November 2nd, 2021

NEED TO KNOW

Open for Member Comment: VMS Position on Commercialized Sales of Cannabis

The VMS Council will be considering an updated position on commercialized sales of cannabis. at their November 17th Council meeting. All members are encouraged to submit feedback on the resolution here. The Resolution would replace VMS’ 2018 resolution Opposing a System of Commercialized Sales of Recreational Marijuana. The new resolution would state that:

VMS strongly opposes the advertising, marketing and promotion of cannabis in the state of Vermont, including through the use of packaging, flavorings and placement/density of retail locations, because the incentives created for establishments to push sales through fostering high use and addiction, since 80% of product will be consumed by 20% of users or less, those with current or future dependence or addiction to cannabis.

The resolution would also urge:

  • That all cannabis grown, produced or sold whether through dispensaries or retail establishments in the state be less than 15% THC cannabis
  • Prominent labeling of all cannabis products and advertising with up-to-date, evidence-based warnings
  • That the State dedicate adequate resources, including but not limited to those generated by cannabis excise taxes and addiction-related settlement funds, to statewide prevention and education efforts.

As further background, see the American College of Emergency Physicians recently-adopted resolution “Complications of Marijuana” and letter from the Colorado Child & Adolescent Psychiatric Society.

Members interested in attending the Council meeting on the 17th from 6:30-8:30 pm via zoom should contact Birdie Pauley at bpauley@vtmd.org

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Invitation to Participate in Wait Time Investigation

In response to reports of lengthy wait times for medical appointments, the State of Vermont has launched an interagency investigation into health access across the state. The team is studying excessive health service wait times and potential solutions and is requesting input and information from clinicians. You can contribute information (anonymously if you so choose) through the survey at the link below. Through the same survey you also have the option to sign-up for a listening session with the investigation team. These conversations will not be open to the public or media.

Link to survey: https://lp.constantcontactpages.com/sv/G0MWgxo/providerfeedback

Please note that the survey has a disclaimer that you are consenting to receive marketing emails from: Vermont Department of Financial Regulation. However, you will not receive any unsolicited e-mails as a result of participation in this survey.

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VMS Prepares for the 2022 Legislative Session 

VMS has begun its annual pre-session meetings with lawmakers, Administration leadership and health care regulators to educate them on the VMS 2022 Policy Priorities and primary care platform and to better understand their priorities for the upcoming legislative session. In meetings with the Green Mountain Care Board, the Governor's office and various legislators, VMS has heard that health care workforce, health care affordability, access to mental health services and prevention will be among the top legislative priorities for 2022. The VMS continues to engage in numerous off-session studies and stakeholder-led work groups designed to inform policy proposals that will help achieve these overarching goals. Last week, the Task Force on Affordable, Accessible Health Care met for the third time to review policy options that Vermont lawmakers could implement to help make health care more affordable for Vermonters. Last week's Task Force presentation focused on seven policy options that consultants believe have the most ability to be implemented on a reasonable timeframe, at a reasonable cost and help Vermonters

  1. A Public Insurance Option
  2. Expanding Medicaid Post-Partum Coverage 
  3. Expanding Remote Access to Health Care Services 
  4. Extending Moderate Needs Supports 
  5. Cost Growth Containment/ Affordability Boards/ Affordability Standards 
  6. Expanding the Vermont Blueprint for Health
  7. Legislation directed at Pharmacy Benefit Managers (PBMs) 

The next meeting of the Task Force will be November 22nd, 2021. At the same time, the Green Mountain Care Board continues to focus energy on hospital sustainability planning and heard from consultants last week with frameworks for measuring and analyzing hospital payment and cost variation and capacity planning. The Vermont Association of Hospitals and Health Systems criticized the capacity planning report for relying on 2019 hospital use and not taking into account the significant current demand for hospital services.

The VMS also continues to engage in these stakeholder groups: 

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VMS 208th Annual and Collaborative Meeting - Register Now!

We hope you will be able to join us on both Friday, November 5th and Saturday, November 6th for this year's 2021 VMS Annual & Collaborative meeting, a virtual event, held in collaboration with the American Academy of Pediatrics Vermont Chapter, Vermont Academy of Family Physicians, and the Vermont Psychiatric Association.

