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NEED TO KNOW
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UVM Health Network Announces Administrative Cost Cuts and Clinical Service Reductions
As has been widely covered by the media, last Thursday the UVM Health Network announced plans to reduce administrative expenses and reduce patient clinical services as a result of Green Mountain Care Board budget orders. The cuts include the following, with additional detail in the full press release, available here:
- Reduce the number of patients who stay overnight at University of Vermont Medical Center from approximately 450 to 400 and limit regional incoming non-emergency patient transfers.
- Eliminate surgical renal transplants at University of Vermont Medical Center and collaborate with Dartmouth Health on care alternatives. University of Vermont Medical Center performed approximately a dozen kidney transplants this year.
- End University of Vermont Health Network staffing and operation of kidney dialysis clinics outside of its primary service areas in Vermont, impacting approximately 220 patients across three clinics in St. Albans, Rutland and Newport.
- Consolidate some Family Medicine and Rehabilitation clinics that are part of Central Vermont Medical Center by merging its Family Medicine main campus and Mad River sites with existing sites - which should not impact access to CVMC-run primary care services for existing patients.
- Close the Inpatient Psychiatric Unit at CVMC, which has had an average daily census of approximately eight patients.
- Cut more than $18 million in administrative expenses, with reductions in expenses, open positions and employees.
An additional Q&A document authored by Health Network CEO Sunny Eappen, MD, addresses questions such as whether the GMCB was aware or approved of the cuts, whether the Health Network had options other than making services cuts and whether salary cuts for leaders would have avoided cuts to patient care. VMS welcomes questions and concerns from members regarding the impact of these cuts and can help facilitate having questions answered by the Health Network. Please reach out to jbarnard@vtmd.org. |
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Understanding Senate Confirmation and Recess Appointments
As the incoming Trump administration begins to take shape, many in the healthcare community are expressing concerns about the potential impact of key Cabinet appointments on healthcare policy. These appointments, which include leadership roles overseeing Medicare, Medicaid, public health funding, and regulatory decisions, have far-reaching implications for physicians, PAs and patients alike. Understanding the processes of Senate confirmation and recess appointments is essential for advocating for leaders who prioritize patient access to care and evidence-based health care practices.
Senate Confirmation
Under the U.S. Constitution, many high-ranking federal positions require Senate confirmation. The process is designed to ensure that appointees are qualified and reflect the nation's interests. Here's how it works:
- Nomination: The President nominates an individual for a role.
- Committee Hearings: Senate committees hold hearings to evaluate the nominee's qualifications, vision, and potential conflicts of interest.
- Full Senate Vote: After the hearings, the nominee goes to the full Senate for a vote. A simple majority is needed for confirmation.
This process enables the Senate to vet appointees thoroughly, ensuring accountability and transparency.
Recess Appointments
When the Senate is not in session, the President can make recess appointments to fill vacancies temporarily. This process is outlined in Article II, Section 2, Clause 3 of the Constitution.
- How It Works: During a Senate recess, the President appoints someone to a vacant position without waiting for Senate approval.
- Duration: The appointee serves until the end of the Senate’s next session. If not confirmed by the Senate before this deadline, the position becomes vacant again.
- Controversy: Recess appointments can bypass Senate oversight temporarily, leading to tension between the executive and legislative branches.
VMS is actively monitoring appointments and engaging with our senators to advocate for healthcare leaders who prioritize patient care and evidence-based medicine. VMS members can amplify these efforts by contacting Senators Sanders and Welch directly to share feedback on proposed appointments.
Contact Senator Bernie
Sanders and Senator
Peter Welch. |
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Legislative Work Groups Nearing Conclusion – Psychedelics, Cannabis, Naturopaths Under Review
The 2024 legislative session directed a number of study and work groups to provide reports back to the 2025 legislature. VMS staff and members participated in a number of work groups related to health care, ranging from the Medicaid fee schedule methodology to how medical conditions are added to the cannabis program. A number of the groups are nearing conclusion or have finished reports, including:
- The Psychedelic Therapy Advisory Group, tasked to make findings and recommendations regarding the advisability of the establishment of a State program to permit healthcare providers to administer psychedelics in a therapeutic setting. The majority of the work group ultimately did not recommend the creation of a state program for psychedelic therapy at this time but recommended extending the current working group with the expansion of participants to monitor the evolution of research and programs across the country. See the final report here.
