November 29, 2022

NEED TO KNOW

Green Mountain Care Board Approves Extension of Current All-Payer Model Agreement

In late 2021, Vermont submitted a request to the Center for Medicare and Medicaid Innovation (CMMI) to extend its All-Payer Model (APM) Agreement for one year to allow the state more time to develop a proposal for a subsequent agreement and to engage partners; this request included a list of proposed technical changes for the extension period. CMMI responded in April 2022 with an offer of a one-year extension plus an additional year at the State’s option. These extensions would provide a bridge to a new federal-state model, which would likely start in 2025.  At its meeting yesterday, the Green Mountain Care Board approved the terms of an extension.  The participation and payment models for health care facilities and professionals largely continue unchanged from prior years of the APM Agreement, including potential for shared savings and shared risk. Vermont will continue to receive Medicare funding for the Blueprint for Health (including Blueprint payments to participating primary care practices and Community Health Teams) and Support and Services at Home (SASH) program. For a more detailed summary of the extension, see the GMCB presentation here and summary document here. At the same time, the Agency of Human Services and GMCB are convening stakeholders to begin discussions of a new federal model, still to be developed by CMS and begin in 2025. It is likely that such a model would be built for multiple states – rather than individual to Vermont - and include global hospital budgets and a total cost of care benchmark for the state. Notes from the most recent stakeholder meeting outlining discussions with CMMI can be found here. 

Next VMS Public Health Update with the Commissioner of Health, Mark Levine, M.D. is December 1st at 12:30pm EST

The next time we will speak with the Commissioner of Health will be December 1st where he will provide us with the most pressing information affecting the state and nation. You will have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting. Notes from the call with the Commissioner held last Thursday, Nov. 17th can be found here.

You can join the zoom meetings here which take place on the 1st and 3rd Thursday of the month from 12:30pm to 1pm EST or add to your calendar by following this link and clicking download (you will then need to open the downloaded file and click save to add to your calendar).

MISC.

Applications Still Open for 2023 VMS ERF Leadership Course – A Few Spots Remaining!

The Vermont Medical Society Education & Research Foundation is open for enrollment for a 4th statewide Physician Executive Leadership Institute Foundational Course beginning in January 2023.

This course is offered in partnership with the Daniel Hanley Center for Health Leadership and Lumunos and is supported by funding from the Physicians Foundation. Perhaps more than ever before physicians and PAs are being asked to step up and skillfully lead rapid change. Every clinician is being called upon to bring their leadership and management styles and skills to the forefront to ensure the best outcomes for Vermont patients. 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 January through November 2023.  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.  Rolling applications now being accepted through December 9^th (new extended deadline). View the full 2023 brochure, schedule and application information here.

HHS Proposes Updates to SUD Record Confidentiality Requirements

Yesterday, the U.S. Health and Human Services Department, through the Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), announced proposed changes to the Confidentiality of Substance Use Disorder (SUD) Patient Records under 42 CFR part 2 (“Part 2”), which protects patient privacy and records concerning treatment related to substance use challenges from unauthorized disclosures. Specifically, the proposed rule is intended to allow increased coordination among providers in treatment for substance use challenges and to increase protections for patients concerning records disclosure to avoid discrimination in treatment. Currently, 42 CFR Part 2 imposes different requirements for SUD treatment records protected by Part 2 than the HIPAA Privacy Rule, which can create barriers to information sharing by patients and among health care providers and create dual obligations and compliance challenges for regulated entities. Proposed changes to Part 2 include:

• Permitted use and disclosure of Part 2 records based on a single patient consent given once for all future uses and disclosures for treatment, payment, and health care operations.
• Permitted redisclosure of Part 2 records in any manner permitted by the HIPAA Privacy Rule, with certain exceptions.
• New patient rights under Part 2 to obtain an accounting of disclosures and to request restrictions on certain disclosures, as also granted by the HIPAA Privacy Rule.
• Expanded prohibitions on the use and disclosure of Part 2 records in civil, criminal, administrative, and legislative proceedings.
• New HHS enforcement authority, including the imposition of civil money penalties for violations of Part 2.
• Updated breach notification requirements to HHS and affected patients.

