December 21st, 2021

NEED TO KNOW

Happy Holidays to our Members from the VMS Staff and Leadership!

Thank you for all you have done throughout 2021 to care for Vermonters. We hope all of you have the opportunity to rest and relax over the next week. VMS will not be publishing a Rounds on December 28^th and will be back on January 4^th. Wishing you all a happy and healthy 2022.  

Vermont COVID-19 Rates Stabilize, Expected to Increase after the Holidays

At today’s administration press conference Commissioner of Health Mark Levine, MD, emphasized that “Omicron is here” and likely has been in Vermont for several weeks. The first case was confirmed in Vermont this weekend, 3 more cases have now been confirmed with more likely to be confirmed very shortly. While case rates in Vermont are currently stable and hospital capacity has seen a slight improvement over the past week, cases are expected to increase again due to the holidays and the Omicron variant. All administration officials repeated steps Vermonters could take to make holiday gatherings safer regardless of Omicron such as getting a booster, keeping gatherings small, testing before and after and wearing a mask. Since state testing will be delayed due to the holidays, take home antigen tests will be available from select testing sites on December 23^rd and 30^th. Secretary of the Agency of Commerce and Community Development outlined new resources for employers to implement vaccine or test mandates, available on the ACCD website. For notes from the press conference click here. For notes from last Thursday’s VMS call with Commissioner Levine click here.

Other COVID-19 updates from the week include:

• The CDC announced Monday that the Omicron COVID-19 variant is now the dominant strain in the U.S. and accounted for 73.2 percent of cases between Dec. 12 and Dec. 18.
• On Thursday, December 16, the CDC endorsed updated COVID-19 vaccination recommendations made by the Advisory Committee on Immunization Practices (ACIP) preferring mRNA COVID-19 vaccines over the Janssen COVID-19 vaccine.  Updated Guidance for Clinicians from a CDC COCA call held on Friday can be found here; CDC’s Interim Clinical Considerations is now updated to reflect this change and emphasizes that even a concern that a patient will not return for a second dose is not a reason to give the J&J vaccine.
• After a Federal Appeals Court found that the OSHA’s vaccine or test requirement for large employers can move forward, OSHA will move forward with enforcement though not issue citations for noncompliance before January 10 and will not issue citations for noncompliance with the standard’s testing requirements before February 9, so long as an employer is exercising reasonable, good faith efforts to come into compliance.  The CMS requirement for health care employers is still on hold, pending the outcomes of federal litigation.
• CDC endorses Test to Stay as an option for children in schools exposed to COVID-19 to remain in the classroom.
• Finding two, 3 microgram, doses of its COVID-19 vaccine did not elicit expected immunity in children ages 2-5, Pfizer will add a 3^rd 3 microgram dose in trials and approval is now not expected until the second quarter of 2022.  

Governor Scott Appoints Thom Walsh, PhD to Green Mountain Care Board

Last Friday, Governor Phil Scott announced his appointment of Thom Walsh, PhD, MS, MSPT to the Green Mountain Care Board (GMCB). Dr. Walsh is a professor of health policy who holds academic appointments at the Dartmouth Institute for Health Policy and Clinical Practice and Boise State University’s College of Health Science. He is also a physical therapist who previously practiced at several locations across the country, including at Dartmouth Hitchcock in New Hampshire. The Vermont Medical Society looks forward to working with Dr. Walsh and welcomes his background in health policy and health care practice. VMS continues to advocate for practicing Vermont clinician input into Board deliberations and as part of VMS’ effort to strengthen primary care is campaigning for a Chief Medical Officer of primary care to become a permanent GMCB staff position.   

