February 28, 2023

NEED TO KNOW

There will be no VMS Rounds Weekly Newsletter next Tuesday, March 7, 2023, due to Town Hall Meeting Day. 

With One Week Before Town Meeting, VMS Members' Voice Making an Impact.

Thank you to everyone who reached out to lawmakers on several priority health care bills last week. We heard from lawmakers that your input is making a difference. We also want to thank Dr. L.E. Faricy for excellent testimony and support for S. 18, the bill regarding a ban on the sale of flavored tobacco. This is the last week before the Vermont Legislature goes home for Town Meeting and a weeklong break. When lawmakers return they will have until March 17^th to have policy committees complete work on legislation that will advance this session. Please continue to take action by emailing these Committees on these bills (the link below has each Committee's member emails):

1. House Health Care: Increased Medicaid Rates for Primary Care: The current Governor’s proposed FY24 Medicaid budget cuts the professional (RBRVS) fee schedule by $380,000, which with current inflation rates and 2023 Medicare cuts is inadequate support for Vermont medical practices. Please email both the House Appropriations and House Health Care Committee members to urge them to include at least a 3.8% inflation increase in the FY24 RBRVS fee schedule. Click here for email addresses.
2. House Government Operations: H.270, a bill making changes to Vermont's cannabis laws: Please email the House Government Operations Committee and urge them NOT to expand qualifying conditions for the medical cannabis program to conditions lacking evidence, such as autism and Alzheimer’s disease, and NOT to increase the package serving size for commercial products from 50 mg to 100 mg. Click here for email addresses.
3. Senate Judiciary: H.72, a bill to remove THC potency caps: Contact the Senate Judiciary Committee to urge them NOT to remove the 60% potency cap on solid cannabis concentrates and to prohibit the sale of flavored oil-based cannabis vape products. Click here for email addresses.
4. Senate Health and Welfare: S.18, a bill to prohibit flavored tobacco products: Urge the Senate Health and Welfare Committee to prohibit flavored tobacco products including menthol, to stop people from starting a dangerous nicotine habit. Click here for email addresses.
5. Senate Health and Welfare: S.36, a bill to address workplace violence: Please urge the Senate Health and Welfare Committee to support this bill that would allow for warrantless arrest for violence or threats against health care workers in health care facilities. Click here for email addresses.

Thank you for your participation. Please contact Jill at jsudoffguerin@vtmd.org if you would like to weigh in or testify on these or other pending legislative items.

2023 VT Educational Loan Repayment Open For Applications - Up to $50,000 

The 2023 Vermont Educational Loan Repayment (Recruitment/Retention) Program for Physicians, Nurse Practitioners, & Physician Assistants application is now available.

Application and corresponding documents can be found here. This year employer matching funds are encouraged but not required.

The 2023 application deadline is Friday, March 31^st, 2023.

View the full flyer here.

DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities for Controlled Substances, Buprenorphine

Last Friday, the Drug Enforcement Administration (FDA) announced proposed permanent rules for the prescribing of controlled medications via telemedicine, expanding patient access medication beyond the scheduled end of the COVID-19 public health emergency. The public will be able to comment for 30 days on the proposed rules.

The proposed rules do not affect (would continue to allow):

• Telemedicine consultations that do not involve the prescribing of controlled medications.
• Telemedicine consultations by a medical practitioner who has previously conducted an in-person medical examination of a patient.

