November 8, 2022


Thank You for Joining us at Our 209th Annual and Collaborative Meeting

The Vermont Medical Society (VMS) physician and physician assistant members met this month for the 209th VMS Annual meeting. Hosted in collaboration with the American Academy of Pediatrics Vermont Chapter, the Vermont Academy of Family Physicians, and the Vermont Psychiatric Association, this was the first in-person meeting since 2019. During the meeting, VMS members elected a new slate of 2023 Society officers, including electing Ryan Sexton, MD, as the VMS President, awarded the Mildred Reardon medical student scholarship and honored 2022 VMS Leadership awardees. Members also recognized Simi Ravven, MD, for her two years of service as VMS President from 2020-2022.

Read the full press release here.

November 2022 Resolution Feedback – Survey Closing Today

The VMS member survey to provide feedback on four proposed VMS policy resolutions closes today. The resolutions propose action-oriented solutions to address protections for receiving/providing cross-state health care, coverage for preventive screenings, access to health care while in police custody and increasing Vermont’s Workers’ Compensation Fee Schedule. All members are encouraged to provide feedback and non-binding comments on the resolutions by the end of the day today. If you did not receive your survey links or have any questions or concerns with completing the survey please contact

The resolutions next will be discussed together with the feedback received from members by the VMS Board for potential action at its November 16th Board Meeting.  Resolutions are now considered by the VMS Board on a year-round basis and members can submit resolution topics for consideration at any time.  For more information on the resolution adoption process see:  Members wishing to listen to the VMS Board discussion or share feedback at the Board meeting can contact for zoom log-in information.   

CMS Issues Final 2023 Medicare Physician Fee Schedule Rule – Cuts Pending

Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2023 Medicare Physician Payment Schedule final rule.  The CY 2023 Medicare conversion factor (CF) is $33.06, a decrease of $1.55 or 4.5% from the 2022 CF of $34.61. The decrease is largely a result of an expiring 3 percent increase funded by Congress through 2022. The additional approximate 1.6 percent decrease is the result of budget neutrality requirements that stem from revised E/M changes contained in the rule. The AMA and state and national medical societies are strongly advocating that Congress avert this payment cut, as well as implement an inflationary update for physicians.   VMS is particularly concerned that cuts to the Medicare conversion factor will also be mirrored in the Vermont Medicaid fee schedule.  Please reach out to Vermont’s Congressional Delegation to urge a fix to these pending cuts.

Other changes made by the rule include:

  • CMS adopted revised CPT guidelines and codes and the AMA/Specialty Society RVS Update Committee (RUC) recommended relative values for additional E/M visit code families, including hospital visits, emergency department visits, home visits and nursing facility visits.
  • In response to the Consolidated Appropriations Act, which extended payment for telehealth services to all communities in the country, not just rural areas, and allowed patients to receive telehealth services in their home for 151 days, or five months, after the end of the COVID-19 public health emergency (PHE) ends, CMS finalized its proposal to extend telehealth coverage for the codes that were only going to be on the telehealth list through the end of the PHE for an additional five months.  For example, Telephone E/M visit codes (CPT codes 99441, 99442, and 99443) will continue to be paid for 150 days after the end of the PHE. 
  • Steps to make it easier for Medicare beneficiaries to get mental and SUD health services, such as paying for clinical psychologists and licensed clinical social workers to furnish integrated behavioral health care as part of a primary care team and a new monthly payment for comprehensive treatment and management services for patients with chronic pain.
  • Medicare will now reduce the minimum age for colorectal cancer screening from 50 to 45 years and pay for dental examinations and treatments in more circumstances.
  • CMS finalized the proposal to annually update the payment amount for vaccine administration services.

More information from the AMA and VMS will be available after staff have reviewed the final rule in more detail. Please see the following documents for more information:

Vermont Medicaid (DVHA) Proposed Changes to Prior Authorization

The Department of Vermont Health Access, Vermont Medicaid, is proposing a number of changes to prior authorizations in order to implement recommendations from a legislative report “Clinical Prior Authorization Requirements in the Vermont Medicaid Program: Findings and Recommendations.”  The intent is in part to align prior authorization for ACO and non-ACO attributed Medicaid members.  As the report found, “The waiver of prior authorization in the Vermont Medicaid Next Generation ACO program has shown promise in reducing administrative burden in some instances while having little negative impact on cost and utilization for the Department as a payer. Because the Vermont Medicaid Next Generation program has demonstrated significant growth and a greater and greater proportion of its members qualifying for the waiver of prior authorization year over year, a single set of rules around prior authorization for Medicaid is crucial to decrease confusion and reduce administrative burden both on providers and the Department.”   The proposed changes are open for public comment through December 2, 2022.  Please reach out to Jessa Barnard at VMS as by November 28th with questions or concerns so that these can be submitted to DVHA.