Vermont Medicaid Proposes $9 Million Increase to Fee Schedule

The Vermont Department of Vermont Health Access (DVHA) presented to the House Appropriations Committee a proposal for increasing Medicaid rates in 2022 through the alignment of the Resource-Based Relative Value Scale (RBRVS) fee schedule with Medicare's rates, which would provide a much-needed increase in reimbursement for primary care services. The proposal would result in a $4,716,275 increase in Medicaid payments for January to June 2022 (the second half of the state fiscal year) and a $9,309,448 increase over the full 2022 calendar year. VMS applauds the work of DVHA to professionalize and standardize DVHA’s fee schedules and to align the RBRVS fee schedule with Medicare. The increase is now being considered by the Vermont legislature. VMS has been meeting for several months with DVHA and Vermont legislators to strongly advocate that the legislature implement this increase as a part of VMS’ 2022 primary care platform. More details will be coming soon regarding the breakdown of these increases by specialty and code. 

Taskforce on Affordable Health Care Delivers Final Recommendations

The Taskforce for Accessible, Affordable Health Care met last week to receive further recommendations on four policy options the Taskforce is considering in their aim to make health care more affordable and more accessible for all Vermonters. The Taskforce began their work by looking at 22 policy options consultant Joshua Sluen put forth, that were quickly narrowed to 7 policy options. Three of those options: postpartum expansion, remote access to care and PBM regulation, are already in some stage of implementation, so last week's Taskforce presentation focused on these remaining four policy recommendations: 

1. A Public Insurance Option - If premiums are held to 95 percent of historic increases, the public option could save Vermont households hundreds of dollars per year, and year over year that could be as much as $1,300.
2. Extending Moderate Needs Supports - Use all claims data to target Vermonters most in need and provide broader support services. 
3. Cost Growth Benchmark - Expand Vermont's cost growth benchmark to all payers and providers.
4. Expanding the Vermont Blueprint for Health - Expand the referral of Vermonters to Blueprint Community Health Teams and conduct ongoing ROI analysis to find downstream savings.

The consultants will come back in January of 2022 with a final report that gives more specific estimates on cost savings. Lawmakers on the Taskforce asked for more equitable definitions of "affordability" and pushed for more specific legislative fixes that could quickly be integrated into current health reform models. Most lawmakers have heard some version of these recommendations in their tenure. Yet, overall the themes of prioritizing access to primary care and strategic care management resonated, as well as doing consistent return on investment (ROI) analysis on all health reform initiatives. 

MISC.

FDA Allows Dispensing of Mifepristone via Mail

Last week, the FDA announced that after conducting a review of the single, shared system Risk Evaluation and Mitigation Strategy (REMS) for mifepristone, known as the Mifepristone REMS Program, FDA determined that the data support modification of the REMS to reduce burden on patient access and the health care delivery system and to ensure the benefits of the product outweigh the risks. The modifications to the Mifepristone REMS Program will remove the requirement that mifepristone be dispensed only in certain healthcare settings, specifically clinics, medical offices, and hospitals (referred to as the “in-person dispensing requirement”) and will therefore allow distribution via mail order and facilitate prescribing of via telehealth. However, 19 states including Texas have laws that supersede the FDA decision by barring telehealth consultations or mailing of abortion pills. 

Jill Rinehart, MD, Discusses Cannabis Risks for Vermont Youth on WDEV

Last week, WDEV interviewed University of Vermont Medical Center (UVMMC) pediatrician Jill Rinehart, M.D., on the risks that the State's new retail cannabis market could potentially present for Vermont youth and young adults, as well as the risks to adult users of high potency cannabis. She said, "Back in the '90s, the potency of cannabis was close to 4 or 5 percent THC, now it is closer to 14 percent and that doesn't include the higher potency concentrated products." Dr. Rinehart directs the pediatric residency program at UVMMC and sits on the Substance Misuse Prevention Council, which advises the Department of Health on prevention strategies regarding cannabis, alcohol, tobacco and opioids. Dr. Rinehart said that part of the problem with recreationalizing cannabis is that social normalization reduces the perception of harm and evidence shows youth use has increased significantly in states where cannabis is sold commercially.  Currently, the Cannabis Control Board is engaged in rule-making regarding Vermont's legal cannabis market and Vermont municipalities are voting on whether to allow retail cannabis in their towns. Click here for a recent VT Digger article on the process. The WDEV interview came after the VMS published a press release on our recently adopted policy resolution regarding commercial sales of cannabis, in which VMS provided warning label suggestions and recommended that all cannabis products sold should contain less than 15% THC potency. Click here to hear Dr. Jill Rinehart's full interview. 

