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NEED TO KNOW
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Election Impacts on Health Care in VT and the US
Strong Republican showings in both Vermont and national elections last week will have impacts on health care policy and legislation.
In Vermont, Governor Phil Scott not only won every town in the State, but his focused advocacy in bringing about a "more balanced Legislature" resulted in Republican wins across both the House and the Senate. VT Public said this was the biggest swing any party has seen in three decades. Democrats maintain the majority across both chambers, but this shift takes away the veto override power Democrats have been able to employ in response to vetoes by Governor Scott. In 2025, the Senate will have 13 Rs, 16 Ds, and 1 Progressive, compared to the current 7 Rs, 22 Ds and 1 P. Along with the deaths of 2 Senators and several retirements, the retirement of Sen. Jane Kitchel, D-Caledonia, will have a significant impact on the Senate. The former Chair of the Senate Appropriations Committee was the de facto architect of the State's budget and had a keen understanding of the need for strategic investments in healthcare. In 2025, the House will have 55 Rs, 88 Ds and 7 Progressives and Independents, compared to the current 38 Rs, 105 Ds and 7 P/Is. Two incumbent chairs of House committees also unexpectedly lost reelection, Mike McCarthy, chair of the House Government Operations Committee, and Diane Lanpher, chair of the House Appropriations Committee. The to-be-determined leadership changes in these Committees will impact VMS priorities such as cannabis policy, professional licensure and health care funding.
Amid the recent Oliver Wyman Report, the new AHEAD model (end of OneCare VT), BCBSVT's 22.8% increase in small group health insurance rates (gaining not only recent state but also national media attention) and the 2024 election focus on affordability, Vermont’s changed political landscape will impact how the Vermont Legislature advances health care investments, addresses prevention and public health policies, and engages with health reform. Vermont Republicans have largely spent the last decade playing defense, largely voting no on the budget and other progressive policies. With their increased power, they will need to determine how they will answer the Vermont electorate's call for affordability. This VTDigger article shows Republicans are still grappling with this new power and responsibility. Click here for the full Vermont Secretary of State 2024 Election Results.
Meanwhile the outcome of the national election has implications in areas including public health and vaccinations, the Affordable Care Act, Medicare drug price negotiations, Medicare Advantage regulation, Medicaid coverage and more. One unknown is the Trump administration’s approach to Medicare’s current value-based payment programs and how this could impact the AHEAD Model negotiations underway in Vermont. Read an analysis from the KFF here and Politico here. Ten states also voted on ballot measures related to abortion access; seven states approved ballot measures to expand or protect access, three states rejected measures or preserved bans. Read more from CNN here. |
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Public Meeting on Act 167 Tentatively Scheduled for November 20th;
Gifford Public Meeting Today (11/12) at 6pm
The
Green Mountain Care Board and AHS have tentatively rescheduled a public meeting
to discuss the Act 167/Oliver Wyman Report for the morning of Wednesday,
November 20th with both a virtual and in-person option. More
information will be coming soon with details on the time and agenda for the
meeting; information should be available at: https://gmcboard.vermont.gov/2024-meetings. Members can also continue to submit public comments
to the Green Mountain Care Board here.
Leaders from Gifford Health Care also invite community members to
a forum to discuss the future of Gifford and access to rural health care in the
White River Valley of central Vermont. The community forum will be held from 6
to 7:30 p.m. tonight, Tuesday, Nov. 12, in Judd Hall Gym on the Randolph Center
campus of Vermont State University (formerly Vermont Technical College). Learn
more here. |
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Future of Payment Reform in Vermont: State Deep in AHEAD
Negotiations; OneCare Announces Wind Down at End of 2025
Vermont’s Agency of Human Services and Green Mountain Care
Board have been in detailed negotiations with Medicare over the terms of
joining the AHEAD payment reform model, as the current All-Payer Model comes to
an end at the end of 2025. As outlined in recent Green Mountain Care
Board meetings (see slides here),
the current stage is for Vermont and Medicare to reach agreement on a Term
Sheet. The Term Sheet would define major terms of a potential State
Agreement, including Medicare’s commitment to funding a hospital global budget
and primary care program, but may be amended and does not require signature by
the State of Vermont. Vermont negotiators have been pushing Medicare to
include funding in the Model for the Blueprint and OneCare Vermont’s current
primary care programs such as the PHM payments. Especially with the pending
change in federal administration, the goal is to have a Term Sheet drafted and
available for public review and comment before the end of this month.
