February 27, 2024

NEED TO KNOW

The VMS office will be closed on March 5th for Town Meeting Day. The next Weekly Rounds Newsletter will be on Tuesday, March 12th.

Lawmakers Double Down to Advance Legislation Before Town Meeting Week

The VMS Policy team is trying to be all places at once as Legislative committees push to complete work on health care legislation before going home next week for Town Meeting Week. The House Health Care Committee finalized its FY25 Budget memo with their ranked health care recommendations for next year's budget. Included in the memo is a VMS priority requiring the Department of Vermont Health Access (DVHA) to meet with interested stakeholders to develop a proposed methodology for setting the Medicaid Resource-Based Relative Value Scale professional fee schedule for calendar year 2025. As part of this, DVHA will consider:

• how to maintain alignment with Medicare, without decreasing fees when Medicare fees decrease;
• which conversion factors Medicaid should benchmark to Medicare conversion factors from specific years;
• whether to maintain two separate conversion factors for primary care and specialty care.

DVHA will be required to report back to the legislature on the proposed methodology and the fiscal impact and whether an inflationary increase can be included in the FY26 Budget.

These are some of the bills and conversations we are following this week:

• Please Take Action: S.18, the bill to end the sale of flavored tobacco was amended and passed by the House Ways and Means Committee by a vote of 7-5 last week. The full House is scheduled to vote on this bill on Wednesday of this week! Please email your lawmaker and ask them to vote YES! on this bill and prevent the next generation of Vermonters addicted to nicotine. Click here to find your lawmaker's email address.
• Telehealth: Click here for the VPR story, "Telemedicine Could Become More Accessible in Vermont, Thanks to Legislation Approved by House."  The bill will require payers to continue to pay for audio-visual telehealth at the same rates as in-person services and create payment parity for audio-only services.
• Sunscreen in Schools: S.187, the Senate Health and Welfare Committee took up an American Academy of Pediatrics Vermont Chapter priority bill that would allow students with parental permission to apply sunscreen in schools. Click here for this VTDigger story.
• Vermont Data Privacy Act: H.121: The House Commerce Committee has released a much-anticipated new draft of a data privacy bill that has all industries concerned. The VMS, along with other health care associations, has submitted joint testimony urging for HIPAA compliant entities to be provided exemptions. 
• Cannabis Medical Program: H.612, The VMS testified on the cannabis bill after the House Government Operations Committee released a new draft of the bill that retains the THC potency caps. This bill is up for a possible vote this week. The Committee is also considering adding an amendment that would allow outdoor cannabis consumption events. Click here for VMS testimony.
• Prior Authorization: H.766, the House Health Care Committee is going to take up H.766 again this week for a possible vote. The VMS has submitted written comments pushing back on the claim from BCBSVT that this bill will cost ratepayers $100 million.
• Medicaid Expansion: H.721, the House Health Care Committee will take up this bill, which is now studying Medicaid expansion, for a possible vote this week. This bill also includes a provision to expand the Medicare Savings Program. It is unclear whether the $18 m. price tag will prevent it from advancing. 
• Primary Care: S.151, the Senate Health and Welfare Committee will be taking testimony on a new draft of the bill aimed at increasing support for primary care and prevention. VMS will testify in favor of many provisions of the bill this week.
• Forensic Beds: S.192, the Senate Health and Welfare Committee unanimously passed this bill that authorizes a forensic facility in Vermont's State Psychiatric Hospital by July 1, 2025. The bill now heads to the Senate Appropriations Committee.
• OPR Optometry Scope Report: Last week, the House Government Operations Committee heard from the Office on Professional Regulation on their Optometry Scope Report. Ophthalmologist Jessie McNally, MD, testified in support of public safety. The VMS is urging the Committee to leave this scope expansion out of this year's OPR bill. 
• Obesity Coverage Equity bill: Please Take Action: S.164, a bill that would require Medicaid and Vermont commercial payers to cover weight-loss medication and lifestyle interventions has had one hearing in the Senate Finance Committee. Last week, Kimberley Sampson, M.D., was on the Vermont Edition show, "Weight Loss Drugs: How They Work, Why People Take Them, and Their Cost," advocating for this bill and the assistance these medications provide her patients. Please email the Senate Finance Committee to urge them to advance this bill to cut risk to chronic disease and improve quality of life. Here are the Committee email addresses: acummings@leg.state.vt.us, mmacdonald@leg.state.vt.us, cbray@leg.state.vt.us, rmccormack@leg.state.vt.us, rbrock@leg.state.vt.us, kramhinsdale@leg.state.vt.us, tchittenden@leg.state.vt.us, zbuckminster@leg.state.vt.us
• Hospital Boarding of Long-Term Care Patients – The House Health Care and Human Services Committees held a joint hearing last week to receive an update on the issue of long-term care patients boarding in hospitals.  The committee heard from the UVM Health Network, VNAs of Vermont, long term care agencies and the Department of Aging and Independent Living (DAIL).    Dr. Stephen Leffler, President and CEO of UVMMC testified that this issue affects all hospitals and that investments are needed in the continuum of care to increase nursing home capacity, increase beds for high acuity/complex patients and support home care when appropriate.   DAIL updated the Committees on ongoing strategies to support the long term care and home health systems and emphasized that the Scott Administration has included  in their State Fiscal Year 2025 Budget proposal $9.9 million in stabilizing rate method changes to address minimum occupancy penalties and outdated cost caps. This stabilization effort is intended to prevent closures and allow some nursing homes to hire staff and admit more residents. 