- Medicaid Fee Schedule: VMS staff is meeting regulatory with the Department of Vermont Health Access to propose alternative methodologies for the Medicaid professional fee schedule to avoid mirroring Medicare cuts in the Medicaid fee schedule. The group is still meeting and a report is due to the legislature from DVHA by January 15th, 2025.
- The Naturopathic Physicians Technical Advisory Group, of which the Vermont Medical Society is a member, was charged in this year’s OPR bill with providing recommendations to the House and Senate Health Care and Government Operations Committees on authorizing naturopathic physicians to participate in Vermont’s Patient Choice at End of Life law, do not resuscitate (DNR) orders and advanced directives, and clinician orders for life-sustaining treatment (COLST). The group met several times over September and October . The majority of the members expressed that while naturopaths provide primary care and play an important role in discussing end of life decisions with their patients, both DNR/COLST and Act 39 require specific medical education and training on interventions that do not appear from available evidence to be standardized or taught in naturopathic training. The Vermont Department of Health is completing comments to submit to the legislature.
- Cannabis Regulation: Act 166 contained several studies including two that the Vermont Medical Society was named to participate in regarding cannabis advertising restrictions and an assessment of the Medical Cannabis Program. The Cannabis Control Board recently released a draft report and VMS submitted comments in response, emphasizing support for the creation of a non-legislative entity to evaluate new qualifying conditions and the need to reestablish the requirement for a bona fide healthcare relationship prior to the medical endorsement process for cannabis retailers going into place. VMS comments also raised concern with the State acquiring a state-owned license to an online tool called “Cannify.us” and whether the app can serve as an unbiased source of evidence-based cannabis education.
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DEA and HHS Extend Telemedicine Flexibilities through 2025
Last week the DEA, jointly with HHS, extended current telemedicine flexibilities allowing the prescribing of controlled substances without an in-person visit through December 31, 2025.
In 2023, in response to a set of proposed telemedicine rules, DEA received more than 38,000 comments and held two days of public listening sessions. In light of that feedback and discussion, DEA and the Department of Health and Human Services (HHS) extended current telemedicine flexibilities through the end of 2024 and just announced the extension again for 2025 as they “continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations.” See the announcement here. |
MISC.
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Reminder Vermont MD Licenses Expire November 30th
A reminder to all MD
members that MD licenses expire on November 30th of this year. If you did
not already submit your renewal by November 16th it may not be able to be processed before the
November 30th expiration date. Any license issued
prior to September 1st of this year will also expire on November
30th. For more information, including CME hour requirements for 2024 and
CME FAQs, see the Board of Medical Practice website, here: https://www.healthvermont.gov/systems/board-medical-practice/applications-licensing-and-fees.
For information on no- or low- cost courses that meet the CME
requirements, see the VMS CME webpage here: https://vtmd.org/cme-requirements-and-course-resources. |
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Vermont Clinician Prior Authorization Impact Survey Still Open
VMS has launched a survey to inform policy makers regarding the impact of prior authorizations on your health care facility/practice and patients. This survey was requested by the Vermont legislature in Section 7(a) of Act 111 of 2024 to measure the impact of the law on prior authorizations both before and after the law goes into effect on January 1. Thank you in advance for your assistance in completing the survey! Your input is very important! Contact the Vermont Medical Society with questions at https://vtmd.org/contact-us.
Please find the links below.
Clinician Survey Link. Intended for clinicians who participate in the prior authorization process.
Practice Administrator Link. Please have the practice or facility staff familiar with the prior authorization process and staffing at your location complete this survey for your practice. Please only complete once per facility/practice. |
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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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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. |
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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