December 20, 2022


Happy Holidays from the VMS Staff! We wish you a safe and peaceful holiday season

Please note that there will not be a Rounds Weekly Newsletter published on December 27th.

VPHP Announces New Medical Director

The Vermont Medical Society and Vermont Practitioner Health Program (VPHP) are pleased to announce the new VPHP Medical Director beginning this month, Nels Kloster, MD. Dr. Kloster is an addiction psychiatrist. He received his M.D. from the University of Vermont and completed his residency in adult psychiatry at the University of Vermont Medical Center. He has more than 15 years of experience working at all levels of addiction treatment and psychiatry in Vermont. Dr. Kloster currently serves as the medical director for the Hub in Brattleboro and for Serenity House residential treatment center in Wallingford. In 2019, he merged his private Spoke practice with SaVida Healthcare with the expectation of impacting many more Vermont communities. He was an advisor for the establishment of the Medication Assisted Therapy (MAT) guidelines for the state of Vermont and is a member of Medicaid’s Clinical Utilization Review Board. He has been guided by the principle that substance use disorders are complicated illness that not only impact individuals, but our entire community. Because of this he has been dedicated to providing long term treatment and working with agencies that offer the variety of supports that are necessary for recovery.

Dr. Kloster will be overlapping with current VPHP Medical Director, Joe Lasek, MD, through the remainder of December, taking over full responsibilities beginning in January. The VPHP staff and Committee welcome Dr. Kloster and look forward to his contributions to the program, participants and professional health community. He can be reached at

The Vermont Medical Society Releases Updated Guide to Health Care Law

The Vermont Medical Society is pleased to announce the release of the latest edition of the Vermont Guide to Health Care Law.  The Guide is designed to give physicians and health care facilities a fundamental understanding of legal and regulatory requirements that affect the delivery of health care in Vermont today.   VMS has worked with leading health care attorneys and experts across the state to review, revise or author each chapter of the Guide, including frequently-requested topics such as retaining medical records, closing a medical office and minor consent for health care. The Guide has been fully revised for fall 2022 to include new chapters on End of Life, Mental Health and Substance Abuse Treatment and updated content to reflect new laws, regulations and considerations raised by COVID-19 since the last edition was released in 2018. VMS is grateful to the attorneys and other experts whose research, writing, and editing made this Guide possible. Please click here to see the new edition. 

GMCB to Determine OneCare Budget, Discusses Budget Reductions

OneCare Vermont has been in the budget deliberation stage with the Green Mountain Care Board (GMCB) since submitting their proposed 2023 budget in September.  OneCare’s budget presentation highlighted several areas of planned programmatic changes for 2023, such as creating a new Population Health Management payment to primary care practices that incorporates the $3.25 PMPMs, Care Coordination program funding, and Value Based Incentive funding; and continuing with the Comprehensive Payment Reform (CPR) primary care program while moving to additional accountability in the program. Overall the presented budget is a net $0 budget with $1.449 B in revenue and $1.449 B in expenses: 96.9% going directly to claims payments, 1% to OneCare operations and 2.1% for population health investments.  At it’s meeting last Wednesday, Green Mountain Care Board members raised a number of concerns regarding the depth of OneCare’s evaluations, performance measurement and return on investment.  They also discussed additional evaluation of the CPR program to better understand the strengths and accomplishments of the program.   Citing disappointment in OneCare’s performance, Board Chair Foster proposed reducing the OneCare 2023 budget (by the amount of executive bonuses in 2022 and marketing/communications budget) as well as changes to calculating the base for the 2023 spending rates, and shifting additional risk to by held by OneCare for Blueprint payments.  OneCare submitted a letter on Friday expressing the financial untenability of these decisions and that they may threaten OneCare’s participation in the All-Payer Model.  VMS submitted a letter in response on Monday outlining the devastating financial impact it would have on medical practices for OneCare to abruptly end participating in the All-Payer Model.  Also on Monday, BCBSVT announced it would not be participating in OneCare programs for 2023. The GMCB will meet again this Wednesday, December 21st to take action on the budget.  Full budget materials can be found here and the agenda and information regarding joining the Dec. 21 meeting is posted here.

