February 7, 2023

NEED TO KNOW

Action Alert: Urge the Vermont Health Care and Appropriations Committees to Increase the Medicaid Fee Schedule for Inflation

Despite the fragile state of access to health care and primary care in particular, the Governor’s proposed Fiscal Year 2024 Medicaid budget includes NO increase for the physician fee schedule (RBRVS or Resource Based Relative Value Scale fee schedule), which takes effect July 1, 2023. This week, the House Appropriations Committee is hearing testimony from Vermont Medicaid (Department of Vermont Health Access or DVHA) on their budget. Now is the time to 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. Please explain how an inflationary adjustment is the minimum needed to sustain health care practices.

Practice expenses are up, reimbursement is down, and Medicaid is already one of the lowest payers. Practices are not sustainable with flat payments from Medicaid.

• Inflation: The consumer price index, reflecting real expenses facing medical practices, rose 6.5 % from December 2021 to December 2022
• Medicare cuts: Practices just received a Medicare cut of 2.5% in 2023.
• Blue Cross Blue Shield of Vermont Primary Care Payment Cut: In late December 2022, BCBSVT abruptly pulled out of One Care Vermont contracts, immediately ending $2.50 per member per month primary care payments and threatening to end an additional $3.50 per member per month payment starting in July.
• Physicians Not Eligible for Additional Stabilization Funds – In AHS’ most recent Premium Pay grant program, only employees of primary care practices qualify for payments and physicians are not eligible.

Let lawmakers know how a flat Medicaid fee schedule will impact your practice. The State has said they are working to address access to care and support primary care. The Medicaid RBRVS fee schedule must be increased in the Fiscal Year 2024 Budget just to make up for inflation and multiple fee losses. The Medicare Economic Index (MEI) used by Medicare to measure practice cost inflation was 3.8% for 2022, please ask lawmakers to include a 3.8% inflation increase in the FY24 RBRVS fee schedule.

Please email:

dlanpher@leg.state.vt.us; RScheu@leg.state.vt.us; pbrennan@leg.state.vt.us; tbluemle@leg.state.vt.us; edickinson@leg.state.vt.us; kdolan@leg.state.vt.us; jharrison@leg.state.vt.us; rholcombe@leg.state.vt.us; mmihaly@leg.state.vt.us; wpage@leg.state.vt.us; TSquirrell@leg.state.vt.us; ttoleno@leg.state.vt.us; lhoughton@leg.state.vt.us; fmcfaun@leg.state.vt.us; ablack@leg.state.vt.us; jandriano@leg.state.vt.us; dberbeco@leg.state.vt.us; bcina@leg.state.vt.us; mcordes@leg.state.vt.us; ademar@leg.state.vt.us; bfarlice-rubio@leg.state.vt.us; lgoldman@leg.state.vt.us; and apeterson@leg.state.vt.us

Federal Public Health Emergency to End May 11 – Regulatory Implications

The White House announced last week that it will end the federal public health emergency (PHE) on May 11, 2023 – a one month extension from the previous end date of April 11, 2023.

Many state and federal regulatory flexibilities are tied to the end of the PHE and the end of the PHE will have implications for both clinicians and patients.  On the clinician and facility side,  CMS' 1135 waivers are tied to the PHE.  See provider-specific fact sheets for information about COVID-19 Public Health Emergency(PHE) waivers and flexibilities from CMS here: https://www.cms.gov/coronavirus-waivers.  The fact sheet for physicians can be found here, and provides a detailed description of current waivers and the impact of the end of the PHE on issues like payment for COVID-19 vaccine administration, oral antivirals, telehealth services and workforce flexibilities.  Of note, the year-end package passed in late December by Congress extended Medicare telehealth coverage until December 31, 2024, regardless of when the PHE ends.

There will also be impacts on patients, and those with health insurance coverage could begin facing out of pocket costs for COVID-19 tests and treatments.  For a comprehensive list of all flexibilities in place during the PHE related to patient care coverage, cost and access, and what will happen when the PHE ends, please see this Kaiser Family Foundation article.  As covered in an earlier Rounds article, this also means that Vermont will begin the process of redetermining whether individuals are eligible for Medicaid.  See more details on the Medicaid redetermination process here. 