HHS is encouraging all stakeholders, including patients and their families, health care professionals and health care professional associations to submit comments through regulations.gov. Public comments are due 60 days after publication of the proposed rule in the Federal Register. The NPRM may be viewed or downloaded here. A fact sheet can be found here.

EVENTS

Cannabis Symposium

Thursday, December 1, 2022

11:30am to 4:30pm EST

The Cannabis Symposium is a one-day series of web-based trainings on the ever changing landscape of cannabis. 

Agenda topics include

• Cannabis & College Students: Mental Health, Memory Effects, and More
  
• Cannabis Advertising & Social Media
  
• Cannabis Impaired Driving
  
• Cannabis & Recovery
  
• Effective Strategies for Talking to Students about Cannabis
  
• Cannabis Policy & Regulation
  

Learn more and register here.

Ukrainian Humanitarian Parolees: Tuberculosis

Thursday, December 1, 2022

11:30am to 12:30pm EST

Learning objectives of this free webinar:

• Describe the epidemiology of tuberculosis in Ukraine.
• Review LTBI and TB disease workup and management.
• Identify two to three tuberculosis-related technical assistance resources

Register here.

Emergency Medicine Update

January 22 - 25, 2023

In-Person - Lodge at Spruce Peak, Stowe, VT

This course will discuss a variety of timely, practical issues that are encountered in the emergency department on a daily basis. Lectures will be engaging, sometimes controversial, and present the audience with examples of both successes and failures in emergency medicine. At the end of this program, participants should be able to distinguish between advancement and change in the emergency department in a relaxed, family-oriented environment where learning does equal fun!

All emergency medicine professionals are welcome.

Hospital Medicine 2023

January 29 - 31, 2023

In-Person - Lodge at Spruce Peak, Stowe, VT

This course will provide practical approaches to common problems in hospital medicine informed by experts and the latest evidence. Target audience: physicians, physician assistants, nurse practitioners, and nurses practicing Hospital Medicine. Also open to program administrators, resident physicians, and medical students with an interest in careers in Hospital Medicine. Topics will include: Curbing the Opioid Crisis, Pharmacy Pearls, Long COVID, Biliary Disease, End of Life Care in the Hospital. Optional workshop: POCUS

Eastern Winter Dermatology Conference

February 2 - 5, 2023

In-person - Stoweflake Mountain Resort & Spa, Stowe, VT

The 34^th Annual Eastern Winter Dermatology conference is designed to provide high-level continuing education for dermatologists and medical professionals specializing in dermatology, keeping them abreast of new and exciting findings in basic science, clinical dermatology and dermatologic therapy. Primary care physicians and medical professionals with a special interest in dermatology are also welcome to attend. Topics will include: Acne & rosacea update, innovations in connective tissue disease management, diagnosis of early CTCL, hidradenitis suppurativa, pediatric psoriasis issues, professional development - “how to say no,” erythema migrans pearls, management of high risk skin cancer, medical pearls from the literature and more!

2023 Epilepsy & EEG in Clinical Practice

February 10, 2023

In-person - Main Street Landing, Burlington, VT

Held in Burlington for the first time, the 2023 Epilepsy & EEG course will focus on providing a review of current medical and surgical clinical practices related to seizures and conjunction with adjunctive EEG testing and will address errors that may lead to incorrect diagnosis and treatment. An interactive and didactic format that includes multimedia presentations and allows for audience participation. Target audience: internists, family practice and general practice physicians, pediatricians, neurologists, physician assistants, nurses, allied health professionals and residents involved in the care of patients with seizures and epilepsy are encouraged to attend.

Note: This is being held in conjunction with the EAEEG Annual Meeting. There is a discount for attending both events.

More conferences from UVM CMIE are expected this Spring to include these topics: Anesthesia, Cardiovascular/Vascular Disease, Geriatrics and Family Medicine. Sign-up to get updates via email for topics that are of interest here

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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