The proposed rules would address a subset of telemedicine consultations—those telemedicine consultations by a medical practitioner who has: never conducted an in-person evaluation of a patient; AND that result in the prescribing of a controlled medication. For these types of consultations, the proposed telemedicine rules would allow medical practitioners to prescribe:

• a 30-day supply of Schedule III-V non-narcotic controlled medications; or
• a 30-day supply of buprenorphine for the treatment of opioid use disorder
• To issue more than a 30-day supply, you would first have to conduct an in-person medical evaluation of the patient

Additional resources for practitioners can be found here:

• Press Release with Summary
• Proposed Rules Summary Telemedicine Rules Summary.pdf (dea.gov)
• Proposed Rules Highlights for Medical Practitioners Telehealth Highlights Medical Practitioners.pdf (dea.gov)
• The full text of the proposals may be found here (non-buprenorphine) and here (buprenorphine induction)

In parallel efforts, a new proposed rule from the Substance Abuse and Mental Health Services Administration (SAMHSA) proposes to make permanent telehealth flexibilities for hubs (or Opioid Treatment Programs/OTPs).  The rule proposes to allow initiation of buprenorphine via audio-only or audio-visual telehealth technology, and methadone via audio-visual telehealth, if an OTP physician, primary care physician, or an authorized healthcare professional under the supervision of a program physician, determines that an adequate evaluation of the patient can be accomplished via telehealth.

For more information contact jbarnard@vtmd.org.  The Vermont Medical Society is working with the legislature and Department of Health to try to ensure that Vermont rules and statutes align with federal changes. 

MISC.

Commissioner of Health Public Health Update on March 2nd

The next Public Health Update call with Commissioner of Health Mark Levine, MD will be on Thursday, March 2nd at 12:30 pm. Hear about the 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.

Commissioner of Health Mark Levine, MD, gave a public health update on February 23, 2023 to the Vermont Association of Hospitals and Health Systems. Notes from the call can be found here.

Applications for the Madison-Deane Award for Excellence in End-of-Life Care

Applications are now being accepted through March 17, 2023 for the Madison-Deane Award for Excellence in End-of-Life Care at UVM Health Network Home Health & Hospice

The Madison-Deane Award for Excellence in End-of-Life Care is awarded to a Vermont individual, group or organization that exemplifies the original mission, vision, and continues the legacy of James Madison, MD and Robert Deane, MD and their intent to transform end-of-life care in Vermont.  Nominees must be a Vermont resident, organization, or group doing work in Vermont.  Nominated individuals, groups, or organizations must reflect the original mission, vision, and continue the legacy of Dr. Jim Madison and Dr. Robert Deane.

Excellence is evidenced in the following areas:

1. A catalyst for the acceptance of death as a natural part of life;
2. A leader for education, information and resources relevant to end-of-life issues; and
3. Support for those who create and encourage dialog about how individuals and families face life-threatening illness.
4. Recipient must not have received the Award in the past.

To nominate someone for this award, please submit the nomination form by March 17, 2023.

Feel free to nominate someone and/or share this information.  

Increase in Extensively Drug-Resistant Shigellosis in the United States

The Centers for Disease Control and Prevention (CDC) has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems [1]. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains, compared with 0% in 2015. Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible. XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission.

Shigellosis is an acute enteric infection that is an important cause of domestically acquired and travel-associated bacterial diarrhea in the United States. Shigellosis usually causes inflammatory diarrhea that can be bloody and may also lead to fever, abdominal cramping, and tenesmus. Infections are generally self-limiting; however, antimicrobial treatment may be indicated to prevent complications or shorten the duration of illness [2]. CDC defines XDR Shigella bacteria as strains that are resistant to all commonly recommended empiric and alternative antibiotics — azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin. Currently, there are no data from clinical studies of treatment of XDR Shigella to inform recommendations for the optimal antimicrobial treatment of these infections. As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR Shigella infections.

Learn more here.

EVENTS

The UVM CORA Clinician Office Hours

Weekly on Thursdays from 12pm to 1pm ET

This program offers free and confidential consultation from addiction medicine-certified physicians focusing on substance use evaluation and management. Information shared will be general in nature and should not be considered as case-specific medical care.

The UVM CORA Clinician Office Hours program is intended only for healthcare providers or others directly serving people with substance use disorders in HRSA-designated rural areas.

Please complete the form here to register for the Clinician Office Hours sessions held weekly on Thursdays, 12:00 -1:00 pm ET.