The State would still have until July 1, 2025 to finalize an agreement to
join as a Cohort 1 participating state.
In part in response to the end of the All-Payer
Model and development of the AHEAD Model, last week OneCare Vermont, Vermont’s
statewide Accountable Care Organization, announced plans to wind down its
operations at the conclusion of 2025. In its final operational year, the
organization intends to maintain consistency for participants and all programs,
investments, and waivers will operate through 2025 as previously planned. |
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Implementation of Act 111 Prior Authorization Reform Underway
Act 111, Vermont’s landmark prior authorization reform bill, goes into effect on January 1, 2025. VMS and other provider organizations have been meeting with the Department of Regulation (DFR) and payers to work towards a successful implementation of the law. One section of the law requires that commercial payers exempt primary care providers from prior authorization for imaging and procedures. DFR is currently drafting guidance on issues including how to identify qualifying primary care providers, how payers and rendering providers will know a qualifying PCP has ordered a service and more. One sticking point is the interpretation by DFR that the prior authorization exemption will only apply to Blueprint for Health-participating PCPs rather than all PCPs, as VMS contends the legislature intended. See VMS comments here. VMS also joined comments related to implementing the exemption process for Step Therapy, and DFR plans to release guidance on that section of the law, as well. VMS will keep members informed of implementation details. VMS is also circulating a survey, as requested in the law, to measure the impact of prior authorization on practitioners and patients before and after the law goes into effect. Please help VMS by completing the survey!
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2024 AMA Interim Meeting Concludes Today The AMA House of Delegates, representatives of states and specialties across the country, met this week for the Interim Meeting, focused on policies related to advocacy. Delegates offered testimony on more than 150 reports and resolutions up for consideration and attended educational sessions on how the AMA is fighting for physicians on Medicare payment, scope of practice, and more. Vermont is represented in the House of Delegates by Norman Ward, MD, family physician, and Catherine Schneider, MD, general surgeon. Due to term limits, this was Dr. Ward’s last meeting as Vermont’s AMA Delegate and Dr. Schneider will assume the Delegate role for the June AMA Annual Meeting. Catch up on news from the AMA Interim Meeting. |
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VMS Board Elects Two New Student Reps.
The VMS Board met last Wednesday to take up Society business. The Board elected two new non-voting Board members from the Larner College of Medicine, Raihan Kabir and Ryan Marawala. Both are second year students and are co-chairs of the VMS Student Interest Group. LCOM third year student, Surya Radhakrishnon, was also elected to the voting student board seat. Surya was instrumental in creating the VMS Student Interest Group last year. The Board also adopted a 2025 budget, set 2025 dues (unchanged from last year), and decided to support policies to require schools to adopt Cardiac Emergency Response Plans and to allow prescribing of abortion medication via an adaptive questionnaire. For more information contact jbarnard@vtmd.org. |
MISC.
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Input Sought on Update to Workers’ Compensation Fee Schedule – Submit by Dec. 15th
The Vermont’s Workers’ Compensation Fee Schedule, set by rule, has not been updated since 2006. The Department of Labor has recently retained FAIR Health, a New York based non-profit specializing in health insurance information, to help the DOL craft an updated workers’ compensation medical fee schedule. DOL and FAIR Health held a preliminary information-gathering meeting on November 4th to provide opportunity for stakeholders to identify priorities and concerns in a fee schedule. They are continuing to accept input through December 15th at VTFeedback@fairhealth.org. It would be particularly helpful for them to receive any suggestions of codes or services that practices would like to see included in the fee schedule that are not currently covered or examples of areas of high administrative work/time with Workers’ Compensation cases. Contact jbarnard@vtmd.org with questions or for more information. |
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2025 Medicare Physician Fee Schedule Continues Payment Cuts
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a rule finalizing changes for Medicare payments under the Physician Fee Schedule and other Medicare Part B policies, effective on or after January 1, 2025.
For the fifth year in a row, the fee schedule contains payment cuts. By factors specified in law, average payment rates under the PFS will be reduced by 2.93% in CY 2025, compared to the average amount these services were paid for most of CY 2024. The AMA and state medical societies continue to advocate for Congress to take action to avert this cut.
A number of other payment, coding and service changes are incorporated into the rule, including:
- For CY 2025, CMS finalizes proposal to establish new coding and payment for caregiver training for direct care services and supports
- Absent Congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency will retake effect for most telehealth services. These include geographic and location restrictions on where the services are provided, and limitations on the scope of practitioners who can provide Medicare telehealth services. However, the final rule reflects CMS’ goal to preserve some important, but limited, flexibilities.
