May 17, 2022

NEED TO KNOW

The 2021/2022 Legislative Biennium Adjourns and Top Legislative Leaders Leave in Droves

Last Thursday evening the gavel fell on Vermont’s 2021/2022 Legislative Biennium and many stalwart stewards of the State said goodbye to friends and colleagues, as they prepared to leave long-held leadership positions in the Vermont legislature. With over a third of the Senate reportedly not returning and over half of the House Committee Chairs announcing they will not seek re-election in 2023, there will be a massive leadership change up next year. The VMS Policy Team thanks the entire Legislature for their work during the 2022 legislative session and celebrates many policy successes, including:

• Vermont Medical Student Incentive Scholarship in the FY23 Budget: the funding for the Vermont Medical Student Incentive Scholarship was put into statute in 2021 and the FY23 budget continues to fund up to ten scholarships per year for graduates of the Larner College of Medicine who commit to practicing primary care in Vermont;
• Vermont Health Care Professional Loan Repayment Program in the Workforce Development Bill (S.11): AHEC will oversee this new health care professional loan repayment program, which appropriates $2 million in loan repayment dollars for nurses and physician assistants who live and work in the State and $500,000 for medical technicians, child psychiatrists and primary care providers who live and work in the State;
• Medicaid Payments for Primary Care Increased to 100 percent of Medicare in the FY23 Budget;
• Cannabis Potency Caps Retained – 30% for flower, 60% for solid concentrates in S.188: in a last minute effort to keep the existing THC potency caps in place, House leadership put all of the policies in H.548 that “needed to pass” onto S.188 and left the language that removed the potency caps to die. The Senate accepted the compromise, but called for a study by the Cannabis Control Board of lost revenue from the State being prohibited from selling products above 60% potency;
• Expanded Optometrist Scope of Practice Bill Dies (S.158): after a herculean effort from the Vermont Ophthalmological Society in advocating for safe surgery practices, the bill seeking scope expansion for optometry to allow surgical procedures died in Committee.

These are only a handful of the policy initiatives in which we had a positive outcome this session. Next week, we will publish our 2022 Final Legislative Bulletin, in which we will provide a comprehensive summary of all of the 2022 health care policies that will impact your practice and profession.

Contact Governor Scott: Support Important Pharmacy Safety & Access Bill

Please contact Governor Phil Scott’s office to ask for his support for H. 353, a bill that will implement important patient- and medication-access and safety measures. 

H.353 takes steps to:

For more information, see VMS support for the bill here and written summary of the bill and testimony in favor here. VMS has heard that the Governor is being pressured by the PBM industry to veto the bill. Send a message to Governor Scott here.

Press Conference Highlights Availability of Paxlovid, Changes to Testing and Case Dashboard

Governor Phil Scott opened today’s press conference condemning the recent mass shooting in Buffalo, NY. He also recognized the legislature for its work making historic investments in broadband, infrastructure, economic development and housing. Commissioner of Health Mark Levine, MD, then highlighted several areas of focus in ongoing efforts to address COVID-19:

For full notes of the press conference, click here. Other COVID-19 updates from the week include:

Department of Health Urges Increasing Paxlovid Prescribing

The Vermont Department of Health released a HAN last week urging prescribers to provide Paxlovid to all Vermonters who qualify, even those with mild symptoms.  Paxlovid, which is now widely available in Vermont pharmacies for people who meet eligibility criteria, appears to be currently underutilized, related to a variety of patient and system-related factors. This means Vermonters are at risk of preventable hospitalization and death due to inadequate receipt of Paxlovid.

A review of the medical literature and a recent convenience survey of Vermonters at risk of severe COVID-19 reveal several barriers to accessing Paxlovid:  Lack of awareness among at-risk individuals that there is residual risk of severe COVID-19 despite vaccination; clinician misconceptions that Paxlovid should not be prescribed for mild disease;  slow clinician office responses to at-risk patient calls about a new COVID-19 diagnosis; rapid decompensation; and, difficulty accessing Paxlovid at a convenient pharmacy.

REQUESTED ACTIONS: 

• Use this new FDA guide to support clinical decision making: screening checklist for Paxlovid.
• Prescribe Nirmatrevlvir/ritonavir (Paxlovid) to at-risk individuals who meet eligibility criteria, even if they have mild symptoms.
• Ensure there is a screening triage practice in your office so the appropriate patients get Paxlovid.

Update on Infant Formula Shortages

With supply chain issues due to COVID-19 and a recent product recall, the impact of limited supplies of formula is being felt by parents across the United States.

