May 21, 2024

NEED TO KNOW

Governor Scott Signs H. 766!  Bill to Reduce Prior Authorization to Become Law

Last night, Governor Scott signed H. 766, the prior authorization and insurance paperwork reduction bill.  As stated by VMS VP Katie Marvin, MD in a press release sent last night, "Vermont patients are the winners today." Thank you to our amazing members for speaking up for your patients and staff and testifying, reaching out to lawmakers and contacting the Governor this session regarding the need for the bill to decrease burnout and increase patient access to care.  We know we called on you many times to advocate for this bill.  Your work made a difference as lawmakers and the Governor referenced the stories they heard from you about why the bill was necessary.  In his signing letter, Governor Scott recognized how “the requirements for pre-authorization can add delays and stress for patients, as well as additional administrative burden on providers focused on providing better and more effective patient care.”  He also directed the Department of Financial Regulation (DFR) and the Agency of Human Services (AHS) to jointly study and report on the impacts of the bill on health care outcomes, costs and insurance rates, as well as how this effort fits into the State’s overarching health care reform goals.  VMS looks forward to working with DFR and AHS on this study.  

VMS also extends a huge thank you to the legislative champions of the bill, especially lead bill sponsor Alyssa Black, chair of the House Health Care Committee Lori Houghton, the members of the House Health Care Committee; and Chair Ginny Lyons and members of the Senate Health & Welfare Committee.  Watch the Rounds for more information about an event to celebrate the passage of the law! In the meantime, please reach back out to Governor Scott to thank him for his signature on the bill, as well as your own legislators! 

The bill will apply to state regulated commercial insurance plans in Vermont (MVP, BCBSVT and Cigna individual and small group plans) and:  

1. Prohibit insurers from applying any prior authorization to primary care clinicians (excepting prescriptions and out of network care);
2. Require insurers to cover, without requiring prior authorization, at least one readily available asthma controller medication from each class of medication and mode of administration;
3. Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
4. Require authorization of treatments and medications to last for at least one year – and require authorizations for ongoing treatments to last 5 years.
5. Require health plans to allow requests for exceptions to prescription drug step-therapy under specific conditions, like if a patient is stable on an existing therapy or if the drug is expected to be ineffective;
6. Mandate adherence to coding standards and guidelines for processing healthcare claims and prohibit prepayment claims edits (ending a burdensome Blue Cross Blue Shield of Vermont policy that requires prepayment review of certain claims, including those used with Modifier -25 and -59); and
7. Limit claims edits for services other than pharmacy to those instances when Medicare uses claim edits.

Preliminary Round Up of the Legislative Session

The 2024 legislative session ended with a number of successes for health care in Vermont.  Along with H. 766, described above, the legislature also advanced bills that will:

1. Require payment parity for audio-only and audio-visual telehealth services (H. 861)
2. Expand health insurance coverage for diagnostic breast imaging (H. 621) and colorectal cancer screening (H. 741)
3. Provide more help paying for out of pocket costs for low income individuals with Medicare coverage (budget)
4. Study the Medicaid fee schedule and consider a floor for reimbursement so Medicaid reimbursement does not fall if the Medicare fee schedule is reduced (budget)
5. Made permanent remote witnessing and explaining of advance directives (H. 469)
6. Study Medicaid coverage for doula services (S. 109)
7. Allow students to apply sunscreen at school (S. 187) and update Vermont’s child restraint system laws including remaining rear-facing until age 2 (S. 309).  

VMS Deputy Director Stephanie Winters presented a summary of legislation to the GMCB Primary Care Advisory Group last week.  See the presentation here.  VMS will be preparing a full legislative bulletin in the coming weeks, which will also reflect bills that are vetoed or considered at the legislature’s scheduled veto session on June 17th.  

VMS Submits Comments on the AHEAD Model 

Last Wednesday, VMS participated in a Green Mountain Care Board panel discussion regarding the AHEAD Model and the impacts on clinicians and practices.   In advance of the panel, VMS submitted comments to the GMCB, Agency of Human Services and legislative leaders regarding the model.  The comments focused on points for consideration in deciding whether to join the AHEAD Model, potential terms to negotiate with CMS and other concerns regarding assisting clinicians and health care practices in transitioning to a new payment reform model given the disruption that this will cause. VMS is also gathering resources regarding the AHEAD Model on a new webpage.  Following the meeting, the Agency of Human Services summarized common themes heard from many panel participants including:

1. AHEAD is complex and challenging to understand.
2. Concerns about loss of CPR program for independent primary care; ACO support with data sharing, quality measurement, attribution estimates, financial modeling; need glidepath between models.
3. Workforce challenges and increases in expenses need to be addressed.
4. Should strive towards all-payer, all-hospital and value-based care models.
5. Adequate clinician involvement in model governance is essential.
6. Need to better understand alternatives and comparisons between options including impact on affordability, access to care, and provider stability.  
7. Consider “Cons” as well as “Pros” - need to monitor impacts over time to ensure reforms are working for Vermonters.
8. Care delivery and payment reform across the system is essential.
9. Sustaining primary care is critical.  
   • Continue capitation models, Blueprint, SASH, Medicare waivers.
   • Concerns about how Primary Care AHEAD payments may impact primary care providers differently based on how they are currently paid and patient mix.
   • Administrative burden needs to be reduced; concerns about Vermont losing current MIPS reporting exemption. 