Transgender Youth Program and the Adolescent Medicine Eating Disorder Consult Clinic at UVMMC Suspend Referrals

The Transgender Youth Program (TYP) and the Adolescent Medicine Eating Disorder Consult Clinic (EDCC) within the Division of Adolescent Medicine at the University of Vermont Children’s Hospital are currently facing high demand and a long waitlist for services in both clinics. At this time both programs are suspending acceptance of new patient referrals for a period of six months until July 2023.  For information on other care resources for young people struggling with disordered eating please call EDCC social worker Amy Kiviranna at 802-847-4696, or see the VCHIP resource page on eating disorders.  For information about other clinics that are providing transgender youth care in our region (VT, NH, NY) please call TYP social worker Joshua Shamoon at 802-847-4696 or see the links to other community resources at the UVMCH TYP website.  See the full announcement here. This comes on the heals of an announcement last week that the Autism Assessment Clinic at the Vermont Center for Children, Youth, and Families and the Developmental Behavioral Pediatrics Program at the University of Vermont Children’s Hospital have also suspended referrals for 6 months.  Contact American Academy of Pediatrics Vermont Chapter Executive Director Stephanie Winters at with further questions or concerns. 

Physicians Will Face a 2% cut in Medicare Payment in 2023

U.S. physicians will face a 2% cut in Medicare payment in 2023, and 2024 will bring at least a 1.25% cut under the massive, must-pass omnibus spending just deal struck by congressional leaders. “The AMA is extremely disappointed and dismayed that Congress failed to prevent Medicare cuts next year, threatening the financial viability of physician practices and endangering access to care for Medicare beneficiaries,” said AMA President Jack Resneck Jr., MD. “This 2% cut, following two decades of flat payment rates, will have consequences on health care access for older Americans.”  Doctors had been staring down as much as 8.5% in 2023 Medicare pay cuts, but an advocacy campaign led by the AMA and joined by the Vermont Medical Society and more than 150 organizations  representing over 1 million physicians and other health care clinicians helped stave off many of the reductions.  VMS is now focused on preventing this cut from being mirrored in the Vermont Medicaid RBRVS fee schedule, which typically matches Medicare funding for primary care.  See the AMA statement here and additional news coverage here.

Please RSVP: VMS 2023 Advocacy Day is January 18th

You are invited to the Statehouse in Montpelier to meet the 2023 class of legislators and to use your voice to advocate for health care policies that will improve your practice environment. This is a unique opportunity early in the new legislative session to let lawmakers know how they can help address the pressing issues you and your patients are facing. We will start the afternoon off with a brief legislative update on VMS' 2023 Policy Priorities. Attendees will then get an opportunity to observe legislative committees or possibly testify. We will then invite lawmakers to join us for a Legislative Reception in the cafeteria entitled, "Health Care Crisis: Steps to Ensure the Survival of Medicine in Vermont."

RVSP here.

Reach out to Jill with any questions at


Official CDC Health Advisory: Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir

Seasonal influenza activity is high across the United States. The Centers for Disease Control and Prevention (CDC) estimates that in the 2022-2023 season to date, there have been at least 13 million illnesses, 120,000 hospitalizations, and 7,300 deaths from influenza (Weekly U.S. Influenza Surveillance Report | CDC). While the Food and Drug Administration (FDA) has not indicated shortages of oseltamivir (generic or Tamiflu) in any of its forms (capsules, oral suspension), CDC has received numerous anecdotal reports of availability issues for generic oseltamivir in some locations [1]. This may continue to occur in some communities as influenza activity continues.

Reminder- 2022 MIPS Hardship Application Deadline Jan 3 2023

The AMA is reminding organizations that the deadline to submit a 2022 MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application is Jan. 3, 2023.  We are concerned that practices that need the relief will miss the opportunity to file a MIPS exception application, especially since the EUC deadline coincides with the upcoming holidays, continued COVID PHE and the severe staffing shortages. As a result, the AMA has reached out to CMS requesting CMS once again automatically apply the automatic EUC for 2022 MIPS reporting. Alternatively, at a minimum requesting CMS extend the 2022 MIPS EUC deadline until the end of the 2022 data submission period, which is March 2023.

