February 25, 2025

NEED TO KNOW


There will be no Rounds Weekly Newsletter on Tuesday, March 4th.

The VMS office will be closed for Town Meeting Day.

This Week - Contact Lawmakers about Primary Care Funding Cliff

This is the week that the House Health Care Committee is finalizing their budget recommendations. If you have not already, please join VMS in asking the legislature to address gaps left by not joining AHEAD until 2027 by including in the SFY2026 budget one-time funding of $5.5 million for primary care programs and $4.5 million in state funds to continue Medicare-funded Blueprint for Health programs.   In addition, the Governor’s proposed state budget currently does not include funding for the Blueprint’s 2-year expansion of embedded mental health supports.  Please explain how devastating any loss of funds for primary care services will be at this time.

As many members know, due to the winddown of OneCare Vermont at the end of 2025 and decision to not start the AHEAD Model before 2027, there will be a significant gap in funding available for primary care services and supports in calendar year 2026.  VMS has been highlighting this crisis through testimony and a press event last week.  See the press release and press coverage from WCAX and North Star Monthly. 

Please contact the House Health Care Committee and House Appropriations Committee:

ablack@leg.state.vt.us; fmcfaun@leg.state.vt.us; dberbeco@leg.state.vt.us; bcina@leg.state.vt.us; mcordes@leg.state.vt.us; wcritchlow@leg.state.vt.us; ademar@leg.state.vt.us; lgoldman@leg.state.vt.us; lhoughton@leg.state.vt.us; wpage@leg.state.vt.us; dpowers@leg.state.vt.us; kvarin@leg.state.vt.us; rscheu@leg.state.vt.us; jharrison@leg.state.vt.us; tbluemle@leg.state.vt.us; edickinson@leg.state.vt.us; jkascenska@leg.state.vt.us; wlaroche@leg.state.vt.us; mmrowicki@leg.state.vt.us; mnigro@leg.state.vt.us; tsquirrell@leg.state.vt.us; tstevens@leg.state.vt.us; dyacovone@leg.state.vt.us; epedley@leg.state.vt.us;

In more detail the loss of funding for the State Fiscal Year July 2025-June 2026 includes:

  • $4.7 million in payments across the entire network of OneCare Vermont participating practices from the end of the OneCare Vermont Population Health Model (PHM) Program
  • $885,000 to independent primary care practices for OneCare Vermont’s “CPR” prospective payment program
  • $10.8 million ($4.5 million state funds) to backfill Medicare payments to the Blueprint for Health Patient Centered Medical Home program, Community Health Teams & SASH – included in the Governor recommended budget - VMS supports this ask
  • Blueprint Mental Health Integration into Primary Care (CHT Expansion) and the DULCE initiative pilots – this expansion is currently scheduled to end on June 30, 2025. See letter sent from AHS on February 7th. The Blueprint for Health and AHS are working to determine spend-down protocols for any remaining funds. It is expected that any remaining funds will be used to sustain Mental Health Integration (CHT Expansion) staff during a portion of FY2026. The Blueprint is also exploring alternative funding options to stabilize CHT staffing levels and maintain the impactful work teams are doing to increase screening and provide services to Vermonters. VMS supports continuing this successful pilot program.

Payments to primary care would stabilize in 2027, when joining the AHEAD Model means that Medicare will restart their payments to the Blueprint PCMH and CHT programs and begin making $17 per Medicare beneficiary-per month payments to participating primary care practices.   

See VMS’ handout for lawmakers here and contact Jessa Barnard at jbarnard@vtmd.org or Jill Sudhoff Guerin at jsudhoffguerin@vtmd.org for more information. Thank you for your support for these crucial programs – VMS knows how central they are to your practices and patients!

Legislature Tackles State Budget and Health Care Reform

The Legislature has begun to pick up the pace taking up budget and policy bills, as Committees have only this week to meet until their week off for Town Meeting Week and then one additional week before the “crossover” deadline, when bills other than committee bills need to be voted out of committee.   Work last week included:

  • The policy committees are taking testimony from advocates on budget needs and will be presenting their recommendations to the House Appropriations committee by the end of this week.  VMS testified in House Health Care regarding the primary care funding cliff (see related action alert below), while Breena Holmes, MD testified regarding the need for continued Blueprint and DULCE funding; and representatives of Gifford Health Center testified regarding funding needed to get Maple Mountain Consortium family medicine residency program off the ground.
  • The House Health Care Committee and Senate Health and Welfare Committees continue to take background testimony regarding the cost of health care and options for payment reform including reference based pricing and global budgets.  The Senate Health and Welfare Committee has begun to dig into a committee bill draft that calls for: 
    • AHS and the GMCB to create a Statewide Health Care Delivery Plan;  
    • Vermont hospitals to submit hospital strategic plans aligned with the Statewide Health Care Delivery Plan;  
    • Directs GMCB and AHS to jointly establish advisory committee to oversee evaluation of current health system performance and development of Statewide Health Care Delivery Plan;  
    • Requires reference-based pricing for hospital prices in the commercial market at a percentage of Medicare prices to be determined by GMCB;  
    • Directs GMCB to establish budgets for Vermont hospitals.  

VMS has offered preliminary testimony on the bill. 

  • The Senate Health & Welfare Committee continues to work on S. 18, a bill to licensing free standing birth centers.  VMS has urged the committee to address improving Medicaid reimbursement for all labor and delivery services within the bill so that hospital services can remain available when transfers are needed. 
  • Clara Keegan, MD, offered testimony in support of S. 28, a bill to strengthen Vermont’s shield law, and explained how telehealth prescribing for abortion services can be safe and effective.

Optometric Scope of Practice Expansion Taken Up in Senate Government Operations: Contact Legislators!

