicaid to reimburse for doula services.   It’s not too late to join us at the Statehouse!  See the list of remaining VMS and specialty society breakfasts and register here.

Details Emerging on AHEAD Model for Primary Care

As covered in prior issues of the Rounds, Vermont’s agreement with Medicare to participate in payment reform (the “All-Payer Model”) will be ending in 2025.  Vermont’s Agency of Human Services (AHS) is currently drafting an application to participate in Medicare’s new payment reform model, the AHEAD Model, starting in 2026.   The Model includes paying hospitals with a new “global budget” methodology and a Primary Care AHEAD component.  A Primary Care Workgroup has been meeting with AHS to both learn more about the model and provide feedback to the State.  Materials from the workgroup are now available on the AHS website here.  Primary care clinicians and practices are encouraged to review the materials and reach out with any questions, concerns or interest in joining the workgroup to jbarnard@vtmd.org.  Of note, slides from December 15^th crosswalk between the approximately $17 per FFS Medicare beneficiary payment that Medicare will make available to practices participating in the Model with Vermont’s existing Blueprint and ACO payments (see slides 8-12).  While $17 PMPM is greater than most payments currently available to primary care, this will only be linked to FFS Medicare patients, so the impact on each practice will be different.  Slides from the same meeting also demonstrate how the AHEAD Model could potentially work concurrently with a Medicare-ACO program called MSSP.  AHEAD is not an ACO-based model and without an ACO primary care practices could potentially lose an exception from participating in the federal pay-for-performance programs MIPS, as well as lose OneCare Vermont’s capitated Comprehensive Payment Reform Program. In January (see slides 11 & 12), the work group also began discussing primary care quality measures required by AHEAD.  While the measures are largely familiar to Vermont practices (such as colorectal cancer screening and screening for depression), AHEAD does require reporting using the eCQM electronic reporting format. Practices should also reach out to jbarnard@vtmd.org with feedback on reporting via eCQM.  Vermont’s application for the AHEAD Model is due by Monday, March 18^th. 

Becca Bell, VMS president, and Sarah Bushweller, Physician Assistant Academy of Vermont (PAAV) president and VMS board member, at the 41st Annual PAAV Winter Conference in Manchester, VT.

Next Commissioner of Health Call is February 1, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members on Thursday, February 1st at 12:30 pm. View notes from the January 4th call here.

Hear about the most pressing public health information affecting the state and nation and have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting. You can join the zoom meetings here.

MISC.

Physician Salary and Contract Tips Webinar Materials   

Thank you to those who could attend the VMS webinar with Resolve last week discussing physician salary and contract tips.  If you couldn't attend, we have a recording here and slides here.

If you have any questions, feel free to email Kyle Claussen, Resolve CEO, at kyle@resolve.com

As part of your VMS member benefits, you receive 15% off any Resolve's packages, use this code at checkout: VMS15

See all packages here.

In addition to paid packages, you can set up a FREE account to access these tools:

• rData: View salaries, signing bonuses, and more from real physician contracts in your specialty and location.
• Contract Scorecard: Allows you to see how your contract stacks up against market data for your specialty.
• Crowdsourced data: Be part of the movement. Submit your salary data and help build the first ever physician generated salary report.

Study Reveals Blastomycosis More Common than Expected in Vermont

Blastomycosis is a rare but potentially fatal fungal disease caused by Blastomyces spp. Human illness most often results in pulmonary conditions but can involve any organ system; clinical manifestations range from subclinical infection to life-threatening disease. A recent study published in the CDC’s Emerging Infectious Diseases, with contributions by Vermont Department of Health and Green Mountain Care Board staff, analyzed insurance claims to find that the burden of endemic blastomycosis is greater than commonly appreciated, including in Vermont.  See media coverage by NBC News here.

VMS Member Fundraising for Ukraine

VMS member Robert Tortolani, MD, is requesting member support in efforts to raise funds for 240 Individual First Aid Kits (IFAK) for Ukrainian soldiers. Since the massive increase in Russian attacks has exponentially increased the need for critical medical supplies for those who are wounded, there is a need for IFAKs which include tourniquets, compression bandages, hemostatic gauze, chest seals, decompression needles, airway tubes and more to help keep soldiers alive. The cost per IFAK is $50-$100 and they are not standard issue gear.

Make a charitable contribution today to Blue/Yellow USA.

Financial Education Series for March: Presented by Baystate Financials PLANWell
Each session will be held via zoom at 12:30 p.m. or 5:00 p.m.

SaveWell: Gaining Awareness and Setting Goals - March 12th
Will help you understand your financial goals and the factors that will impact these goals.

InvestWell: Understanding How to Put Savings to Work - March 19th
Gain a clearer picture of how to grow a nest egg by investing it.

LiveWell: Protecting a Fulfulled Life and Retirement - March 26th
Protect your ability to make and save money by looking at how to utilize your assets to prepare for the uncertainties of life after work.

EVENTS

35th Annual Eastern Winter Dermatology Conference

February 1-4, 2024

TopNotch Resort, Stowe, VT

Learn more and register here.

Hospital Medicine 2024

February 7-9, 2024

TopNotch Resort, Stowe, VT

The course will provide practical approaches to common problems in hospital medicine informed by experts and the latest evidence. The target audience is comprised of physicians, physician assistants, nurse practitioners, and nurses practicing Hospital Medicine. Some of the clinicians will also be engaged in education, research, quality improvement, and management. The audience may also include Hospital Medicine program administrators, resident physicians, and medical students with an interest in careers in Hospital Medicine. Topics include Congestive Heart Failure; Pain Management; Care of Transgender Patients in Hospital; and more.

Learn more and register here.

Future Health Best: Practices for Advancing Care

March 22, 2024

Virtual and In-Person Waltham, MA

This 2024 conference will focus on the nexus of climate change and its growing impact, AI and new technologies to diagnose and treat patients, and the evolving and expanding role of physicians in this rapidly changing health landscape.

View the event flyer here. Registration will open in January 2024.

For more information about offerings from UVM CMIE, visit here.

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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