November 14, 2023

NEED TO KNOW

Vermont Physicians Represented at AMA Interim Meeting

Vermont physicians have a voice at the annual and interim policy setting meetings of the American Medical Association, represented by one Delegate and one Alternate-Delegate.  Attending this November’s Interim Meeting, wrapping up today in National Harbor Maryland, were Catherine Schneider, MD, general surgeon and VMS Past-President and Rebecca Bell, MD, pediatric intensivist and current VMS President. Naiim Ali, MD, radiologist and VMS Vice President also attended as a delegate for the American College of Radiology. There have been more than 100 reports and resolutions up for consideration at the meeting. Delegates draw on their expertise, the best evidence in the medical and health policy literature, and the insights of their state medical associations and national medical specialty societies to weigh in on proposals that run the gamut of issues affecting patients and physicians. Some of the major issues addressed by the time of publication include directing the AMA to advocate to remove copayments from the Medicaid program, to expand CMS alternative payment models to include Medicaid and pediatric populations, and to call on payers to collect copayments rather than physicians.  Resolutions addressing the AMA position on Medical Aid in Dying and removing opposition to a single payer health care system were referred for further consideration.  Follow highlights of the meeting here. 

OPR Recommends Surgical Expansion for Optometrists

Several year ago, the Vermont Office of Professional Regulation (OPR) was asked by the Vermont legislature to research optometric scope expansion. OPR’s study determined that scope expansion was not recommended. However, a bill was proposed that would have expanded optometric scope despite OPR’s recommendations. The bill died in Committee, but it was clear that some Committee members remained firmly in favor of expansion and tasked OPR to revisit the study.  OPR’s revised study was released late last week. OPR has reversed its 2019 findings and is now recommending that optometric scope expansion move forward to include injections, lasers, and incisional surgery. 

The OPR report can be found here. The legislative recommendations can be found on pages 35-39.

It will be helpful as this unfolds to reach out to your local legislators to express your concerns.  VMS and the Vermont Ophthalmological Society will be reaching out with more information and talking points.

AMA, VMS Urge Congressional Action to Stop Impending Medicare Cuts

The AMA and national and state medical societies, including the VMS, continue to urge Congress to quickly pass legislation to stop another impending round of Medicare payment cuts.  Absent Congressional intervention, physicians are facing a 3.37 percent payment reduction on January 1, 2024 under the CMS 2024 Physician Payment Schedule Final Rule (MFS). 

The combination of ever-increasing practice costs and long stagnated Medicare payment rates has become unsustainable. When adjusted for inflation in practice costs, Medicare physician pay has declined 26 percent from 2001 to 2023. The Centers for Medicare and Medicaid Services (CMS) recently acknowledged that the cost of running a practice will increase 4.6 percent in 2024, yet physicians are being subjected to a 3.37 percent cut next year.  The medical societies emphasize that if Congress does not act by the end of the year to stop this impending payment cut, many physicians will be forced to reduce available health care services, cut office hours, or even forgo treating Medicare patients altogether. America’s physicians and their patients deserve better. You can take action by contacting Vermont’s Congressional Delegation here.  

The AMA has prepared a comprehensive summary of the 2024 Physician Payment Schedule (MFS) Final Rule.  In addition, the AMA has also created the linked specialty impact analysis, which shows the impact of the -1.25% decrease to the conversion factor under current law, as well as the impact of budget neutrality. In addition, the chart includes a table highlighting the impact of both policies on several high-volume services.

Additional links include:  

VMS Board Adopts Pay For Performance Criteria  

The VMS Board met last Wednesday night and adopted a new policy statement: Addressing Ethical Dilemmas in Some of CMS’s Pay for Performance and Value Based Care Programs.   The resolution calls on VMS to advocate to CMS, our Vermont Congressional Delegation and the AMA to adopt principles that should be followed in pay for performance programs, for example excluding venture capital firms and corporate entities that have been found to commit fraud or other deceptive practices from serving as contracting intermediaries.   Two members also presented a new resolution on insurance coverage for obesity treatments, which will be sent to the membership for feedback in December.   AHS Interim Director of Payment Reform updated the Board on the CMS AHEAD model, a new multi-state payment reform option.  The Board also extended the terms of several Board members; elected a new student representative, Surya Radhakrishnan; and set the 2024 dues and budget. 