The U.S. Food & Drug Administration announced it is taking steps to help improve supply of infant and specialty formula products. Health & Human Services has also released a Fact Sheet: Helping Families Find Formula During the Infant Formula Shortage. In the meantime, here are some tips that can help families from excerpted from healthychildren.org:

• Check smaller stores and drug stores, which may not be out of supply when the bigger stores are.
• If it is an option, buy formula online until store shortages ease. Purchase from well-recognized distributors and pharmacies rather than individually sold or auction sites. Do not import formula from overseas, since imported formula is not FDA-reviewed.
• For most babies, it is OK to switch to any available formula, including store brands, unless your baby is on a specific extensively hydrolyzed or amino acid-based formula such as Elecare (no store brand exists). Ask your primary care practitioner about recommended specialty formula alternatives available for your baby.
• Check social media groups. There are groups dedicated to infant feeding and formula, and members may have ideas for where to find formula. Make sure to check any advice with your primary care practitioner.

Families should NOT:

• Add more water to formula
• Make their own formula

Recent News Coverage:

• FDA and Abbott reach deal to reopen shuttered infant formula plant
• Baby formula shortage deals major blow to low-income Vermonters

At today’s press conference, Governor Phil Scott said that anyone who needs help can also call his office at (802) 828-3333. They are working with VDH to create a list of sources for formula.

Health Alert Network (HAN): Iodinated Contrast Shortage

There is a temporary, global shortage of GE Healthcare’s iodinated intravenous contrast media expected to last at least through June 2022, resulting in an approximately 80% reduction in materials. GE is the supplier of intravenous contrast media used for specific computed tomography and radiographic imaging modalities used in numerous U.S. hospitals and imaging centers. Conservation of contrast material through various means over the next few months is necessary to avoid exhausting the available supply. Many sites have less than a week’s supply under conventional use rates.

REQUESTED ACTIONS:

• Evaluate the amount of on-hand inventory and monitor at least weekly.
• Seek other means of securing contrast media, including alternate wholesalers and distributors
• Develop protocols that include alternative imaging modalities for select presentations, such as ultrasound and magnetic resonance imaging, where available.
• Review appropriateness criteria with radiologists, emergency medicine physicians, surgeons, and others to identify CT studies that may reasonably be performed without the use of IV contrast.
• Consider adjusting scanning protocols to scan without contrast and injector protocols to reduce the amount of contrast dose where appropriate.
• Collaborate with imaging technologists on innovative opportunities for conservation of contrast media to limit waste.
• Work with ordering providers and radiologists to identify non-urgent imaging requiring intravenous contrast material that may be deferred if efforts at contrast conservation are inadequate to allow all indicated studies to proceed.
• If the contrast supply is inadequate for clinical needs despite the above efforts at contrast conservation and deferral of non-urgent studies, develop transparent prioritization criteria that maximize clinical benefit of use of contrasted studies.
• Engage in regular communication with referring physicians, radiologists, and imaging staff.

SELECTED RESOURCES:

• https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Contrast-Media-Shortage
• https://www.gnyha.org/news/ge-contrast-media-shortage-and-conservation-strategies/
• https://www.choosingwisely.org/societies/american-college-of-radiology/
• https://media.supplyrisk.com/post/1296/

MISC.

VMS Members Invited: Firestone Medical Research Building Reception, June 23

The Vermont Medical Society is pleased to be working with Dean Richard Page, MD at the UVM Larner College of Medicine to design an event to visit and learn more about the Firestone Medical Research Building, on track to be completed this Fall 2022. We hope you join us!

June 23rd, 5:30-7:30 pm

Hoehl Gallery at the UVM Larner College of Medicine

Save the Date: Emailed Invitation to Follow

Event hosted by Dean Richard L. Page, MD, Marilyn Cipolla, Phd, ’97, James Hebert, MD, ’77, Frank Ittleman, MD and Karen Meyer, ’70. 

With the knowledge and advocacy of the Vermont Medical Society membership, UVM and VMS together can promote and embrace the next generation of interdisciplinary, translational research to address societies’ challenges. The new 62,000 square foot Firestone Medical Research Building will provide an exceptional platform for scientific research, training, collaboration and innovation in medical science and human health. Work “on deck” at Firestone will advance the College’s mission to expand understanding of the human mind and body; advance knowledge and treatment of cancer and cardiovascular disease; as well as vascular neurological health. Firestone will support research to identify health disparities in our communities, investigate health inequities caused by poverty, behavioral issues, and environmental contaminants. All designed to benefit patients, society, and the profession’s ability to improve individual and public health. Learn more at https://www.med.uvm.edu/FirestoneBuilding.