There are now two bills on optometric scope expansion - one in the House (H.241) and one in the Senate (S.64). The Senate bill was taken up last week in Senate Government Operations with the intent to discuss the regulatory issues only.  This committee will be taking more testimony this week from optometrists, the Vermont Board of Medical Practice, and others on the importance of standardized training and residency. If/when it passes that committee, it will then go to the Senate Health and Welfare Committee to do the bulk of the work on the public health, safety and medical issues.

VMS joins the Vermont Ophthalmological Society in its concern with the lack of sufficient standardized surgical training in optometric schools; the absence of mandated residency training; and the risk to public safety. If you have concerns, please contact members of the Senate Government Operations and Senate Health and Welfare Committees to let them know.

bcollamore@leg.state.vt.us; tvyhovsky@leg.state.vt.us; rwhite@leg.state.vt.us; AClarkson@leg.state.vt.us; lhart@leg.state.vt.us; vlyons@leg.state.vt.us; mgulick@leg.state.vt.us; acummings@leg.state.vt.us; lhart@leg.state.vt.us; sdouglass@leg.state.vt.us; GDAcierno@leg.state.vt.us; KCarasi-Schwartz@leg.state.vt.us

Talking Points:

  • Difference between Ophthalmologists and Optometrists (Ophthalmologists attend 4 years of medical school and then at least 4 years post grad training in surgery/advanced medicine; Optometrists attend 4 years of Optometry school with training in primary eye care with no standardized surgical training and no required post grad education)
  • Patient safety- dangerous to allow anyone with no standardized surgical training to perform laser/scalpel surgery around/on/in the eye.
  • Access- we have skilled ophthalmologists across the state who currently take care of Vermonters’ eye surgical needs. The wait list for routine eye exams with Optometrists is already months’ long. We need to utilize our skill set/training appropriately: surgical/advanced medical eyecare by Ophthalmologists and desperately needed primary eye care by Optometrists. OPR’s 2023 report concludes that it is “unable to determine whether expanding the optometric scope of practice would improve patient access to care. [pg. 31]”. It also states that “OPR cannot determine the impact expansion of the optometric scope of practice would have on costs. [pg. 34]”.

For more details on the issue visit - https://safevisionvt.org/.
 

MISC.

Planning for Retirement: March 11th, 5pm EST

VMS has partnered with Planwell to present the Planning for Retirement webinar.

Retirement is often the first thing we think about when we talk about our overall financial well-being. In this seminar, you will learn the basics of retirement planning and what strategies you can use to secure your plan. This presentation covers how to envision your retirement, build your retirement strategy, different sources of retirement income, building your nest egg, and key risks to consider.

View the event flyer here. 

Register here.

Feedback Sought on VT's State Health Improvement Plan (SHIP)

You are invited to share your thoughts on the 2025-2030 State Health Improvement Plan!

The Vermont State Health Improvement Plan (SHIP) is a five-year roadmap for ensuring that all people and communities in Vermont have inclusive, equitable, and sustainable access to opportunities for health and well-being. It reflects the shared efforts of people and organizations across the state. It outlines what we plan to achieve, how we will achieve it, and how we will know if we have achieved it.

There are four areas of focus in the SHIP:

  • access to care,
  • cost of living,
  • housing, and
  • mental health/substance use.

We are looking for feedback from people with professional and/or lived expertise on the draft plan to make sure that it is clear and meaningful. Here is a short slide deck that provides an overview of the draft SHIP and how it was developed. After reviewing the slide deck, please complete this survey by COB Friday, February 28 to share your thoughts.  If there are other people or organizations who you think would like to provide feedback, please feel free to share this information.

Salary Data and Contract Review Tips: March 18th, 12-1pm

VMS has partnered with Resolve to help connect members to contract review services and access to compensation data. On March 18th from 12-1pm join Resolve CEO Kyle Claussen for a webinar to learn tips about physician employment contracts. Register here. How do you know what you are worth? What's in a normal contract? How do you know if you have leverage? Kyle will address key contract provisions including:

  1. Compensation
  2. Call Coverage
  3. Maternity Leave
  4. Non-competes
  5. Side Gigs
  6. Intellectual Property
  7. Private Equity Buy-outs

Bring your questions! Whether you are considering your first job after residency, thinking about a position change or just want to understand what is in your current contract, this webinar is for you.

Kyle Claussen is the CEO of Resolve, an attorney and physician compensation and contract expert. He has spent the last decade advocating for physicians in their employment contracts. Kyle is married to an ophthalmologist, has 3 kids, and a dog.

Register for the webinar here.

There Will Be No Commissioner Call - Thursday, March 6, 2025

The Commissioner of Health, Mark Levine, MD, will be retiring. We will be determining how these calls look in the future. Please stay tuned for more details.  

EVENTS

Learning Collaboratives on In-Basket Reduction and Reducing Regulatory Burden

February 2025 – March 2025

AMA STEPS Forward® Innovation Academy is launching two new, six-month learning collaboratives on optimizing the in-basket to reduce work burden and rethinking how organizations apply regulatory rules to clinical practice. Each collaborative will convene dyads or triads of leadership representatives from multiple organizations to engage in a longitudinal shared learning experience. Limited space available. Learn more.

Navigating Workplace Violence: A Webinar Series on De-escalation Strategies for Healthcare Professionals

March 20, 2025

March 20th, 1:00 PM to 2:00 PM - "Workplace Violence Prevention: Focusing on What’s Most Important"

This session is led by Brendan Riley and is designed to provide professionals with advanced strategies to effectively address workplace risks and foster a safe, supportive environment. This webinar is crafted to address the challenges faced by all healthcare workers, offering insights that can benefit professionals across the entire spectrum of care.

Register here for either webinar.

For more information about offerings from UVM CMIE, visit here.

VTMD.ORG

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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