November 18, 2025

NEED TO KNOW

AMA House of Delegates Meets in Maryland – Addressed by Dr. Oz

The American Medical Association (AMA)’s House of Delegates met last Friday through this Monday in National Harbor, Maryland for its interim meeting to consider policy resolutions.  Vermont is represented by Delegate Cathy Schneider, MD and alternate delegate Simi Ravven, MD.  The full AMA House of Delegates was addressed on Monday morning by CMS Administrator, Dr. Oz, who identified areas of common cause with the AMA, including reducing prior authorization and positioning Medicare as the leading payer – giving the example of negotiating lower drug costs for GLP-1s.  He also provided his perspective on recent cuts to Medicaid as preserving the program for the future and protecting it from overexpansion to the “able bodied” and concerns with subsidies for health insurance plans on the exchange as leading to extensive fraud.  He called on physicians to be open to questions and curiosity about accepted doctrine and to “sheath their swords” and be open to engaging with the administration on these issues.  See the AMA statement on the speech here.  Other topics receiving significant attention at the meeting included the AMA clarifying its position on the use of health savings accounts in lieu of health insurance subsidies and the role of AI in the future of medicine and medical education. 

Registration Open: 2026 Legislative Breakfasts

Please join us in 2026 to meet your lawmakers and to advocate for health care policies over coffee and a light breakfast.  These breakfasts, which will all be held in the cafeteria from 8-9am at the Vermont Statehouse in Montpelier, are an informal opportunity to educate lawmakers on ways to improve Vermont's practice environment.

The Vermont Medical Society (VMS) will be trading off hosting the breakfasts with the Vermont Academy of Family Physicians, the American Academy of Pediatrics Vermont Chapter, the Vermont Ophthalmological Society.

Registration is now available! Register here. 

Vermont Medical Society - All MD, DO, PA and Medical Students Encouraged to Join

• January 21, 2026
• April 29, 2026

Vermont Ophthalmological Society

• February 4, 2026

Vermont Academy of Family Physicians

• February 18, 2026
• April 1, 2026

American Academy of Pediatrics Vermont Chapter

• March 18, 2026
• April 15, 2026

Learn more and RSVP for any of the dates here. Please reach out to Jill Sudhoff-Guerin at jsudhoffguerin@vtmd.org if you have any questions.

Key Telehealth Flexibilities Now Extended Through January 2026

The continuing resolution passed by Congress and signed by President Trump last week extends previous Medicare telehealth flexibilities through January 30, 2026. These flexibilities include the following:

• A patient’s home can be the originating site and there are no geographic restrictions for Medicare non-behavioral telehealth visits
• Federally Qualified Health Centers and Rural Health Centers can serve as distant-site providers
• Audio-only non-behavioral telehealth visits
• Telehealth meets the face-to-face recertification requirements for hospice care
• Expanded provider eligibility for general telehealth (i.e., occupational therapists, physical therapists, speech-language pathologists, and audiologists)
• Delayed in-person visit requirements for behavioral telehealth visits

VMS has received conflicting reports at this time regarding retroactive reimbursement for Medicare services provided back to October 1, 2026 and will share more information as it becomes available.  Read more here.   The DEA has also posted a notice indicating that it will once again extend prescribing flexibilities waiving the need for in-person visits for prescribers that prescribe controlled substances via telehealth.  Read more here.

Final 2026 Medicare Fee Schedule Rule Summary and Analysis

The American Medical Association has completed a more detailed summary and analysis of the 2026 Payment Policies under the Medicare Physician Payment Schedule (PFS) and Other Changes to Part B Payment and Coverage Policies final rule.  Click here for the summary and here for a Specialty Impact Table. 

All physicians will benefit from positive conversion factor updates for 2026, including a 3.77 percent increase for advanced alternative payment model (APM) qualifying participants (QPs) and a 3.26 percent increase for all other physicians. The conversion factor increases reflect:

• A temporary 2.5 percent pay bump passed by Congress in H.R. 1;
• Small, permanent updates to the baseline as required under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2025, including a 0.75 percent increase for QPs and a 0.25 percent increase for all other physicians; and
• A positive 0.49 percent budget neutrality adjustment.

