March 22nd, 2022

NEED TO KNOW

House Appropriations Committee Sends FY23 Budget to the House Floor

Vermont representatives will be spending most of the week on the House floor this week to continue to debate bills passed during crossover week and to debate the $8 billion dollar FY23 spending package as drafted by the House Appropriations Committee. The bill includes the $12,576,731 million for the increase to Medicaid reimbursement rates through their alignment with the Medicare RBRVS. The House Human Services Committee is taking more testimony on H.728, a bill that aims to reduce barriers to medication-assisted-treatment (MAT) and to provide more opioid recovery supports, including a provision that would delay prior authorization for all MAT for 60 days. H.711, a bill that creates an Opioid Settlement Advisory Committee, passed the House last week and has advanced to the Senate Health and Welfare Committee. This Committee will determine the estimated $38 million that will be coming to Vermont from the Purdue-Sackler settlement as reported in VPR.  The VMS Policy Team will include these bills and more in our 2022 Mid-Session Legislative Bulletin that we will publish next Tuesday in the VMS Rounds. 

President Biden Signs Bill to Promote Physician Mental Health

Last week, President Joe Biden signed into law the Dr. Lorna Breen Health Care Provider Protection Act, which had been previously approved by the by U.S. Senate by a unanimous voice vote.

The bill is designed to bolster the mental health infrastructure supporting physicians and other health professionals by establishing:

• Grants for health professionals to help create evidence-based strategies to reduce burnout and the associated secondary mental health conditions related to job stress.
• A national campaign to encourage health professionals to prioritize their mental health and to use available mental and behavioral health services.
• Grants for employee education and peer-support programming.

The legislation also funds a comprehensive study on the mental health and burnout of doctors and other health professionals. The bill is named after Lorna Breen, MD, who died by suicide in April 2020 following an intense stretch treating COVID-19 patients at the onset of the pandemic. Read more from the AMA here. VMS has funding to provide clinician wellbeing workshops at practices and medical staffs this spring. Click here for more information on workshops and here for more resources on clinician wellness.

Vermont to Begin to Ramp Down COVID-19 Vaccine Clinics, Testing Continues to Transition to Rapid Tests

This week’s DFR Modeling Report indicates that COVID-19 cases in Vermont increased this week but remain more than 90% below peak January levels. Forecasts predict continued low-level viral activity in Vermont, but the spread of the more-transmissible Omicron BA.2 subvariant has introduced increased uncertainty in these projections. Hospitalizations and fatalities in Vermont remain at stable low levels.  Experts continue to debate the degree to which these factors will influence case and hospitalization growth in the US in the coming weeks.  At today’s weekly administration press conference, Commissioner Levine stated it is unclear if BA. 2 will cause the US and Vermont to see a slight surge in cases or rather a “prolonged tail” of Omicron based on factors such as high vaccination and prior Omicron infections.  Commissioner Levine also reminded listeners that they can now pick up rapid antigen or PCR LAMP tests from state testing sites and added that state-run vaccination clinics will be ramping down with decreased demand – and vaccination will continue to be transitioned to pharmacies and health care practices.  The last state run vaccine clinics are likely to be offered in mid-April pending future developments or need.  When vaccine is approved for children ages 6 months through 5 years old, it is anticipated that all vaccines will be scheduled directly with health care practices and not through state sites.   The administration was also asked about a report by the Vermont State Auditor finding that 17 providers were overpaid by the AHS Provider Stabilization Grant Program implemented early in the pandemic.  AHS Interim Secretary Jenney Samuelson stated that AHS has also implemented a post-payment review of the program that has requested documentation from a number of providers who received funds, including 10 of the 17 discussed in the Auditor’s report, and has found appropriate documentation of financial need and no evidence of fraud or misconduct. 

The DFR Modeling Report can be found here and notes from the press conference can be found here. To view the call notes from the Commissioner of Health call with Dr. Mark Levine, click here.

New Blueprint Executive Director Letter of Introduction to VMS Members

Dr John Saroyan was appointed as the Executive Director of Vermont’s Blueprint for Health Patient Centered Medical Home (PCMH) program and he has been in the role as of January, 2022. Dr. Sayoran is a pediatrician and hospice and palliative care specialist based in Norwich, Vermont. We want to welcome him into his new role at the Blueprint and he has provided this letter as an introduction to the members of the Vermont Medical Society:

Thank you for the invitation to introduce myself to the esteemed members of the Vermont Medical Society (VMS).  It’s an honor to serve as Director of Blueprint for Health at the Agency of Human Services.  I consider both prior Directors, Dr. Craig Jones and Beth Tanzman, visionaries in Vermont’s health care reform.  Their combination of leadership and collaboration with you is humbling and inspiring as I begin my attempt to fill their shoes.  