MISC.

AHRQ Safety Program for Telemedicine: Improving Antibiotic Use

The AHRQ Safety Program for Telemedicine: Improving Antibiotic Use, led by NORC at the University of Chicago and Johns Hopkins Medicine, is recruiting primary care practices, community-based health centers, specialty practices that provide primary care, and urgent care clinics to learn about adapting antibiotic stewardship efforts for the telemedicine environment. Practices may provide care exclusively via telemedicine or in addition to in-person visits. 

• Practices will learn about and implement best practices in antibiotic use in the telemedicine environment through short educational presentations and support from experts.
• There is no cost to participate.
• Participating staff can earn CEUs, CMEs, and ABIM MOC points

The deadline to enroll is May 23, 2024. Learn more at https://safetyprogram4telemedicine.org/

Mastering Touch Conversation: Improving Serious Illness Communication Skills

The TalkVermont team is offering a "Mastering Touch Conversations" workshop on Monday June 3rd as a preconference activity attached to the UVM Annual Family Medicine Course at the DoubleTree in South Burlington.  This course utilizes evidence-based small group learning and deliberate practice techniques to help healthcare professionals improve their serious illness communication skills.  The course uses simulated patients to practice the VitalTalk conversation model as 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. 

You can register for just this preconference workshop and it is open to all members of the care team (physicians, PAs, NPs, social workers, chaplains, nurses).  

Register Today - https://na.eventscloud.com/ereg/index.php?eventid=785950&
Discounts are available for trainees (contact ben.clements@uvmhealth.org for a discount code).

Commissioner Call Thursday, June 6, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members Thursday, June 6th at 12:30 pm. You can join the zoom meetings here.

He held his most recent VMS member call on April 4th. Notes from the call are here. 

EVENTS

June 4th-June 7th, 2024

In-Person South Burlington, VT

This intensive four-day program 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. An optional, pre-conference full-day workshop on Mastering Early Goals of Care Conversations will also be offered. Conference emphasis is on practical, clinically applicable diagnostic and management issues in primary care. This conference will be presented in-person and virtually; participants may choose to join via a mixture of in-person and remote attendance. This conference is also anticipated to overlap with the Burlington Jazz Festival, taking place June 5-9, 2024.

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

Birth Certificate Quality Improvement Initiative Learning Series

June 10, July 15, September 9, October 7, 2024

Virtual

In collaboration with the Vermont Department of Health Division of Family and Child Health and the Division of Health Statistics and Informatics, the Perinatal Quality Collaborative - Vermont (PQC-VT) is embarking on a vital statistics birth certificate quality improvement initiative (BCQII).

The project aim is to improve the accuracy of key birth certificate variables to support public health and quality improvement efforts. The objective is to increase birth certificate data quality in Vermont by providing education opportunities, technical assistance, and shared learning to Vermont hospital teams involved in birth certificate data collection.

Register here for the learning series.

Xylazine Trends and Public Health Implications for Rural Communities 

Virtual, June 12th, 12pm to 1pm ET

Please join us on Wednesday, June 12th from 12:00 p.m. - 1:00 p.m. ET for a UVM CORA Community Rounds Workshop Series session, “Xylazine Trends and Public Health Implications for Rural Communities.” Our speaker is Michael Chaple, PhD, Assistant Professor of Clinical Psychiatry at Columbia University Irving Medical Center, and Director of the Northeast and Caribbean Rural Opioid Technical Assistance Center. This presentation will provide an overview of xylazine, current data on prevalence and other trends associated with its use, and will also discuss the public health implications associated with xylazine use. This presentation will also offer harm reduction strategies for mitigating the public health impact of xylazine. Throughout the presentation, unique implications for rural communities will be systematically addressed.

Register here.

Whole Person Care: Enhancing Substance Use Disorder and Mental Health Treatment

June 14, 2024

Lake Morey, VT

Please mark your calendars for Friday June 14 when we will be hosting "Whole Person Care: Enhancing Substance Use Disorder and Mental Health Treatment", an in-person conference at Lake Morey, VT.

This is a part of the Collaborative to Advance Mental Health Treatment and Substance Use Recovery for Everyone (or CARE Series).

Learn more here.

Reducing Barriers to Physician PTO

Virtual, June 18 at 12 pm CT

Curious about how to overcome barriers to personal time off (PTO) at your health care organization? Join us for a webinar and live Q&A with Jill Jin, MD, MPH, and Marie Brown, MD, MACP.

Learn more here.

Saving Time: Practice Innovation Boot Camp

September 23 - 24 AMA Plaza, Chicago

This two-day, interactive boot camp from the AMA STEPS Forward® Innovation Academy equips attendees with the time-saving tools and strategies needed to reform their organizations and enhance professional satisfaction. CME eligible.

Learn more here.

Vermont ACP Chapter Annual Scientific Meeting

October 18, 2024

Trapp Family Lodge, Stowe, VT

The Vermont ACP Chapter's Annual Scientific Meeting will occur on

Friday, October 18, 2024.

This will be an in person meeting. We will

again host a poster competition for resident and student members.

Update your medical knowledge, engage with colleagues.

Meeting details and agenda forthcoming.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

-- Unsubscribe --