The proposed changes include:

Read more here: Global Commitment Register (GCR) proposed policy 22-101: Changes to Prior Authorization Requirements and Global Commitment Register (GCR) proposed policy 22-102: Changes to ACO and Out-of-Network Prior Authorization Requirements.  

Increased Respiratory Virus Activity, Especially Among Children, Early in the 2022-2023 Fall and Winter

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about early, elevated respiratory disease incidence caused by multiple viruses occurring especially among children and placing strain on healthcare systems. Co-circulation of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2, and others could place stress on healthcare systems this fall and winter. This early increase in disease incidence highlights the importance of optimizing respiratory virus prevention and treatment measures, including prompt vaccination and antiviral treatment, as outlined below.

Learn more here.

Next VMS Public Health Update with the Commissioner of Health, Mark Levine, M.D. is November 17th at 12:30pm EST

The next time we will speak with the Commissioner of Health will be November 17th 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. 3rd can be found here. Commissioner Levine discussed new COVID-19 recombinants, RSV, influenza and other public health topics.

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).


Governor's Commission on Alzheimer's Disease and Related Disorders (ADRD) Seeks a Member to Represent Physicians

The ADRD was founded by statute in 1991 with the charge of identifying key public policy issues related to ADRD, educating the public and private sectors regarding these matters and making policy recommendations in support of developing programs and services essential to providing accessible and appropriate services to people with dementia illnesses and to their families and other care partners. The ADRD consists of 17 members representing various sectors and regions of the state. We meet virtually every other month for 2 hours. For more information or to submit an application please contact ADRD Chair, Meg Polyte

    Vermont Initiative Gives Clinicians New Tools for Infectious Disease Diagnosis and Response

    The Vermont Department of Health has launched a first-of-a-kind program to support healthcare professionals with timely information on disease diagnosis, testing, treatment and patient education resources — improving public health response statewide.  The Clinician Support Initiative provides access to a vast collection of images and clinical information about public health threats, including hMPXV (human monkeypox virus), COVID-19 and Lyme disease. Available on the web or through an app, these tools help improve the speed and accuracy of diagnosis and facilitate the timely reporting to public health for diseases of public health significance.  These resources are being made available to Vermont healthcare professionals in partnership with VisualDx, a healthcare informatics company based in Rochester, NY. A phased rollout is currently underway, and all Vermont medical professionals can expect access by the end of the year.

    See the full news release here. For more information about the initiative and how to enroll, visit

      CDC Releases UPDATED Clinical Practice Guideline for Prescribing Opioids for Pain

      Last Thursday, the Centers for Disease Control and Prevention (CDC) released updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations can be found here: CDC Clinical Practice Guideline for Prescribing Opioids for Pain. The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. The final version emphasizes clinical judgment rather than MME limits on opioids. A summary, Guidelines at a Glance can be found here, and an overview of what is new and changed in the rules can be found here.  

      Providing Health Care to Refugees Final Webinar: Medical Legal Partnerships

      Join us on November 10th from 12:15pm to 1pm EST, for our webinar that will discuss medical legal partnerships.

      This webinar is a part of a series of webinars on Health Care for Refugees hosted by the Vermont Medical Society. Anyone interested is encouraged to attend.

      Registration is free and required here.

      To view previous topics and their recordings that were included in this series, click here.



      Fall 2022 Virtual Ethics Education Series

      November 9th, 12:00pm to 1:15pm EST

      November 9th - Mounting Pressure in the Emergency Department – Are there ethical and legal solutions?, presented by Shireen Hard, JD

      Learn more and register here.

      Medical Mutual' s 2022 Risk Management Seminar

      November, 15, 2022, 12pm to 4pm

      Understanding the Rules of Play

      for Telemedicine Virtual care is no longer a nice to have, but a necessity.

      Come join healthcare legal guru, Nan Gallagher, as she conveys how to engage in telehealth services so as best to minimize risk, administrative scrutiny, and payer woes, while maximizing your practice’s revenue and overall worth to patients.

      Learn more and register here.

      Webinar: Rapid Treatment Access for Alcohol Use Disorder

      November 16th and November 18th, 11:30am to 1 pm EST

      Join the Vermont Department of Health for a webinar that will have topics including:

      • Walk through of Clinical Protocol including the Use of Medication to treat Alcohol Use Disorder and withdrawal management
      • Epidemiology of Alcohol Use Disorder, recognizing signs and symptoms
      • Organizing Systems of Care Within a Community

      For more information and to register for either the November 16th or 18th session, click 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.

      For more information about the speakers, sessions, accreditation and to register please visit:

      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

      For more information about the speakers, sessions, accreditation and to register please visit:

      Eastern Winter Dermatology Conference

      February 2 - 5, 2023

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

      The 34th 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!

      For more information about the speakers, sessions, accreditation and to register please visit:

      Eastern Winter Dermatology Conference

      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.

      For more information about the speakers, sessions, accreditation and to register please visit:

      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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