In a recent “meet and greet” with one of the Commissioners at AHS, I was asked to make the connection between hospice and palliative medicine and my interest in this leadership position. I would like to share with VMS some background on how I got from there to here. Click here to read the full letter. 

Medicare Telehealth Flexibilities Assured for the Bulk of 2022 

Congress’ recent $1.5 trillion spending bill has provisions enabling doctors to keep offering telehealth after the Federal Public Health Emergency (PHE) is over and sets the stage for permanent fixes.  Many of Medicare’s telehealth flexibilities that have helped dramatically improve patient access to care are temporary and limited to the duration of the COVID-19 PHE, and they affect both public health programs and private health coverage. The PHE must be renewed every 90 days, and is set to expire April 16. It is expected the PHE will be renewed for another 90 days, with a mid-July expiration date. In addition to keeping the telehealth flexibilities in place for 151 days after the PHE ends (expected to be through Dec. 2022), the new law also calls on the Medicare Payment Advisory Commission to issue a report on telehealth use by June 15, 2023. Learn the bill’s main telehealth provisions.

MISC.

Final Call for Applicants: The Physicians Foundation Fellowship Program

AMA asks Congress Not to Adopt MedPAC Recommendation to Continue Medicare Physician Payment Freeze

The AMA instead asks Congress to establish a stable, annual Medicare physician payment update that keeps pace with practice cost, similar to other Medicare providers and Medicare benefit categories such as Medicare Advantage plans, which are projected to see nearly an 8% payment increase in 2023. Read more from the AMA.  Last Thursday, HHS Secretary Xavier Becerra also said that he is "definitely interested" in looking at reforming the Medicare Physician Fee Schedule. Read more here.

OSHA To Begin Covid-19 Focused Inspections

The Occupational Safety and Health Administration announced that it will ramp up inspections of hospitals and nursing facilities that care for covid-19 patients over the next three months to assess their readiness to address future surges or emerging variants of the virus.

Medicaid PERM Audit Update – Informational Webinars

Vermont Medicaid (DVHA’s) Payment Error Rate Measurement (PERM) audit has commenced and will examine sampled claims from July 1, 2021, through June 30, 2022. Providers with a sampled claim will receive a medical record request letter from NCI Information Systems, Inc., and are required to submit all requested claim medical records and documentation.

CMS will be hosting a few webinar sessions for providers focusing on the below topics:

• The PERM process and provider responsibilities during a PERM review
• Recent trends, frequent mistakes and, best practices
• The Electronic Submission of Medical Documentation, esMD program

These sessions will be held on:

• Tuesday 4/12 1pm-2pm
• Wednesday 4/13 3pm-4pm
• Thursday 4/14 3pm-4pm

Please see here for a link to register for the webinar. Registration closes April 10th.

Southern Vermont Area Health Education Center

The Southern Vermont AHEC is excited to showcase 3 videos featuring 4 extraordinary physicians from their surrounding service areas including two familiar faces (Dr. Kim Kurak and Dr. Meghan Gunn) along with Dr. Robert Tortolani-Family Physician-Brattleboro and Dr. Jasminder Multani-Hospital Medicine Specialist from Rutland Regional Medical Center. One video is called “Advice” with each physician talking about how students should prepare themselves if they’re interested in going into medicine. The others “Why Practice Medicine, and “Why Practice in Vermont”  focus on - why each of them became doctors and why they chose to work in VT.

View the videos here.

2021 VMS Dashboard

Throughout the last year, the VMS has worked consistently to provide the utmost service and highest value to our members. The VMS 2021 Dashboard provides a graphic snapshot of the breadth of our work and ability to continue to meet our members' needs despite the pandemic. To view more information about the VMS Dashboard, click 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).

No Cost Well-Being Workshops

VMS is continuing our partnership with Doug Wysockey-Johnson of LumunosWellBeing to offer no-cost clinician wellbeing workshops at up to 10 Vermont medical staffs/practices over 2022. There are 3 remaining slots available this spring.  New topics for 2022 include A Clinician’s Guide to Recovering from the COVID Marathon and A Realistic Look at ‘Work-Home Balance’ for Clinicians. See the full list and additional details here.  Members can contact jbarnard@vtmd.org or doug@lumunos.org for more information or to schedule a workshop. 

