December 7th, 2021

NEED TO KNOW

VMS Spotlight on Primary Care Campaign

Fay Homan, M.D., family physician at Little Rivers Health Care Office in Bradford, Wells River and Newbury, Vermont has shared a story which illustrates the power of primary care in rural Vermont Click here to read her story and to learn how you can participate in our "Let's Make Primary Care a Vermont Priority" campaign. Currently, the VMS is meeting with lawmakers to prepare for the 2022 legislative session, and we are calling for legislators to prioritize primary care in Vermont by providing significant investment to:

• Increase Medicaid payments for primary care;
• Establish a minimum percent of commercial and Medicare spending on primary care; 
• Support practices engaging in payment reform; 
• Hire a Chief Medical Officer of Primary Care at the Green Mountain Care Board; and
• Require payment parity for audio-only telehealth services.

Judy Orton, M.D., independent pediatrician, shared how her practice could benefit from a financial commitment to sustain access to the primary care her practice provides to over 700 patients in Bennington, Vermont. Click here to read her VTDigger commentary. 

Will you share your story of why NOW is a critical time for Vermont to invest in the sustainability of primary care? Please contact Jill at jsudhoffguerin@vtmd.org for more information. 

COVID-19 Updates from Administration, Commissioner of Health

The Scott Administration held its weekly press conference earlier today. Commissioner of the Department of Financial Regulation presented his modeling report and indicated it is unlikely to see a drop in cases or hospitalizations in the next 4 weeks. He confirmed Vermont has experienced a surge after Thanksgiving – led by those not fully vaccinated – who have a 5 times greater case rate. Cases are up 54% over last 7 days, 31% over 14 days and there has been an increase of 18% in the rate of hospitalization over 7 days. Secretary of Agency of Human Services Mike Smith outlined how hospital and ICU capacity is being bolstered and Commissioner of Health Mark Levine, MD, emphasized mitigations steps Vermonters can take over the holidays and that Vermonters are not fully protected against the virus until they receive a booster.  For full notes from the press conference, click here.

In other COVID-19 news:

• Find notes from VMS’ Dec. 2 call with Commissioner of Health, Mark Levine, MD, here and notes from the Dec. 3 VAHHS call with Dr. Levine here.
• CMS is now requiring state Medicaid programs to cover COVID-19 vaccine counseling visits in which healthcare providers talk to families about the importance of kids’ vaccination
• The FDA has revised its EUA of bamlanivimab and etesevimab administered together, for the treatment of mild to moderate COVID-19 and for post-exposure prophylaxis for prevention of COVID-19, in all younger pediatric patients at high risk of progression to severe COVID-19
• Vermont anticipates access to very limited supplies of Molnupiravir (Merck) this week or early next and Paxlovid (Pfizer) in limited supply perhaps in the next 30-45 days; distribution is likely to be coordinated via the hospitals or central distribution points given limited supply
• VPR airs a series highlighting Northeastern Vermont Regional Hospital staff’s response to COVID-19: episodes from Monday and Tuesday
• Vermont’s Department of Financial Regulation is drafting emergency rules to require insurance companies to pay for at-home COVID-19 tests picked up a local pharmacies
• There is a temporary hold on enforcement of the Centers for Medicare & Medicaid Services vaccine mandate for health care facilities in all states (OSHA rules for large employers are also on hold); follow updates on the mandates and litigation here
• President Biden announces new actions to combat COVID-19 heading into the winter, including increased access to boosters and at-home tests

“No Surprises Act” Requirements Becoming Effective January 1 – Providing Cost Estimate to Self-Pay Patients

The Consolidated Appropriations Act of 2021 established new requirements for providers, facilities, and providers of air ambulance services to protect consumers from surprise medical bills. These requirements are collectively referred to as “No Surprises” rules. Among other things, these include prohibiting balance billing in certain circumstances and requiring disclosure about balance billing protections, requiring transparency around health care costs, providing consumer protections related to continuity of care, and establishing requirements related to provider directories.

Effective January 1, 2022, health care providers and facilities must begin provide to patients who are not enrolled in a health plan or federal health care program or plan to self-pay a good faith estimate of expected charges, expected service and diagnostic codes of scheduled services.  Note the following:

• This provision does not apply to patients with/submitting claims to a health insurance plan
• The provider or facility must inform uninsured (or self-pay) individuals that good faith estimates of expected charges are available to uninsured (or self-pay) individuals upon scheduling an item or service or upon request
• The estimate must be provided when the individual schedules a service or upon request, and the rule contains specific timelines for providing the information to a patient
• In a situation where an uninsured (or self-pay) individual receives a good faith estimate and then is billed for an amount substantially in excess of the good faith estimate (currently defined as $400 more than the estimate), HHS establishes a patient-provider dispute resolution process to determine a payment amount, triggered when the patient submits a notification via a Federal dispute resolution portal 
• Where the service will involve multiple healthcare providers, the scheduling provider is required to coordinate with the other providers to gather information necessary to timely provide this estimate, although enforcement of this coordination is delayed until December 31, 2022. 
• These requirements are contained in interim final rules which were open for public comment until Dec. 6^th and may be modified when the rule is finalized. However, practices should start to prepare in anticipation of a Jan. 1 effective date.

