February 8th, 2022

NEED TO KNOW

Your Voice is Needed: Virtual Advocacy Town Hall on Monday, February 14th, 12pm

Please join the VMS on Monday, February 14th from 12-1pm for our 2022 VMS Health Care Policy Townhall with Vermont legislative leaders. Please join us for this candid conversation with Vermont's health care policy decision-makers this Monday. In an article below we highlight just some of the bills the VMS Policy team is following this legislative session. Our members have the most to offer in these conversations and we need your leadership to help increase Medicaid reimbursement rates, protect reproductive health care rights, and invest in mental health care solutions. Log onto this Zoom link.

Please email Jill to let her know you can attend at jsudhoffguerin@vtmd.org, so we know we have a great team to meet with these lawmakers.

Legislature Advances Medicaid Reimbursement Rate Increases and Prop 5 

The legislature began the week by taking up Prop 5, the Reproductive Liberty amendment on the House floor, and providing final approval for the FY22 fiscal spending package that provides Medicaid reimbursement rate increases and health care workforce recruitment and retention funding. Here are just some of the issues the VMS Policy Team will be following and testifying on this week: 

• FY22 Budget Adjustment: The Senate has advanced the FY22 Budget Adjustment , which increases state spending by $367 million. This spending package now goes back to the House for final approval. The Senate passed version:  
• Maintains an increase to Medicaid’s RBRVS reimbursement rates through its alignment with the Medicare fee schedule, which provides a bump in payments for primary care services;  
• Includes the legislature’s support to pursue federal approval of Medicaid coverage for 12-months of post-partum care. The application process begins in April of 2022; 
• Funds eight FTE positions and $200,000 to the Cannabis Control Board, along with the transfer of $850,000 from the General Fund to the Cannabis Regulation Fund;
• Provides $25 million in one-time funds for an Agency of Human Services health care stabilization funds for workforce recruitment for eligible health care employers (as defined on p.30); 
• Provides $60 million in workforce retention funding for long term care facilities, home health agencies, designated agencies, substance use treatment providers and recovery centers.  
• S.74, Patient End of Life Choices bill: this bill passed the Senate and would eliminate in-person requirements for oral requests and the 48-hr waiting period. The bill has advanced to the House Human Services Committee.  
• H.654, COVID-19 Flexibilities: The bill that aims to extend regulatory COVID-19 flexibilities until March 31, 2023, passed the House and is scheduled for a hearing in the Senate Health and Welfare Committee this week.   
• Prop 5: the Reproductive Liberty Amendment: the House floor debated for several hours this morning before approving the proposed constitutional amendment by a vote of 107-41. It will now go before all Vermont voters as a ballot initiative on the 2022 General Election ballot. 
• S.30: Prohibits Firearms in Hospitals: This bill passed the Senate and is scheduled for final approval on the House floor today. The bill as amended would close the “Charleston loophole,” which currently allows firearm sales to be approved if background checks take longer than 3 days to complete. Please urge Governor Scott to support this bill as passed by emailing him here.  
• H. 655, a bill to establish a telehealth licensure and registration system passed the House Health Care Committee by a vote of 10-0-1 and has been referred to the House Committee on Ways and Means to discuss fees.  
• Mental Health legislation aimed at preventing emergency department wait times: S.194, S.195, and S.197 is scheduled for mark-up and potential vote this Friday in the Senate Health and Welfare Committee.  
• S.244, a bill aimed at strengthening primary care by raising reimbursement, increasing the overall spend on primary care and providing parity reimbursement for audio-only telehealth services will receive a hearing in the Senate Health and Welfare Committee this Wednesday. The Committee is also continuing their discussion on S.285, which proposes to expand the Blueprint for Health program.  
• H.631, the bill to end child marriage: is scheduled for mark-up and vote in the House Judiciary Committee this week.  
• S.158, a bill that would expand the scope of procedures optometrist may perform to include injections, lasers and surgeries to the eye and adjacent structures is scheduled for a hearing in the Senate Government Operations Committee this afternoon. 