EVENTS

Join us every 1^st and 3^rd Thursday of the month from 12:30pm to 1pm as Commissioner of Health, Mark Levine provides us with the most pressing COVID-19 information affecting the state and nation. You will have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting.

You can join the zoom meetings beginning in January here 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).

Please join us for a conversation about COVID-19 vaccines for children. Find the forum dates here. To view recordings from previous forums, click here.

University of Vermont Project ECHO 

Perinatal Mental Health

January 11th to June 14th, ET

This program will highlight best practices and evidence-based care for screening and treating patients with perinatal mood and anxiety disorders. The series will identify strategies and emerging topics in perinatal mental health and highlight resources for patient care. The target audiences are individuals or teams of health professionals in family medicine, obstetrics/gynecology, psychiatry, internal medicine adult primary care, and pediatrics; including prescribers, nurses, mental health professionals, and social workers/case managers throughout Vermont.

This program is offered at no cost to participants through a grant from the Vermont Department of Health.

Participants can receive CME credits for each learning session attended. 

For more information, visit here.

University of Vermont Project ECHO 

Adult Complex Mental Health

January 19th to June 22nd, ET

This program will highlight best practices and evidence-based care for treating patients with complex mental health issues and disorders. The program will identify strategies, best practices, and emerging topics in this field – and highlight resources for patient care. The intended audience is a cohort of individuals or practice teams throughout Vermont, including Family Medicine and Internal Medicine Adult Primary Care.

This program is offered at no cost to participants through a grant from the Vermont Department of Health.

Participants can receive CME credits for each learning session attended. 

For more information, visit here.

Hospital Medicine 2022 and Optional POCUS Workshop

January 30-February 1, 2022, ET

The course will provide practical approaches to common problems in hospital medicine, informed by experts and the latest evidence. All provider types practicing Hospital Medicine are welcome, including administrators, resident physicians and medical students.

An optional Point-of-Care Ultrasound (POCUS) workshop will take place at the UVM SIM Lab in Burlington on Sunday morning, January 30.

For registration information (in-person and virtual option), full agenda & accreditation details, click here. 

Questions: Contact Michele Morin at: Michele.Morin@med.uvm.edu or 802-922-3594

The 33^rd Annual Eastern Winter Dermatology Conference

February 5-7, 2022, ET

Dr.. Glenn Goldman invites you to attend this year’s dermatology conference which is returning to Stowe for its 33^rd year. The conference is divided into morning and late afternoon sessions, with a large mid-day break to allow for recreation. Although the course is designed for dermatologists, medical professionals with an interest in dermatology are welcome to attend.

Topics: Locoregional and in-transit metastatic melanoma, skin reactions to immunotherapy, testing and imaging for SCC, MCC, and MM, cosmetic dermatology, challenging cases, medical pearls, Dermatology Jeopardy, and more!

For registration information, full agenda & accreditation details, click here.

Questions: Contact Michele Morin at: Michele.Morin@med.uvm.edu or 802-922-3594

With the influx of Afghan families resettling to U.S. States under Operation Allies Welcome we know that many clinicians and health care systems will be seeing  these individuals. 

We put together this free four-hour course, composed of recorded lectures and interactive lessons to help prepare providers to serve newly arrived Afghans. It covers topics ranging from Operation: Allies Welcome to Afghan cultural background, general and skin medical exams, and mental health care, to clinical observations from practitioners at welcome centers and in receiving states. 

We hope you will find this resource helpful. Please share this message and link with anyone you think would find it useful. We have additional free resources available here.

Register here! This course is free but does require registration. Once registered you will receive an email receipt with a link to the course.

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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