See the overview of the rules and resources available from CMS, as well as new CMS template forms to implement with patients, AMA summaries of the rules, and additional guidance for health centers here.

Action: VMS Cannabis Policy Press Release Draws Press Attention and Ire from Pot Proponents

Last week, after the VMS distributed a press release announcing VMS' recent adoption of our new policy resolution regarding commercial sales of cannabis, the VMS received numerous press requests and many direct responses from cannabis proponents. Please see the linked news stories below. According to a VTDigger article from over the weekend, the Vermont Cannabis Control Board (CCB) took a vote on our expanded warning label suggestions and our recommendations that all cannabis products sold should contain less than 15% THC potency. According to the article, the CCB voted against both of recommendations, saying they did not want to add to the length of the warning label and that limiting the potency will prevent the Board from "bringing the illicit market into the commercial market." The VMS urges you to submit public comments to the CCB urging them to adequately prepare consumers of cannabis products of all of the potential mental health and public health risks. Click here to submit public comment. 

• https://www.vpr.org/vpr-news/2021-12-02/news-roundup-vt-health-dept-reports-all-time-highest-covid-positivity-rate-case-count
• https://www.wcax.com/2021/11/30/vermont-group-calls-limiting-pot-potency/
• https://vtdigger.org/2021/11/30/vermont-medical-society-urges-banning-sale-of-cannabis-with-more-than-15-thc/
• https://vtdigger.org/2021/12/03/state-board-decides-against-warning-labels-on-cannabis-products/

AHS Continues Wait Time Investigation; Reaching out to Physician Practices

In response to reports of lengthy wait times for medical appointments, the State of Vermont is continuing its interagency investigation into health care services access across the state.  Practices may be receiving an email with a survey asking for information regarding their 1st and 3rd next available appointment. The email may come from the Department of Vermont Health Access, the Blueprint for Health or hospital leadership.  Your response to such requests is appreciated. Physicians have also been invited to participate in focus groups regarding wait times.  Please contact Jessa Barnard at jbarnard@vtmd.org for more information or to indicate your interest in participating. 

MISC.

HHS Distributes $46 Million to Rural Vermont Medical Providers

Last week, the US Department of Health and Human Services (HHS) began distributing nearly $46 million to 143 of Vermont’s rural medical providers and suppliers serving Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries under the American Rescue Plan Act (ARPA) Rural payments program.  HHS made these payments to providers based on the amount and type of Medicare, Medicaid, and CHIP services provided to rural beneficiaries from January 1, 2019 through September 30, 2020.  See additional coverage regarding the awards here and more information about the ARP rural payments here.  HHS is also expected to announce Phase 4 Provider Relief Fund recipients this month.  

Medicaid Begins Payment Error Rate Measurement (PERM) Audit

The Department of Vermont Health Access (DVHA) has announced that the Payment Error Rate Measurement (PERM) audit has commenced and will examine sampled claims from July 1st, 2021 through June 30th, 2022. Providers selected for the audit are required to submit all requested claim medical records and documentation.

Please see https://dvha.vermont.gov/providers/audits/payment-error-rate-measurement for more information.  

EVENTS

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.

Financial Planning Highlights for Residents, Fellows, and New Attending Physicians

December 7th, 7-8pm, ET

Pastore Financial Group, LLC are bringing back their Complimentary Financial Educational Webinar Series for Physicians that will cover:

• Model and project cash flow needs for retirement income
• Align investment allocation with retirement goals
• Mitigate estate transfer taxes and costs
• Effectively manage income taxes in retirement
• Maximize Social Security benefits
• Organize your finances using technology so you can make informed financial decisions

Financial Planning Highlights for Residents, Fellows, and New Attending Physicians

December 9th 7-8pm, ET

Pastore Financial Group, LLC are bringing back their Complimentary Financial Educational Webinar Series for Physicians that will cover:

• Understand the pro’s and cons of loan forgiveness and loan repayment
• Consider protecting your income for yourself as well as your family
• Understand the ins and outs of individual disability insurance
• Set financial goals and priorities for your finances the early years of your career
• Organize your finances using technology so you can make informed financial decisions

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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