In the interim, physicians that are interested in requesting a 2022 MIPS EUC and avoid a 2024 payment adjustment may do so by going to the CMS MIPS EUC Exception application page until 8 p.m. ET on January 3, 2023. If you believe you’ve been affected by an extreme and uncontrollable circumstance (such as the public health emergency triggered by the COVID-19 pandemic), you can apply whether reporting traditional MIPS or the APM Performance Pathway (APP).  Learn more about the COVID-19 flexibilities

Technical Assistance Available Through Rural Northern Border Healthcare Support Center

As of September 2022, the Rural Health Redesign Center has been working in cooperation with the Health Resources and Services Administration (HRSA) and the Northern Border Regional Commission (NBRC) to provide technical assistance to rural healthcare providers and communities in the Northern Border Region (Maine, New Hampshire, New York, Vermont).  Leveraging experience in Pennsylvania, the project works in coordination with consortium partners to help rural healthcare providers and their communities explore and implement strategies that drive improvements in the following priority areas:

  1. Access to care, including mental health, behavioral health, and substance use disorder.
  2. Workforce recruitment and retention.
  3. Transitions to value-based care efforts.

At least one community within each of the four states of the region will receive technical assistance each year for the next three years.  To read more about the project or request no-cost technical assistance, visit

Commissioner of Health Updates on COVID-19, Flu, RSV

Commissioner of Health Mark Levine, MD, shared updates last Thursday with VMS members on a number of pressing public health issues. Notes from the call can be found here. Notes from the Commissioner’s call with the Vermont Association of Hospitals and Health Systems can be found here. Highlights include:

  • The Department of Health is sharing messages with the public to get flu and COVID boosters before the holidays and holding extended vaccine clinic hours; state-sponsored vaccine clinics will be ramping down starting at the end of January
  • The public can now order more free COVID tests from the federal government
  • A health alert will be coming soon from the Department of Health about influenza testing and treatment, especially as Tamiflu becomes harder to locate
  • RSV is now on a downslope, including in Vermont; the State continues to have a pool of pediatric nurses and respiratory therapists available to help staff critical access hospitals.

VMS will host its next call with the Commissioner on Thursday, January 5th at 12:30 pm. Beginning in 2023, calls will now be held on the first Thursday of each month. 

You can join the zoom meetings 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:

Grand Rounds with Dr. Libby Stuyt

January 31, 2023, 9am to 10:30am ET


Dr. Libby Stuyt is a board-certified Addiction Psychiatrist and has worked in the addiction/behavioral health field since 1990.

Her current mission is to educate as many people as possible on the un-intended consequences of the

commercialization of marijuana in Colorado, focusing primarily on the deleterious effects of high potency

THC on the developing brain.

This webinar will discuss the negative impacts of high potency THC on community and patient safety.

Learn more here.

Register here.

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:

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:

Future Health Best: Practices for Advancing Care

March 31, 2023

Virtual and In-person at Waltham, MA

Join physician leaders and health care experts from the Northeast for a signature event to share knowledge and research that advances equitable, sustainable, patient-centered, and best-in-class health care.

For more information about the speakers, program, CME accreditation and to register please visit here.

Note: You can use the discount code of FHB23NE when registering for this event 

Save the Dates - Preparing for and Delivering Value-Based Care in Rural Communities

April 4th, May 2nd, June 6th, and June 27th, 2023

The Northern Border Region Technical Assistance Center (NBR-TAC) is pleased to present a four-part webinar series on the journey to Value-Based Care (VBC) for rural hospitals and primary care providers/facilities (FQHC’s/RHC’s) interested in learning more about operating in a value-based care environment. This webinar is open to organizations or individuals interested in this topic who are welcome to attend.

View the topics of the webinar series here.

Look for more information and registration details in February 2023 

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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