The budget neutrality adjustment results from misvalued code changes and a -2.5 percent “efficiency adjustment.” Although AMA comments raised several questions about the efficiency adjustment and recommended alternative approaches to achieve CMS’ objectives, CMS is moving forward with the negative adjustment. Based on the methodology used, this will result in a significant shift of payment between sites-of-service. Payment for physician services performed in facilities (regardless of whether the physician is employed by the facility or in independent practice) will decrease overall by -7 percent while payment for physician services performed in non-facility settings will increase on average by 4 percent.

The final rule summary provides additional detail about these changes, discusses other Medicare physician payment policies finalized for 2026, and describes the positive and negative impacts on the physicians affected by these policies, which include:

• Telehealth;
• Individual code changes and valuations;
• Skin substitutes;
• Geographic Practice Cost Indices (GPCIs);
• Medicare Diabetes Prevention Program (MDPP);
• Medicare Shared Savings Program (MSSP)
• Merit-based Incentive Payment System (MIPS);
• MIPS Value Pathways;
• Advanced alternative payment models; and
• Ambulatory Specialty Model.

Vermont Releases Rural Health Transformation Fund Application – Shared Services, Primary Care, Workforce at the Center

Last week, Vermont’s Agency of Human Services shared publicly its application for the Rural Health Transformation Fund, the national pool of $50 billion provided over five years (2026–2030). Each year, $10 billion will be awarded to states. Vermont’s exact allocation will be determined by the federal government after reviewing our application.    The application and a summary can be found here.  Projects proposed for funding include:

The Vermont Medical Society and other health care associations submitted a joint letter of support for the application, which can be found at the end of the application here.  Awards are expected by December 31, 2025.

The Agency of Human Services also distributed yesterday an update on Health Care Transformation activities, providing a narrative report on the outcomes and next steps in their conversations with hospital leaders across the state and their interest in better communications, more coordinated transfers and shared services. 

MISC.

VDH Health Alert: Increased Pertussis Activity

Pertussis cases are increasing in Vermont with 36 cases reported since September 1. Additional suspect cases are under investigation. Although cases have occurred in multiple counties, most (n=23, 64%) have occurred in children and adolescents in Washington (n=18) and Lamoille (n=5) Counties; 16 cases are associated with a Washington County school outbreak with all cases being unimmunized or incompletely immunized for pertussis.

Requested Actions

Consider pertussis as a diagnosis for anyone who has at least one of the following conditions, regardless of vaccination history:

• Cough illness of any duration with either paroxysms, inspiratory whoop, post-tussive vomiting/gagging, or apnea (with or without cyanosis) in a person who has been exposed to pertussis, especially anyone who has been notified of potential exposure.
• Cough illness lasting ≥ 2 weeks with either paroxysms, inspiratory whoop, post-tussive vomiting/gagging, or apnea (with or without cyanosis), even without a known exposure history.

In infants, apnea may be the only symptom, and cough may be minimal or absent. In adolescents and adults, illness is generally less severe, and the typical “whoop” occurs less frequently. When the patient has close contact with an infant or others at increased risk for pertussis complications, have a lower threshold for considering pertussis.

Report all suspected and confirmed cases to the Health Department Infectious Disease Epidemiology program at 802-863-7240, option 2 (24/7).

For more information on testing and treatment read the full Alert here.

Department of Mental Health Quarterly Report Provides Update on the VT Consultation and Psychiatry Access Program and Other Mental Health Initiatives 

The Vermont Department of Mental Health (DMH) included in their November 2025 Quarterly Report new data regarding utilization trends and benefits of the VT Consultation and Psychiatry Access Program (VTCPAP). VTCPAP is a statewide service connecting medical providers to licensed clinical social workers and board-certified psychiatrists for real-time consultation on mental health diagnosis, treatment, medication, and referrals.  The VTCPAP data found that practices in all 14 Vermont counties are enrolled in VTCPAP, with 11 out of 14 counties having 50% or more of their existing eligible practices enrolled in VTCPAP. The report highlights survey data showing that VTCPAP consultation services increase provider confidence and knowledge, expand clinical expertise, and decrease the likelihood of provider burnout. 60% of surveyed providers reported that, without VTCPAP, they would have had to refer out the patients who benefited from consultation services. Additionally, 85% reported improved work life because of VTCPAP support. 