Registration will close weekly on Wednesdays at noon.

Addressing Physician Burnout

March 9, 2023, 12pm ET

Virtual

Physician burnout is a growing crisis. The latest research into physician burnout shows the impact of the COVID-19 pandemic on physicians and health care workers. Nearly 63% of respondents said they experienced symptoms of burnout in the last year, a 25% surge from the prior year and ending a six-year decline.

Join American Medical Association President Jack Resneck, Jr., MD, the U.S. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA, and a panel of physician wellness experts: Anjalee Galion, MD; Nigel Girgrah, MD; and Christine Sinsky, MD as they discuss the symptoms and drivers of physician burnout and examine solutions to address this crisis. Speakers will share their experiences, analyze the latest research and its implications for our nation’s health, and discuss the system-level changes necessary to reduce burnout and restore physician wellness. 

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.

You can view the full flyer here.

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 

UVM Medical Center Cardiovascular / Vascular Forum

April 3, 2023

In-person

This course will provide primary care, internal medicine and urgent care providers education about cardiovascular and vascular disease, including additional POCUS skills for evaluation. The objective is to improve accuracy of appropriate and timely cardiovascular disease treatment, and efficiently use expert consultation in a value-based environment.

For more information about our speakers, sessions, accreditation and to register, visit here.

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

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

View the topics of the webinar series here.

Look for more information and registration details in February 2023 

Howard Center Annual Conference: Breaking Barriers: Finding Purpose & Possibilities Together

April 19, 2023

In-person and Virtual

The 6th Annual Howard Center Spring Conference is taking place on April 19th from 8:30am to 4:30pm with featured speakers including Dr. Nadine Burke Harris, Dr. Dacher Keltner, Dr. BJ Miller, Dr. Jeffrey Swanson, and Dr. Anna Malaika Tubbs.

For more information about the speakers, sponsors, and to register, visit here. 

Vermont Geriatrics Conference

April 20, 2023

In-person

The 17th Annual Vermont Geriatrics Conference is designed to equip physicians, advance practice providers, nurses, pharmacists, social workers and other healthcare professionals with practical and innovative approaches to the medical care of older adults.

For more information about our speakers, sessions, accreditation and to register, visit here. 

Diabetes 2023: Updates on Management and Treatment

May 12, 2023

In-person

This conference is designed to equip primary care clinicians and other professionals, including dietitians, with updated knowledge on issues related to outpatient management of patients with diabetes.

For more information about our speakers, sessions, accreditation and to register, visit here.

June 5, 2023

We believe that empathic, honest conversations are cornerstones of patient- and family-centered care. Research shows that patients who speak with their clinicians about their goals and values are more likely to receive the care they want, have fewer non-beneficial medical treatments, spend fewer days in hospitals and intensive care units, and report a better quality of life. Take part in this safe, small group pre-conference workshop. Minimum enrollment: 14 ~ Maximum enrollment: 21.

For more information about our speakers, sessions, accreditation and to register, visit here.

49th Annual Family Medicine Course

June 6-9, 2023

In-person and Virtual

This intensive four-day program (with optional pre-conference full-day workshop taking place June 5, 2023) 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. Emphasis is on practical, clinically-applicable diagnostic and management issues in primary care.

The conference dates will overlap with the Burlington Discover Jazz Festival, and all ages, live-music event on four stages in downtown Burlington that brings the community to life! 

The pre-conference workshop titled Mastering Early Goals of Care Conversations will take place on June 5, 2023

Empathic, honest conversations are cornerstones of patient- and family-centered care. Research shows that patients who speak with their clinicians about their goals and values are more likely to receive the care they want, have fewer non-beneficial medical treatments, spend fewer days in hospitals and intensive care units, and report a better quality of life. Take part in this safe, small group pre-conference workshop.

For more information about our speakers, sessions, accreditation and to register, visit here.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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