VMS Board Seeking Resolution Feedback by March 27th

The VMS Board is seeking member feedback on a policy resolution related to:

The full text of the Resolution is available here.

You will be receiving an email with a survey link specific to you on Wednesday, February 28th. If you did not receive your survey link or have any questions or concerns with completing the survey, please contact bpauley@vtmd.org.

The survey will be open for member comment between February 28, 2024 and March 27, 2024. The resolutions will be discussed together with the feedback received from members by the VMS Board at its April 10th Board Meeting. If you would like to join this meeting via Zoom, please contact Birdie Pauley at BPauley@vtmd.org.

Cyberattack on Optum/Change Healthcare Results in Impacts to Medicaid Prescriptions

Last Wednesday, Change Healthcare, the prescription processor for Vermont's Medicaid program experienced a "temporary outage" as a result of a cyberattack that could impact the 200,000 Vermonters enrolled in Medicaid. The Department of Vermont Health Access (DVHA) issued these guidelines to pharmacies and health care providers on suggested workarounds to ensure patients have access to necessary medication while the Change Healthcare systems are down. On Monday, February 26, DVHA announced that this issue, that is impacting pharmacies across the country, has not resulted in a healthcare data breach. In an updated FAQ DVHA recommended prescribers and pharmacies dispense 30-day medication supplies in order to protect against disruptions. On Tuesday, February 27, DVHA released this guide for the prior authorization process for physician administered drugs. 

MISC.

Updates on AHEAD Model        

Last Wednesday, the Vermont Agency of Human Services (AHS) provided the Green Mountain Care Board an update on the AHEAD Model application that the State will be submitting to the Center for Medicare and Medicaid Innovation by March 18^th.   AHS expects that CMMI will be notifying states if they are selected in May or June 2024.  States will then negotiate the terms of the agreement between July 2024 and May 2025 with a state agreement to be finalized by July 1, 2025.  The agreement would outline the details of hospital global budgets and later be amended to include targets for how much the state spends on health care and on primary care services.  The presentation includes detailed slides describing the model.  The recording of the meeting can also be found here (part 1 of 2; starting at minute 19:16) and here (part 2 of 2). For more information contact Jessa Barnard at jbarnard@vtmd.org and see the February 6th Rounds.

Senator Welch Calls on Senate Leadership to Address Medicare Cuts

Last week, Senators Welch and Boozman sent a bi-partisan sign-on letter to Senate leadership asking them to urgently address the 3.37% Medicare cut that went into effect at the beginning of 2024.  In total 32 Senators signed on to the letter.  VMS thanks Senator Welch for his leadership on this issue and for recognizing the hardship that it is causing practices to have faced a cumulative 10 percent reduction in Medicare payments over the past four years. Read the full letter here.

One Care 2024 Fund for Health Care Delivery Projects Using Waivers

In 2024, OneCare is committed to increasing the utilization of waivers that allow providers to better work together to support patient and community needs. These waivers are available to OneCare network providers because OneCare, as an accountable care organization in the All-Payer Model, has been given unique waivers of federal rules and regulations to clear the path for local health care delivery innovation.

To ensure we are maximizing this resource to improve health care access and delivery, OneCare has allocated $100,000 to fund up to five delivery system projects intended to impact the key areas of focus and goals.
 

Strong applications will describe projects that: 

• Influence one or more of OneCare’s Population Health Model measures or goals 
• Potentially decrease total cost of care 
• Support transformation to a value-based delivery system 
• Identify key metrics to quantify results 

Applications due March 22, 2024 by 5pm. We will be hosting a webinar on March 6, 2024 to review the funding opportunity and offer space for any questions

Learn more and register for the webinar here: https://www.onecarevt.org/waivers-funding-opportunity/

Survey: Integrating Gender-Affirming Care into Primary Care

Throughout Vermont, transgender and gender-diverse people look to primary care providers for inclusive, respectful, affirming healthcare. We’d like to learn more about the care that PCPs currently provide for transgender patients, barriers that they encounter, and what resources they would find helpful to meet these patients’ needs.