AMA STEPS Forward^TM Webinar: Racial and Health Equity: Concrete STEPS for Health Systems

March 24, 2022, 12pm CST

The new AMA STEPS Forward™ toolkit “Racial and Health Equity: Concrete STEPS for Health Systems,” developed in collaboration with HealthBegins, offers five steps to advancing health equity for clinicians, patients, and the communities served. The toolkit helps motivated leaders develop a shared understanding and commitment, set data-driven goals, and embark on a journey of continuous learning and improvement for racial justice and health equity. Join co-authors Denard Cummings, AMA Director of Equitable Health Systems Integration, and Rishi Manchanda, MD, MPH, President and CEO of HealthBegins as they provide actionable steps for advancing racial and health equity in your health care system.

Register for the webinar.

Gambling and Its Effects: Help and Treatment is Available

March 28, 2022, 6pm to 7pm

Like alcohol, tobacco, and opioids, gambling can become a serious and harmful addiction. Online sports betting and igaming put gambling within easy reach, and research shows that gambling disorders now affect about one percent of the population. Along with financial loss, problem gambling can lead to broken interpersonal relationships, a range of medical consequences, anxiety, domestic violence, and substance use. Our panel will discuss the signs of problem gambling and resources available to Vermonters who are concerned for themselves or loved ones. This event is part of The Marna and Stephen Wise Tulin Spring Community Education Series presented by the Howard Center. Read more about the series here.

Register here.

The Howard Center 5th Annual Conference: Vision, Visionaries and Voices

April 7, 2022, 9am to 4pm

Confronting Stigma. Improving Access. Continuing Advocacy. Advancing Policy. Giving Voice. Please join The Howard Center online for a day of inspiration, learning, and rich conversation at Vision, Visionaries and Voices, for their fifth annual spring conference on April 7, 2022 from 9:00 am – 4:00 pm.

Speakers will provide unique perspectives for a broad audience, including educators, healthcare providers, representatives of local and state government, legal and law enforcement professionals, clients and families, and the general public. They expect attendees from throughout Vermont, New York, New England, and Canada.

The conference will be held virtually by Zoom webinar. To register (registration cost is $89) and view the full conference agenda, please click here.

The UVM Medical Center Cardiovascular/Vascular Forum

May 2, 2022

Course Director Dr. Matt Alef invites Primary Care, internal medicine, and urgent care providers to attend virtually or in-person to learn more 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.

TOPICS: SAVR vs TAVR, vascular nurse wounds, aortic dissections, POCUS hands-on workshop, echocardiography and more.

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

The Upstanders, An Indieflix Film About Cyberbullying

May 4, 2022, 6pm to 7:30pm

The Upstanders explores all sides of cyberbullying, from bully to victim, bystanders, and family members. Social media’s power means that bullying is now a 24/7 phenomenon, where even changing schools and phone numbers, or deleting accounts cannot stop the cycle. COVID has increased the incidence of cyberbullying by 70%. Changing human behavior and connection is the key, and this is what the film addresses.

Weaving together personal stories of teenagers and their families, as well as teachers and brain-scientists, The Upstanders shows the importance of empathy and resilience to transforming attitudes and action, and highlights new laws and established programs that are already reducing bullying in schools and communities. It shows that everyone is needed to eradicate cyberbullying, and gives bystanders the confidence and tools to become ‘Upstanders’, and help change the narrative. To view the trailer, please visit their website.

This film screening and panel discussion is hosted in partnership with Champlain Community Services. This event is part of The Marna and Stephen Wise Tulin Spring Community Education Series presented by the Howard Center. Read more about the series here.

Register here.

How Can We Make Vermont More Welcoming and Inclusive for Our Diverse Community?

May 18, 2022, 6pm to 7:30pm

Vermont is one of the least diverse states in the nation. With that as our starting point, how can Vermont attract more people with diverse backgrounds and help them find community so they decide to stay? Join a panel of professionals working to promote diversity and equity in area businesses and institutions to hear about lessons they’ve learned in the workplace, and how those lessons can be applied to make the Green Mountain State more welcoming and inclusive.

This event is part of The Marna and Stephen Wise Tulin Spring Community Education Series presented by the Howard Center. Read more about the series here.

Register here.

The 48th Annual Family Medicine Review Course

June 7-10, 2022

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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