Although we will not be meeting in person, these virtual sessions will provide unique opportunities for you to align with VMS colleagues on how to tackle tough clinical issues in your practice. 

All 2021 Annual Meeting activities will be held virtually. To view the full schedule of events, the speakers, and awardees, click here. 

    Register for the membership meeting here

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    Vermont COVID-19 Updates - Pediatric Pfizer Vaccine Registration to Open 11/3

    The FDA expanded emergency use authorization of the Pfizer-BioNTech COVID-19 Vaccine to include children 5 through 11 years of age on Friday, October 29th. The Pfizer-BioNTech COVID-19 vaccine for 5 through 11 years of age will be a new product with new packaging. The CDC is meeting today to issue its recommendations regarding administration.  Vermont expects to open registration to 5-11 year olds tomorrow, November 3rd at 8 am, with clinics beginning as soon as Thursday or Friday.

    • Vaccine began being shipped to Vermont in the days following issuance of the EUA decision. 
    • The Vermont Department of Health is receiving vaccine between 11/01 and 11/5 in three waves of shipments. 
    • This first allocation of 15,900 doses of vaccine is meant to act as a bolus of supply to the state and has already been prepositioned for community and school-located clinics. 
    • Weekly ordering of pediatric Pfizer vaccine for all other COVID-19 enrolled providers will commence Wednesday, 11/10 using VDH’s standard vaccine ordering process.
    • Children will be able to obtain vaccine in the same locations as adults (community vaccine clinics, pharmacies) as well as school-based clinics and pediatric offices.  Families will be able to learn about registration from the VDH COVID-19 vaccine webpage.

    On November 9, from 1:00 – 1:45, the VDH Immunization Program will hold a training for 5 through 11-year-old approval. This training will be recorded and summarize recommendations, ordering and inventory management, storage and handling, with time for Q+A. If you would like an invitation or more information, please reach out to  AHS.VDHImmunizationProgram@vermont.gov

    The American Academy of Pediatrics Vermont Chapter, in collaboration with the VDH Immunization Program, is providing funding to support expanded influenza and/or COVID vaccination by healthcare practitioners or organizations. AAP-VT is also hosting community forums for caregivers to ask questions from local, trusted pediatric health care professionals about COVID vaccination. Visit www.aapvt.org for more information about grant funding and community educational opportunities. AAP-VT president, Rebecca Bell, MD, spoke at the Administration’s press conference today and stated that pediatricians unequivocally recommend vaccine for every Vermont child.  It is safe and effective and side effects have been mild, primarily pain at injection side, swelling & redness, seeing fewer systemic side effects in this age group (fever, chills, headache). The DFR Modeling report from Tuesday can be found here.

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    Training and Resources for Immunizing Children

    In preparation for the 5 to < 12-year-old approval of the COVID-19 vaccine, the Vermont Immunization Program compiled the below resources:

    • Vax Visits with Less Stress - Training for Providers at Mass Vaccine Sites - Recorded one-hour training led by UVM’s Children’s Hospital Empower Team and Occupational Therapist Karen Downey. Participants will learn strategies and tips for creating a sensory-friendly environment. Sensory Tool Kits will be distributed through the Vermont Department of Health (Live session being held Nov 2 at 12 pm – recording may not be immediately available)
      • VT EMS Pediatric Vaccine Refresher - This 15-minute video created for Vermont EMS goes through patient positioning, correct needle length/size, and injection techniques.

      Pfizer-BioNTech Training Sessions

      Pfizer-BioNTech holds regular training sessions for all providers on the vaccine storage, handling, and administration. These trainings are highly recommended for anyone managing the new pediatric formulation, as the trainings will be continuously updated with new and changing guidance. Additional training links for later dates/times will be shared when available.

      Date & Time

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        Attendee link – October 29 – 12 PM ET

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        Attendee link – November 1 – 5 PM ET

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        Attendee link – November 2 – 5 PM ET

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        Attendee link – November 3 – 12 PM ET

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        Attendee link – November 4 – 12 PM ET

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        Attendee link – November 5 – 12 PM ET

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          MISC.