Vermont Launching Premium Pay for Workforce Recruitment and Retention Program

The Agency of Human Services (AHS) is issuing a grant opportunity per Act 83 of 2022 to certain health care and social services employers. The Program allows Eligible Employers to apply to receive $2,000 per full-time equivalent employee (FTE) to distribute Premium Pay to Eligible Employees who commit to continuing employment with the Eligible Employer for at least one calendar quarter following receipt of the payment.  Eligible employees include those who provide regular, in-person interactions with patients and/or the public and includes front line staff, nurses, PAs, mental health clinicians, and psychiatrists. Eligible Employers include assisted living residences, nursing homes, residential care homes, home health agencies, designated agencies, substance use treatment providers, recovery centers, adult day service providers, area agencies on aging and DCF residential treatment programs.   Access program materials at http://humanservices.vermont.gov/recruitment-and-retention.  Applications open May 18^th and close May 24^th.

Green Mountain Care Board Chair and Member Vacancies – Applications Due 5/27

The State of Vermont has posted the description and application for the upcoming Green Mountain Care Board Chair vacancy and a member seat. The State is seeking candidates for the Chair (full time) and Board Member (32 hours per week) who serve a term of 6 years on the Board.  Applications are due by May 27th.  For more information see https://humanresources.vermont.gov/GMCB-Search-2022.

Deadline Extended to Complete Provider Relief Fund Late Reporting for Period 2 - May 18, 2022

The deadline for providers to request to submit a late Provider Relief Fund (PRF) Reporting Period 2 (RP2) report has been extended to May 18^th at 11:59 pm ET.  Physicians who received more than $10,000 in provider relief funds and did not submit their Period 2 report must act immediately by submitting a late Reporting Period 2 report request by Wednesday, May 18, 2022 at 11:59 pm ET. Provider Relief Fund (PRF) Period 2 spanned from July 1, 2020 thru December 31, 2020, and included physicians who see patients with Medicaid and CHIP coverage. If a provider did not submit a Period 2 report and does not hear from HRSA, click here to learn more about the late reporting request form or call (866) 569-3522.

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. 

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.

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.

Caring for Adolescents and Young Adults with Disordered Eating: A Multidisciplinary Training

May 23, 2022, 9am to 4:00pm

Virtual

Learn how to apply a multi-disciplinary approach to caring for adolescents and young adults with disordered eating, identify best practices for case conceptualization, assessment, and intervention to apply, and more with presenters from the UVMMC Eating Disorder Consultation Clinic, The Adams Center, UVM, and panelists from the field. View the full flyer with the learning objectives and agenda here.

Register here.

Clinician Information Sessions: New 2022 DNR/COLST Form

May 26, 2022, 12pm to 1:15pm

Virtual

On June 1, 2022, the Vermont Department of Health will be launching a new and improved DNR/COLST form for use across the state. Join the Vermont Ethics Network's Executive Director & Clinical Ethicist, Cindy Bruzzese, MPA, MSB, HEC-C, to learn about the new Vermont DNR/COLST form and review best practices for completing medical orders.

Register here.

Virtual Film Screening of Someone You Love: The HPV Epidemic

May 26 2022, 2pm to 4pm

Virtual

Join the Bi-State Primary Care Association for a free virtual film screening of Someone You Love: The HPV Epidemic followed by discussions with experts in the fields of pediatrics and public health. Someone You Love is a powerful documentary showing the impact that preventable HPV-related cancers can have. 

Register here.

The 48th Annual Family Medicine Review Course

June 7-10, 2022

In-Person and Virtual

Course Director Dr. Anya Koutras invites you to this intensive four-day program for family physicians and other primary care professionals. The program will focus on current issues in the practice of Family Medicine, with special attention to new contributions. Attendees will have a choice between in-person at the DoubleTree by Hilton Hotel, Burlington, VT and virtual participation. TOPICS include: genomics testing, Parkinson’s disease, hypothyroidism, headache management, valvular heart disease, type-2 diabetes, HPV disease, bipolar disease, endometrial cancer, LARC, skin biopsies, end of life care, knee exam, substance use disorder, gender-affirming care, geriatric psychiatry, urgent care cases

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

Vermont Medical Society Annual and Collaborative Meeting

November 4th and 5th, 2022

The 209th VMS Annual Meeting will be held on November 4th and 5th in person at Topnotch Resort, Stowe, VT, with virtual options. The weekend will be filled with educational content, time to spend with colleagues, policy-setting meetings, and the opportunity to honor physicians and other health care leaders across the state. VMS’ Annual Meeting, hosted in collaboration with the American Academy of Pediatrics Vermont Chapter, the Vermont Academy of Family Physicians and the Vermont Psychiatric Association, is a celebration of the unwavering commitment Vermont clinicians have to their practice and to the deep connection VMS members have with each other.

To view more information or submit nominees for 2022 leadership awards, please click here. Registration information will be shared in the future.

UVM will have more primary care conferences in Fall 2022. Sign-up to get updates via email for topics that are of interest here.

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

-- Unsubscribe --