- For CY 2025, CMS is finalizing a proposal to establish coding and payment under the PFS for a new set of advanced primary care management services described by three new HCPCS G-codes (G0556, G0557, G0558). The services incorporate elements of several existing care management and communication technology-based services into a bundle of services that reflects the essential elements of the delivery of advanced primary care.
- CMS is finalizing several telecommunication technology flexibilities for opioid use disorder (OUD) treatment services furnished by Opioid Treatment Programs
For a more detailed fact sheet, click here. |
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Sterile Fluids Shortage: Clinical Guidance for Practices
Find practice guidance and communications for management of the current IV fluid shortages from the American Medical Association here. Resources address the extension of expiration dates for some products, substitution and practice changes and resources for alternative product sourcing. |
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New Coaching Resource Available to VMS Members
Beginning in 2025, VMS is making available at no cost up to 3 hour-long coaching sessions with Doug Wysockey-Johnson for interested VMS members. This is available to up to 5 members per year in the order of those who contact us.
Doug Wysockey-Johnson was the Executive Director of Lumunoswellbeing for 23 years, and now is a certified Executive Leadership Coach and consultant/facilitator. He has been working closely with physicians, APPs and nurses through 1-1 coaching and Peer Support Groups.
Coaching provides a confidential opportunity for clinicians to step back from the stresses of practicing medicine to work on specific challenges in their life. Neither therapy nor consulting, coaching helps clinicians identify challenges and create action steps to achieve goals with the support of the coach. Some of the challenges clinicians bring to a coaching practice include burnout, workplace conflict, work-home balance, leadership growth, and potential professional transitions.
For more information, please reach out to Doug@Lumunos.org or jbarnard@vtmd.org. |
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Next Commissioner Call, December 5, 2024
The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members Thursday, December 5th at 12:30 pm. You can join the zoom meetings here.
He held his most recent VMS member call on November 7th. Notes from the call are here. |
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Medical Students Conducting Survey on Adolescent Mental Health Resources in VT
Medical students at UVM are conducting a survey on adolescent mental health resources in Vermont as part of their public health project.
The survey takes approximately 10 minutes or less to complete and will help them better understand the current landscape of mental health support for adolescents in our state. Participation is voluntary, and your responses will remain confidential. Your insights are invaluable to their research and may contribute to improving mental health services for young people in Vermont. Thank you in advance for your time and insight. Link: https://redcap.link/uvmsurvey |
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New Free Educational Materials for Older Adults: Influenza Vaccine and Sepsis
The Sepsis Alliance is offering free resources designed to spread awareness of influenza vaccines among older adults.
77% of adults don’t believe or don’t know the flu can progress to sepsis (2024 Sepsis Alliance survey). With grant-funded support, Sepsis Alliance has developed a suite of FREE Sepsis and Flu materials to help guide older adult patients and their families toward greater awareness and understanding of flu risks, and prevention, as well as the connection between flu and sepsis.
Packaged, printed materials will be free for a limited number. Interested agencies can request packages using this link here.
Materials may include:
- 5 posters for display in common areas like community rooms and elevators.
- 50 brochures for older adults who are managing their own healthcare.
- 50 brochures for the loved ones of older adults who are supporting them with making medical decisions.
- Digital files of the above materials will also be available should additional copies be needed.
Questions may also be directed to Megan Jones at mjones@sepsis.org. You can also find free resources at SepsisandFlu.org for printing and educational purposes.
For additional vaccine and sepsis resources and tools, visit these IPRO QIN-QIO sites:
Ask ‘What About Vaccines?’ Every Time – IPRO NQIIC
Stop Sepsis Now – IPRO NQIIC |
EVENTS
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Learning Collaboratives on In-Basket Reduction and Reducing Regulatory Burden
October 2024 – March 2025
AMA STEPS Forward® Innovation Academy is launching two new, six-month learning collaboratives on optimizing the in-basket to reduce work burden and rethinking how organizations apply regulatory rules to clinical practice. Each collaborative will convene dyads or triads of leadership representatives from multiple organizations to engage in a longitudinal shared learning experience. Limited space available. Learn more.
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For more information about offerings from UVM
CMIE, visit here. |
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Vermont Medical Society 134 Main Street Montpelier, VT 05602 -- Unsubscribe -- |
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