Administration Sites Continuing Improvement in COVID-19 Cases, Move to Normalcy

The Scott Administration held its weekly press conference today and focused on improving COVID-19 case rates, stabilizing hospital rates and the need to continue to examine what the future of living with COVID-19 looks like.  Commissioner of DFR Michael Pieciak reported that Vermont is averaging 396 cases over the last 7 days, which now puts the State back to a pre-Omicron level of December.  There has been a decrease of 41% cases over the last 7 days and 65% over the last 14 days – closely mirroring New England data.  Cases are expected to continue to decline in the coming weeks down to a level of 100-200 per day by the end of the month.  There has also been an improvement in hospital metrics: a 14 % decrease in new hospital admissions over the past week; a 13% decrease in the 7-day hospitalization average over the past week; and a 17% decrease in ICU use.  Reporters asked about the future of mask recommendations for schools and the public.  Governor Scott and Commissioner of Education Dan French acknowledged that these recommendations are under review and more information should be available in the next week or two.  They both stated that schools should be supported in decreasing student anxiety and tension and continuing to move towards normalcy.  There is now adequate antigen test supply for schools and the Administration is working to put in place an antigen “assurance test program” for asymptomatic school staff who want screening testing.  Commissioner of Health Mark Levine credited Vermont’s booster rates with helping the State weather the Omicron surge with fewer hospitalizations than other states and thanked primary care clinicians for their participation – 64% of PCPs are now offering COVID-19 vaccinations and Dr. Levine urged boosters to become part of routine check-ups. See the full notes of the press conference here. To view the notes from the call on February 3rd with Commissioner of Health, Dr. Mark Levine, please click here.

Other COVID-19 Updates from the week:

VMS Board Addresses COVID-19 Impact on Care Availability

The VMS Board met last Wednesday night and adopted a new policy regarding Crisis Standards of Care and other “nonstandard” care required in response to the COVID-19 pandemic. The policy acknowledges that COVID-19 has had far-reaching impacts in Vermont on the volume of patient need, health care worker availability and supply chain limitations leading to ever changing stresses on health care practices, negatively impacting access to care, and requiring the need to make unconventional care decisions. The policy calls on VMS to take a number of steps to address these concerns, including making no cost wellness resources available to members and to gather and disseminate resources on the liability implications of unconventional care and methods of reducing liability exposure. 

The Board also voted to support efforts to extend Medicaid coverage for eligible individuals from 60 days to 12 months postpartum and to end Vermont law that allows marriage at ages 16 and 17 with parental consent. The Board voted in a new at-large Board member, Adam Kunin, MD.  The Board schedule can be found here and meetings are open to any interested member. 

MISC.

Dementia Screening Pilot Open to Primary Care Practices

Vermont Department of Health Alzheimer’s Disease and Healthy Aging Program is seeking 10 primary care practices to participate in an exciting proposal called SPREAD, (System Preparedness and Response for Early Alzheimer’s Disease and Related Disorders) Detection Project beginning Fall 2022.  The project will test a new model to increase screening and diagnosis of dementia (mild cognitive impairment and Alzheimer’s and related dementias). For participating PCPs the nursing students overseen by UVM Nurse faculty will conduct the Medicare Annual Wellness Visits, including a cognitive assessment, with results documented and communicated to the provider. No provider time or exam room is needed. Dementia training is available, which covers how to make screening sustainable using the clinic’s nursing staff. The Davos Alzheimer’s Collaborative Foundation is funding this effort to cultivate systems change to increase earlier detection of cognitive decline.  Please contact Mary Val Palumbo DNP, APRN by Feb 21: (802) 371-7743 or mary.palumbo@med.uvm.edu