We would like to hear from all physicians, NPs, and PAs providing primary care for adults and/or youth in Vermont. If you currently see few or no transgender patients, we are especially interested in hearing from you!

Please click here to take the survey: https://redcap.link/vttranshealth

The survey is open until Friday, March 22, and takes about 10 minutes to complete. Respondents will be entered into a raffle for one of twenty $20 Amazon gift cards.

This project is based at The Fenway Institute and is led by Eli Goldberg, MD, a family physician raised and trained in Vermont who is currently doing a fellowship in LGBTQIA+ Health. Questions? Please email Eli Goldberg: egoldberg@fenwayhealth.org

Next Commissioner of Health Call is March 7, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members on Thursday, March 7th at 12:30 pm. View notes from the February 1st call here.

Hear about the most pressing public health information affecting the state and nation and have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting. You can join the zoom meetings here.

Financial Education Series for March: Presented by Baystate Financials PLANWell
Each session will be held via zoom at 12:30 p.m. or 5:00 p.m.

SaveWell: Gaining Awareness and Setting Goals - March 12thWill help you understand your financial goals and the factors that will impact these goals.

InvestWell: Understanding How to Put Savings to Work - March 19th
Gain a clearer picture of how to grow a nest egg by investing it.

LiveWell: Protecting a Fulfulled Life and Retirement - March 26th
Protect your ability to make and save money by looking at how to utilize your assets to prepare for the uncertainties of life after work.

EVENTS

Vermont Protective Orders

March 11, 2024 at 2pm ET

Virtual Webinar

Everytown for Gun Safety and the Vermont Network Against Domestic and Sexual Violence are pleased to invite you to a webinar to learn about tools under Vermont law that front-line workers can use to keep vulnerable people safe from gun violence.

This webinar will discuss two important, lifesaving forms of court protection from gun violence – Extreme Risk Protection Orders and Relief From Abuse Orders.

View the event flyer here. Learn more and register here.

Future Health Best: Practices for Advancing Care

March 22, 2024

Virtual and In-Person Waltham, MA

This 2024 conference will focus on the nexus of climate change and its growing impact, AI and new technologies to diagnose and treat patients, and the evolving and expanding role of physicians in this rapidly changing health landscape.

View the event flyer here. Learn more and register here.

2024 Vascular and Cardiac Forum

April 1, 2024

In-Person South Burlington, VT

The vascular and cardiac forum this year will provide primary care, internal medicine, urgent care, and physical therapy providers with education about a variety of vascular and cardiac conditions. The objectives are to improve accuracy and timeliness of the diagnosis and treatment of these conditions, and efficiently use expert consultation in a value-based environment.

Registration Information, full agenda and accreditation details can be found here.

April 16, 2024

In-Person South Burlington, VT

Please join us for the 18th Annual Vermont Geriatrics Conference. The conference is designed to equip nurses, nurse practitioners, pharmacists, physicians, physician assistants, social workers and other healthcare professionals with practical and innovative approaches to the medical care of older adults.

Registration Information, full agenda and accreditation details can be found here.

May 3, 2024

In-Person South Burlington, VT

This conference is designed to equip primary care clinicians with updated knowledge on issues related to outpatient management of patients with diabetes. Specific topics to be addressed at this year’s conference include Lipid-Lowering Therapies to Reduce Cardiovascular Disease, Basal Insulin Use, Insulin Titration, MASLD (Liver Disease) and more.

Registration Information, full agenda and accreditation details can be found here.

June 4th-June 7th, 2024

In-Person South Burlington, VT

This intensive four-day program for family physicians, advance practice providers, nurses, and other primary care professionals will focus on current issues in the practice of Family Medicine, with special attention to new contributions. An optional, pre-conference full-day workshop on Mastering Early Goals of Care Conversations will also be offered. Conference emphasis is on practical, clinically applicable diagnostic and management issues in primary care. This conference will be presented in-person and virtually; participants may choose to join via a mixture of in-person and remote attendance. This conference is also anticipated to overlap with the Burlington Jazz Festival, taking place June 5-9, 2024.

Registration Information, full agenda and accreditation details can be found here.

Whole Person Care: Enhancing Substance Use Disorder and Mental Health Treatment

June 14, 2024

Lake Morey, VT

Please mark your calendars for Friday June 14 when we will be hosting "Whole Person Care: Enhancing Substance Use Disorder and Mental Health Treatment", an in-person conference at Lake Morey, VT.

This is a part of the Collaborative to Advance Mental Health Treatment and Substance Use Recovery for Everyone (or CARE Series).

Learn more here.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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