          Review Begins of Granting Certain Psychologists Prescribing Authority

          Vermont’s Office of Professional Regulation (OPR) has begun a “sunrise review” on whether the scope of practice for psychologists should be expanded to include prescribing authority. According to the request made by the Vermont Psychological Association, in order to prescribe, psychologists would need to be doctoral level psychologists, received a master’s degree in clinical psychopharmacology and pass an examination developed by a nationally recognized body and approved by the Vermont Board of Psychological Examiners. They would then obtain “relevant clinical experience,” including at least 100 patient consultations under the direction of a qualified practitioner, including a licensed physician, license advanced practice registered nurse, or a prescribing doctoral-level psychologist with five or more years of experience.

          OPR held a public hearing on the request last Thursday. VMS President, Simi Ravven, M.D., spoke about the serious concerns for patient safety and the vast difference in education and clinical training between those clinicians that have current prescribing authority (physicians, physician assistants & advanced practice registered nurses) and that of psychologists.  Winston Chung, M.D. spoke on behalf of the Vermont Psychiatric Association on the complexities of medications and how “psychiatric drugs” and “non-psychiatric drugs” are not easily defined. Another hearing will be held on November 9th, at which VMS and the Vermont Psychiatric Association will present more information. If you have feedback or comments, please reach out to Stephanie Winters at swinters@vtmd.org.

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          Medicare Cuts Looming – Contact Congress Today

          As Congress continues to fight over reconciliation, infrastructure and raising the debt ceiling there is a looming Medicare payment crisis that, if not addressed, could have devastating consequences for Medicare patients and our health care system. In what amounts to a “perfect storm” of payment cuts going into effect on January 1, physician practices face a stack of Medicare financial hits amounting to a 9.75 percent cut.

          When Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) circulated a “Dear Colleague” letter highlighting the financial uncertainty within the Medicare payment system, 245 of their colleagues, including Vermont’s Representative Welch, showed their support for fixing the problem by co-signing the letter. 

          Now is the time to build on that momentum and demand that Congress take action to address these devastating Medicare cuts. Please take a moment and contact your Senators and Representative to tell them to cancel the cuts!

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          Physician Executive Leadership Institute - Now Accepting Applications!

          The Vermont Medical Society Education & Research Foundation (VMSERF) is proud to announce its third statewide Physician Executive Leadership Institute Foundational Course to begin in winter 2022! This course is offered in partnership with the Daniel Hanley Center for Health Leadership and Lumunos.

          Physicians and PAs have been asked to step up and skillfully lead rapid change throughout the COVID-19 pandemic. Every clinician brought their leadership, management styles, and skills to the forefront to ensure the best outcomes for Vermont patients. VMSERF is pleased to continue an experiential learning opportunity that will enhance and fine-tune the most important leadership skills and concepts for a statewide cohort of Vermont physicians and PAs.

          To learn more details about the 2022 course, the curriculum, and how to apply, click here or contact swinters@vtmd.org.  Applications are due November 19th.

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          EVENTS

          UVM CORA Community Rounds: "Cannabis Use and Cannabis Addiction in Rural Populations: Phenomenology, Intervention, & Policy"

          November 3rd 12-1pm, ET


          Join Dr. Alan Budney, PhD, from Geisel School of Medicine at Dartmouth.


          Register here.

          The Michael Herschorn Symposium: Parkinson’s Disease and Movement Disorders in Primary Care - Virtual

          November 19th, 9am - 2:15pm

          The Binter Center for Parkinson’s Disease and Movement Disorders invites you to attend this virtual symposium which will provide you with the tools you need to diagnose and treat patients with various movement disorders, and to know when referrals may be needed.

          Topics include: Diagnosing PD, Treatment Options for Early and Advanced PD, Cognitive and Psychiatric Manifestations of PD, Diagnosing other common movement and gait disorders such as Essential Tremor, NPH, RLS, Drug-Induced Movement Disorders, and more.

          To register, view the complete program and accreditation information, click here.

          VTMD.ORG

          Vermont Medical Society

          134 Main Street

          Montpelier, VT 05602

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