Submit a Resolution to VMS – Help Direct the Work of YOUR Society

VMS welcomes members to submit resolution ideas.  Resolutions set the policy positions of VMS and often drive VMS advocacy work at the state and federal levels.

Resolutions can be submitted on a year-round basis, any time by any VMS member or group of members, including student members. Resolutions are intended to express composite positions of the VMS and are to suggest a significant course of action to be taken by the Society. To see adopted VMS resolutions, click here.

Once a resolution idea is submitted by a member, the resolution will be reviewed by VMS staff, who may assist with further drafting or clarification.  Resolutions are then distributed for comment and non-binding survey to all membership. At a Board meeting after gathering member feedback, the VMS Board will review the resolution and feedback of membership.  All resolutions presented to the Board then require a majority vote of the Board for action, including adoption, amendment or referral.

To submit a resolution idea, please fill out the form, available here or contact jbarnard@vtmd.org for further assistance.

Application Deadline Extended to Dec 1: VMS ERF Clinician Leadership Course

The Vermont Medical Society Education & Research Foundation is now accepting applications through Friday, December 1st for a 5th statewide Executive Leadership Course beginning in February 2024. VMSERF is pleased to continue to offer an experiential learning opportunity that will enhance and fine-tune leadership skills and concepts for a statewide cohort of Vermont physicians and PAs.  The course will run from February through November 2024.  It is aimed at individuals with 5 or more years of clinical experience but minimal formal leadership training, with a goal of enrolling 15-20 physicians and PAs from across Vermont.  To apply, submit a CV and brief description of interest to swinters@vtmd.org by December 1^st. View the full 2024 brochure, schedule and application information here.

MISC.

Seeking Feedback on Department of Health Proposed Rule Changes: Telehealth Licenses Created, ALS Reporting, Co-Prescribed Naloxone

The Department of Health has released a number of draft rules for comment, described further in the Rounds from last week, available here.  The proposed changes impact:

• The Board of Medical Practice – adding telehealth licensure and registration
• ALS Registry – establishing an ALS reporting registry
• Naloxone co-prescribing – allowing co-prescribing of any opioid antagonist to the Opioid Prescribing Rule
• Hub and Spoke rules: updates to the rules for Office-Based Opioid Treatment (OBOT) Providers and Opioid Treatment Programs (OTP)

Please share comments or concerns regarding any the rule proposals with Jessa Barnard at VMS at jbarnard@vtmd.org by Friday, November 17^th.   

Next Commissioner of Health Call Thursday, December 7th

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members on Thursday, December 7th at 12:30 pm. 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.

Commissioner Levine last joined the VMS for a public health update on November 2nd. You can find the notes here.

Clinician Participation Needed in Community Meetings to Inform Hospital Transformation

In 2022, the legislature passed Act 167 (of 2022) which called for healthcare delivery reform in the state of Vermont, focused on reviewing the services offered in each of Vermont’s hospital service areas.  A central part of the information gathering process is a listening tour to hear directly from health care clinicians and Vermonters about current experiences with the healthcare system.  It is critical that physicians, PAs and other clinicians attend and share input on the services provided in your area.

A schedule of community meetings is available on the Green Mountain Care Board website.   On this page you can register directly for the meeting(s) you’d like to attend in your region.

Provider meetings are all scheduled from 6:30-8:30 pm on the remaining dates:

• Newport / North Country Hospital - November 14, 2023
• Springfield / Springfield Hospital - Wednesday, November 15, 2023
• Rutland / Rutland Regional Medical Center -  Thursday, November 16, 2023

See the full schedule and sign up here: https://bit.ly/Healthcare-Community-Meetings.  

New Resource Guide: Xylazine

UVM Center on Rural Addiction (CORA) is pleased to present a new Resource Guide about xylazine. Please click here or on the image to access, articles, videos, podcasts and other materials meant to educate health professionals on this very important topic. Note that this is a living document and will be updated as needed to reflect current information.