The Vermont Medical Society, along with partner health care organizations, will be testifying to the Vermont House Health Care Committee tomorrow regarding continuing some of Vermont’s regulatory flexibilities, including those related to licensure and insurance coverage for COVID-19 testing and treatment.  Contact Jessa Barnard at jbarnard@vtmd.org with questions.   

Premium Pay for Workforce Recruitment and Retention Grants Open to Primary Care

In March 2022, Governor Scott authorized $60 million for certain health care and social service employers to provide premium pay for workforce recruitment and retention. These funds have been made available to the State of Vermont through the Federal Coronavirus State Fiscal Recovery Fund and Section 9817 of the American Rescue Plan Act.  The Agency of Human Services (AHS) is administering this program.   A second round of funding is now available to applicants, including primary care practices.  Applications will be open between February 8 and February 27, 2023.  Practices can receive up to $2000 per FTE, which can then be distributed in a flexible manner, up to the equivalent of $13/hr additional pay per eligible employee. 

Potential applicants are encouraged to start by reviewing:  Program Guidance

The online application itself doesn't take long to fill out.  The process will go more smoothly if applicants take the two lengthier steps in advance:

1. Register for a unique entity identifier at sam.gov, if your organization doesn't already have one, and ensure the account is set to public.
2. Fill out the “FTE Summary Spreadsheet.” Applicants have two options to choose from:

A recording of the February 2nd webinar will be posted at Premium Pay for Workforce Recruitment and Retention | Agency of Human Services (vermont.gov) and additional sessions will be held in the coming weeks.

Legislature is Picking Up the Pace and VMS Testifies on Priority Legislation

Last week, the House passed the mid-year Budget Adjustment Act (BAA) for Fiscal Year 2023, which includes over $9 million for an increase in youth inpatient psychiatric beds. Now the BAA moves to the Senate, and the House begins its work on the FY24 Budget in which the VMS is seeking an increase to account for inflation in Medicaid reimbursement rates, please see the action alert below. The VMS is also actively testifying on several bills this week, including:

• OBGYN Advocacy Day: Thursday is the OBGYN Advocacy Day and UVMMC OBGYN Residents will be testifying on the "Sheild Laws" and healthcare workforce initiatives;
• H.89 in House Judiciary: Jessa Barnard testified on Tuesday morning on the House version of the "Shield Law," the bill providing protection for health care clinicians who provide abortion services and gender-affirming care, in the House Judiciary Committee. The Committee voted in favor of the bill 9-1 this afternoon;
• S.37 in Senate Health and Welfare: Jessa Barnard and VMS member Erica Gibson, MD are scheduled to testify on the Senate version of the "Shield Law" in Senate Health and Welfare on Wednesday morning. UVMMC OBGYN Residents will testify on this bill on Thursday morning;
• Suicide Prevention in House Health Care: VMS President-Elect Rebecca Bell, MD, will testify on Thursday morning on suicide prevention and reducing access to lethal means;
• Covid-19 Flexibilities in House Health Care: Jessa Barnard will testify Wednesday morning on a discussion of further extensions and making permanent COVID-19 related regulatory flexibilities; and
• Workplace Violence, S.36 in Senate Judiciary: The Committee is continuing work on the workplace violence bill. Last week emergency medicine physicians VMS President Ryan Sexton, MD, VMS Board member Alison Davis, MD, and VMS member Ben Smith, MD, all testified in support of the bill that would give law enforcement the ability to immediately remove individuals who are threatening or committing violence interfering with the provision of care. Click here for a link to testimony. If you would like to testify on the workplace violence bill, please let us know, we also would like to hear from clinicians not working in the ED. Email Stephanie at swinters@vtmd.org. Also, please join VMS and VAHHS on February 21^st for Workplace Violence Day, in which there will be a Legislative Breakfast, testimony and a press conference. RSVP here.