The report also highlighted DMH’s work to meet future system capacity needs, through the planning and development of the Southern Vermont Medical Center’s Youth Inpatient Facility and the creation of a Psychiatric Residential Treatment Facility (PRTF) in Vermont to help reduce the number of children placed out of state for care. 

DMH also reported that they are in the process of hiring a Mental Health Workforce Development Director, a newly established position designed in part to shrink the current mental health workforce shortage which, as reported by the DAs/SSAs is 14%, with 861 out of 5,863 positions open.  

Mildred Reardon Medical Student Scholarship Open for Applications for Class of 2027

Do you dream of becoming a Vermont doctor? 

The Vermont Medical Society’s Education and Research Foundation (VMSERF) is now accepting applications for the Mildred Reardon scholarship, which awards $10,000 to a University of Vermont Larner College of Medicine student committed to practicing medicine in Vermont.

The scholarship will be made to a Class of 2027 student interested in any specialty, with a preference for specialties in high need in Vermont.  The scholarship is tuition-linked and is paid directly to the College of Medicine towards tuition. Applications are due December 12, 2025.  Click here for more information and details on applying for the scholarship.

EVENTS

New England History of Medicine Society: Noah Webster: Proto Epidemiologist with Richard Kahn, MD

November 18, 2025

Virtual

Noah Webster (1758-1843), best known for the dictionary that bears his name (1828), was also an educator, newspaper editor, lawyer, and politician, and he advocated for universal education, social welfare, and public health. Less well known are his efforts to understand the causes and prevention of diseases such as yellow fever that plagued the young nation, Though not a physician, between 1796 and 1800 Webster published two books and many articles on disease, public health, yellow fever, and quarantine, and this work catalyzed the creation of the first U.S. medical journal, The Medical Repository (1797-1824).

Richard Kahn's research explores Webster’s medical writings, their publication challenges, and contemporary responses.

Learn more and register here.

Dartmouth Health: 2025 NNEPQIN Fall Conference

November 19 - 21, 2025

Omni Mount Washington Resort, Bretton Woods, NH

Registration is open for the NNEPQIN Fall 2025 Conference! The conference will be taking place November 19-21, 2025, at the Omni Mt. Washington Resort in Bretton Woods, NH. A pre-conference opportunity is available on Wednesday, November 19, 2025, with either the obstetric track or neonatal track options. The pre-conference is available for actively practicing inpatient providers (MD, DO, CNM, and RN). Registrants can attend just the pre-conference if desired, or join for the main conference as well!

We have presentations related to TeleOB, neonatal cooling, inclusive care for LGBTQIA+ patients, breastfeeding support, SUD and cannabis use in pregnancy, adoption and legal considerations, shared decision-making and its impact on moral injury, postpartum mental health, NICU transitions, and more. We have topics to inspire every member of your care team—covering prenatal, delivery, postpartum, and neonatal follow-up. We hope your interprofessional team will participate!

Learn more and register here.

2026 Hospital Medicine Conference

February 4-6, 2026

Topnotch Resort, Stowe, VT

This conference will focus on key clinical advancements and guidelines to ensure optimal patient care. The target audience is comprised of physicians, physician assistants, nurse practitioners, pharmacists and nurses practicing in hospital medicine. We also encourage hospital medicine program administrators, resident physicians, and medical students with an interest in careers in hospital medicine.

Please visit the conference website the agenda and registration link here.

AlpTerra Wilderness Medicine Course

March 5–9, March 12–16, October 1–5, October 8–12, 2026

Franconia, New Hampshire

Join Alpterra for an immersive, hands-on wilderness medicine course designed to prepare you for real-life scenarios in the outdoors. Treat mock injuries, problem-solve in the elements, and walk away with practical skills that stick.

• Max 4:1 participant-to-instructor ratio for highly personalized, discussion-driven learning.
• Accredited for up to 16 AMA PRA Category 1 Credits™ — an excellent use of your CME allowance.
• Stay on-site in a luxury home-style setting. Enjoy locally sourced, family-style meals tailored to dietary needs.
• Add-on trips let you ski, climb, or explore the White Mountains with expert guides before or after your course.

Learn more about the agenda and registration here.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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