BCBSVT Launches Primary Care Learning Collaborative

Blue Cross and Blue Shield of Vermont has launched a learning collaborative in partnership with independent primary care practices in Vermont. The goal of Vermont Blue Integrated Care is to improve patient quality and cost outcomes, while supporting the practices with a per member per month payment to support care management programs. This program is designed to either supplement the work being done by the All Payer Model through practices working with OneCare Vermont or those without an agreement.  Vermont Blue Integrated Care tackles four meaningful areas of patient health: uncontrolled diabetes; hypertension; FIT testing for colorectal screening; and risk adjustment coding. The program is slated to start in the second quarter of 2022, with a small number of practices in the pilot.  Blue Cross wants to introduce this program to additional interested primary care practices in the fall of 2022. To learn more, contact Lou McLaren at mclarenl@bcbsvt.com.

AMA STEPS Forward Pearl of the Week

As COVID-19 continues to surge, rates of physician burnout are on the rise. But how to combat it? Even the smallest steps toward reducing and/or removing non-essential work can make a big difference in freeing up critical time in a clinician’s day.

Do LESS of this…

• Turn off automatic inbox notifications of orders placed without results

And MORE of this…

• Start prescribing chronic medications for 12-15 months

Learn More:

• Medication Management
• Saving Time Playbook
• De-Implementation Checklist

AMA STEPS Forward^™ offers a collection of engaging and interactive educational toolkits that are practical, actionable “how-to” guides to transform and improve your practice.

If you would like to receive the AMA STEPS Forward weekly email, subscribe here.

EVENTS

Join us every 1^st and 3^rd Thursday of the month from 12:30pm to 1pm as Commissioner of Health, Mark Levine provides us with the most pressing COVID-19 information affecting the state and nation. You will have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting.

You can join the zoom meetings beginning in January here or add to your calendar by following this link and clicking download (you will then need to open the downloaded file and click save to add to your calendar).

February 10th, 2pm to 3pm ET

AMA STEPS Forward^TM Webinar: No One Should Care Alone: Creating Processes for Intentional Professional Connection

February 24th, 11am CST

Dr. Mark Greenawald launched the nationally acclaimed PeerRxMed program (www.PeerRxMed.org) last year to help healthcare professionals support each other as they move away from distress and toward thriving. The tag line for the PeerRxMed program is "No One Cares Alone," which captures Dr. Greenawald’s mission in his work toward advancing professional well-being. Join the AMA at 11 a.m. CST on Feb. 24 to revisit Dr. Greenawald's webinar, “No One Should Care Alone: Creating Processes for Intentional Professional Connection.” A live Q&A session with Dr. Greenawald will follow the presentation.

Project ECHO: Aging, Community, and Equity (PEACE)

2nd Wednesday of Every Month from February to September

12pm to 1:30pm, EST

Project ECHO® (Extension for Community Healthcare Outcomes) is an evidence-based method developed by researchers at the University of New Mexico. During teleECHO™ sessions, expert mentors share their expertise across a virtual network via case-based learning.

In this Older Adult ECHO program, we will explore:       

• Pandemic-related social isolation
• Methods to support formal & informal caregivers
• Impacts of the pandemic on cognitive decline
• Effects of isolation on physical & mental health
• Solutions for rural communities

Intended audience: Medical, mental health, and community social service individuals working to support older adults in rural settings of Maine, New Hampshire, Vermont, and Northern New York

The 27th Annual Vermont Perspectives in Anesthesia Conference

March 2nd - March 4th, ET

Drs. Matt Fisher and Bob Williams invite you to join them for this year’s Live VIRTUAL Conference, with practical reviews and timely informative clinical updates on a variety of topics of current interest in Anesthesia. Registered participants will have access to On-Demand Recordings to view and claim credit for any sessions that are missed during the live conference - for up to 12 months following the conference.

Topics: The Difficult Airway, Obstructive Breathing Patterns in the PACU, Perioperative EEG, Patients with Opioid Use Disorder, NORA emergencies, Non-Cardiac Surgery: Myocardial Injury and Preoperative Assessment, The Value of Women on Teams, The Anesthesia Department on the Other Side of COVID, 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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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