VMS Board Considers Medicare Advantage, REACH Model and Overdose Prevention Sites

The VMS Board met last Wednesday and had robust discussions on a number of policy issues.  The Board voted to send two resolutions to the membership to gather member input: a resolution calling on CMS to end overpayments to Medicare Advantage plans and strengthen traditional Medicare; and a resolution calling for the end of Medicare’s Direct Contracting Entity/ACO-REACH program.  VMS staff will be sending a survey link to provide input on these resolutions in March, leading up to the April VMS Board meeting.  Knowing that the issue will be coming to the legislature and after extensive discussion, the Board also took a position in favor of supporting overdose prevention sites as part of a comprehensive harm reduction strategy and supported further exploration of the feasibility of establishing sites in Vermont.  However, given limited funding and staffing resources, the Board also believes that there are other harm reduction strategies, such as increasing access to take home methadone doses, increasing transportation to hubs and mobile methadone units, improved transitions of care after incarceration, and reducing regulatory requirements on community MOUD prescribers, that should be a more immediate priority.   Please contact jbarnard@vtmd.org with any questions or comments or for more information about attending future Board meetings, which are open to any VMS member. 

MISC.

Medical Mutual Insurance Company of Maine Seeks President and CEO

After long, successful careers as a physician, hospital administer and currently as the leader of Northern New England’s premier medical liability insurance carrier, Medical Mutual President and CEO Frank Lavoie, MD, MBA has announced his plan to retire on December 1, 2023.

The Board has convened a search committee and has begun the process of recruiting the next Medical Mutual President and CEO. Should you or someone you know be interested in applying for the position, please learn more about this opportunity by reviewing the prospectus.

Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about infections with an extensively drug-resistant strain of Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) in 12 states. Most patients reported using artificial tears. Patients reported more than 10 different brands of artificial tears, and some patients used multiple brands. The majority of patients who used artificial tears reported using EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles. CDC laboratory testing identified the presence of the outbreak strain in opened EzriCare bottles with different lot numbers collected from two states. Patients and healthcare providers should immediately discontinue using EzriCare artificial tears pending additional guidance from CDC and the Food and Drug Administration (FDA).

Learn more here.

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 view notes from the February 2nd call here.

You can join the zoom meetings 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.

2023 Epilepsy & EEG in Clinical Practice

February 10, 2023

In-person - Main Street Landing, Burlington, VT

Held in Burlington for the first time, the 2023 Epilepsy & EEG course will focus on providing a review of current medical and surgical clinical practices related to seizures and conjunction with adjunctive EEG testing and will address errors that may lead to incorrect diagnosis and treatment. An interactive and didactic format that includes multimedia presentations and allows for audience participation. Target audience: internists, family practice and general practice physicians, pediatricians, neurologists, physician assistants, nurses, allied health professionals and residents involved in the care of patients with seizures and epilepsy are encouraged to attend.

Note: This is being held in conjunction with the EAEEG Annual Meeting. There is a discount for attending both events.

Vermont Pharmacists Association

February 15, 2023, 7pm to 8pm ET

Virtual

This activity has been designed to address the educational needs of neurologists, emergency room physicians, and hospital clinicians (including hospitalists, nurse practitioners, PAs, and clinical pharmacists). It may also benefit other healthcare providers caring for patients at risk for AIS.

Agenda

• Quick Review: Stroke
• Thrombolysis: 25 Years of Practice Experience Focused on Time
• Newer Thrombolytics: Alteplase Compared With Tenecteplase
• Collaborative Care and Cases
• Q&A

Learning Objectives

Upon completion of this activity, participates should be able to:

• Summarize the latest data from clinical trials of thrombolytic agents used in the treatment of AIS
• Assess the use of collaborative acute care across care settings as it applies to optimal management of patients with suspected AIS

To learn more, click here.To register here.

Indigenous Historical and Intergenerational Trauma Training

for Health/Mental Health Care Providers

February 15 and 22, 2023

Virtual

This training will provide a general overview of indigenous historical and intergenerational trauma and

how this trauma directly impacts the indigenous community’s overall health and wellness.

The presenters for this training will be Kheya Ganguly, the Director of Trauma Prevention and Resilience

Development for the Agency of Human Services and Dr. Frederick Wiseman, a citizen of the Abenaki

Nation of Missisquoi and Coordinator of the Vermont Indigenous Heritage Center.

This training is for all community health and mental health related providers and first responders

View the flyer here.

Click here to join the February 15, 2023 meeting from 1pm to 4pm.

Click here to join the February 22, 2023 meeting from 1pm to 4pm.

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 

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 

More conferences from UVM CMIE are expected this Spring to include these topics: Anesthesia, Cardiovascular/Vascular Disease, Geriatrics and Family Medicine. Sign-up to get updates via email for topics that are of interest here

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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