UVM CORA also recently announced that this fall all three Rural Communities Opioid Response Program (RCORP) Rural Centers of Excellence received continued funding from the Health Resources & Services Administration. This will enable UVM CORA to continue its efforts to support rural providers in Vermont and nationally. 

Open Enrollment for 2024 Health and Dental Plans is Underway

From November 1, 2023, through January 15, 2024, Vermonters can sign up for or make changes to their health coverage through Vermont health Connect. Vermont Health Connect is covering nearly 28,000 Vermonters with a qualified health plan (QHP). This number has been trending up as Vermonters transition from Medicaid to QHP coverage. Over 90% of people who are enrolled through the health insurance marketplace qualify for financial help. Eligible Vermonters in single plans may now qualify for lower costs with incomes up to $134,000. Those in family plans may qualify with incomes up to $376,000.  This year's Open Enrollment is especially important for Vermonters who may have lost Medicaid coverage or otherwise became uninsured in the last year. 

Please share this information about Open Enrollment with your employees, colleagues and patients. Materials are available in the Communications Toolkit for 2024 Open Enrollment

VITLAccess for VMS Webinar, Dec 5^th

This webinar, hosted by VITL in collaboration with the Vermont Medical Society, will serve as in introduction (or reintroduction) to VITLAccess for clinicians. The focus will be how clinicians and staff at hospitals and practices around Vermont are using VITLAccess, and how you and your organization's staff can begin using this tool to access more complete health information about the patients you serve.

This webinar, hosted by VITL, will be held on Tuesday, December 5^th from 12:15-1:00. Register here. A recording will be available to registrants after the session.

A one-page overview document about VITLAccess is available here.

HHS Proposes Rule to Establish Disincentives for Health Care Providers that have Committed Information Blocking

The U.S. Department of Health and Human Services (HHS) requests public comment by January 2, 2024 on a proposed rule that would establish disincentives for health care providers found by the HHS Office of Inspector General (OIG) to have committed information blocking – when a provider knowingly and unreasonably interferes with the access, exchange, or use of electronic health information except as required by law or covered by a regulatory exception.  Proposed penalties would include reducing a practice’s interoperability performance category of the Merit-based Incentive Payment System (MIPS) or disqualifying a practice from participating in the Medicare Shared Savings Program.  See more information about the proposed rule here. See additional background and compliance information with the Information Blocking rules here.

You Are Invited to the 2024 Vermont Voices of Medicine Advocacy Breakfasts

Please join us in January to meet your lawmakers and to advocate for health care policies over coffee and a light breakfast. These breakfasts, which will be held in the cafeteria at the Vermont Statehouse in Montpelier, are an informal opportunity to educate lawmakers on ways to improve Vermont's practice environment. Each breakfast starts on specific Thursdays and runs from 7:30-9 AM. 

The Vermont Medical Society (VMS) will be hosting several of the breakfasts with others hosted by the Vermont Academy of Family Physicians, the American Academy of Pediatrics Vermont Chapter, the Vermont Ophthalmological Society, the Vermont Psychiatric Association, the OB/GYN residency program, and Larner College of Medicine medical students. Please RSVP to attend the breakfasts being hosted by the specialty society of which you are a member. The VMS advocacy breakfasts are open to all specialties to attend. Please reach out to Jill Sudhoff-Guerin at jsudhoffguerin@vtmd.org if you have any questions. 

Click here for the list of dates & to register. 

Click here for more information. 

EVENTS

CPT & RBRVS 2024 Annual Symposium

November 15-17, 2023

CPT & RBRVS 2024 Annual Symposium is the world's only medical coding conference where attendees learn about the upcoming changes to the Current Procedural Terminology (CPT) code set and payment policies directly from members of the AMA-convened CPT Editorial Panel, AMA/Specialty Society Relative Value Scale Update Committee (RUC), and CPT and RUC Advisors.

Join virtually to get the first look at the 2024 CPT code set with guidance from the experts, earn continuing education credits, and join over a thousand of your peers for premier coding education at the CPT & RBRVS Symposium!

Register with early bird discounted rates through September 30th here.

Emergency Medicine Update

January 16-19, 2024

The Lodge at Spruce Peak, Stowe, VT

Learn more and register here.

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.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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