July 19, 2022


This Thursday VMS Hosts the U.S. Senate Primary Candidate Health Care Policy Forum

Please join us this Thursday for the Vermont Medical Society virtual 2022 U.S. Senate Primary Candidate Health Care Policy Forum. This is the second Congressional candidate forum and will feature both the Democratic and Republican candidates for the U.S. Senate race and focus on each candidate's position on health care policy. The U.S. House forum took place last Thursday and was moderated by VMS President-Elect Ryan Sexton, M.D. With 6 out of the 7 candidates running for the House seat participating, this was a fast-paced conversation that allowed for our members to meet the candidates and to get a general understanding of each candidate's health care policy vision. The U.S. Senate forum will take place this Thursday, July 21st from 12-1pm via Zoom and will be moderated by VMS President Simha Ravven. If you are unable to join the forums, they will be recorded and posted to the VMS website. The first forum's recording is located here VMS will also share written candidate answers to member questions before the general election.

July 21st 12-1 pm: U.S. Senate forum (registration not required) - Click Here to Join

Important News and Updates from the Board of Medical Practice

The Vermont Board of Medical Practice emailed important updates to all licensees in a newsletter last week.  Most articles can be found in the Summer 2022 links here and include updates on the 2022 physician license renewal and CME information and updates to the Board Rules that went into effect on July 1, 2022.   All Vermont MD licenses expire on November 30, 2022.  Renewing MDs must certify that they are in compliance with CME requirements at the time of renewal or ask for a grace period and commit to a plan to make up missing credits during that period. As during the 2020 renewal, the Board has modified the required number of credits in consideration of the ongoing stresses on licensees during the COVID-19 pandemic and continuing disruptions of conferences that many physicians rely on for much of their CME. The normal requirement is for a total of at least 30 credits of AMA PRA Category 1 activity. The required number of credits is reduced for this renewal to 15 hours for most licensees.  The requirements for certain required subjects are not modified. VMS members can find a list of no and low-cost CME opportunities here.

COVID-19 Update

VMS’s next COVID Conversation with Commissioner of Health Mark Levine, MD, will take place on Thursday, August 4th from 12:30-1pm.  See more information and the link to join here.   The administration press conference today did not address COVID-19; Dr. Levine gave an update to the Vermont Association of Hospitals and Health Systems on Friday, July 15th and notes are available here. He highlighted that case positivity and hospitalizations in Vermont remain low, despite the BA 4 and 5 variants comprising approximately 50% of cases in the state.  Access to rapid testing will be increasing with municipal sites like food shelves and libraries signing up to help with distribution.  There is currently abundant supply of Paxlovid though it is still unclear if pharmacists in Vermont will use new federal authority to prescribe Paxlovid directly to patients. 

Feedback Needed by July 29: Practice Data Reporting on Patient Wait Times  

The Vermont Department of Financial Regulation (DFR) is in the process of gathering stakeholder feedback to inform ways to gather and track more quantifiable and consistent statewide data on patient wait times for medical appointments.   DFR has proposed several metrics for discussion, with the idea of collecting this data on a practice (not individual physician/provider) level.  The current metrics under consideration are:

  1. Third Next Available Appointment (Reported by Practice), utilizing the methodology recommended by the Institute for Healthcare Improvement. This metric would include telehealth appointments.
  2. First in-person appointment (Reported by Health Insurance Issuers), utilizing the methodology ordered by CMS for plans operating on federally-facilitated exchanges. This metric “measure[s] the number of business days between when an individual requests an appointment and when the first in-person appointment is available. In alignment with the National Committee for Quality Assurance (NCQA), CMS will base the appointment wait time standards on business days.”
  3. New patient median lag time (Reported by Practice), utilizing the methodology recommended by the Clinical Practice Solutions Center, defined by CPSC as the number of days between the date a new patient calls the practice to schedule an appointment and the date the appointment occurs for the new patient using the CPT codes (99201-205) + (99381- 387) + 92002 + 92004 + (99241- 245). 

Please share feedback on practices tracking these measures with Jessa Barnard at jbarnard@vtmd by Friday, July 29th

AMA: CMS Proposed Physician Payment Schedule Threatens Patient Access

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2023 Medicare physician payment schedule. While American Medical Association (AMA) staff continue to analyze the proposal, the rule raises several key issues. Notably, the 2023 Medicare conversion factor would be reduced by about 4.5% from $34.6062 to $33.0775. This is largely a result of the expiration of a 3% increase to the conversion factor at the end of calendar year 2022 as required by law. The AMA will strongly advocate that Congress avert this significant cut and extend the 3% increase for 2023.   CMS would also adopt changes to several evaluation and management (E/M) code families, including hospital, emergency medicine, nursing facility and home visits, as recommended by the CPT Editorial Panel and AMA/Specialty Society RVS Update Committee (RUC).  In addition, under the Medicare Access and CHIP Reauthorization Act (MACRA), the final performance year that physicians are eligible to earn the 5% Advanced Alternative Payment Model (APM) incentive payment and $500 million Merit-based Incentive Payment System (MIPS) exceptional performance bonus is 2022, which will affect payment adjustments made in 2024. Therefore, the proposed rule does not contain any estimates of MIPS participants exceeding the exceptional performance threshold in 2023 or Advanced APM participants earning 5% incentive payments. The confluence of these cuts, coupled with the 0% payment update that fails to account for significant inflation in practice costs, is creating long-term financial instability in the Medicare physician payment system and threatening patient access to Medicare-participating physicians.  Finally, services that were going to be covered via telehealth only through the end of the COVID PHE would now be covered for an additional five months after the PHE ends, including the CPT codes for telephone visits.

The text of the proposed rule can be accessed at: https://public-inspection.federalregister.gov/2022-14562.pdf.

Additional links include:

Vermont Department of Financial Regulation Finalizes Order for Insurance Coverage of Audio-Only Telehealth

Act 6 of 2021 directed the Department of Financial Regulation to work with stakeholders to determine commercial insurance payment for audio-only telephone services for the 2022 and 2023 plan years.  After meeting with stakeholders this spring and summer, DFR recently finalized their order for 2023 coverage by commercial payers for audio-only telehealth services.  Details include:

  • Plans may not reimburse different provider types differently for performing the same service.
  • Health insurance plans shall reimburse providers for audio-only services at a rate no less than 75% of the rate for equivalent in-person or audio/visual telemedicine covered service.
  • Plans are strongly encouraged to negotiate rates with providers for audio-only telephone services that reflect their clinical value, including reimbursing E/M codes recognized by the American Medical Association (AMA) as having a “straightforward” or lower level of Medical Decision Making (MDM) at parity with in-person services.
  • Visits initiated in good faith over audio/visual telemedicine which switch to audio-only for any reason shall be reimbursed as if they were an audio-visual encounter.

The full order can be found here.  VMS advocated strongly for paying at parity for telephone services and is disappointed that the order continues to allow plans to pay at 75% of in-person rates, but appreciates the clarifications contained in the order ending differential reimbursement based on provider type and requiring parity for dropped audio-visual calls. 

Green Mountain Care Board Summer Update

Green Mountain Care Board Executive Director Susan Barrett recently provided legislative leaders and stakeholders an update on the Green Mountain Care Board’s summer regulatory activities. Chair Kevin Mullin also published an opinion piece last week, which discusses the challenging decisions before the Board this summer. Here’s an excerpt:

“As I prepare for retirement and the Green Mountain Care Board enters its busy summer regulatory season, the implications for Vermonters weigh on me heavily. The last two years have been incredibly challenging. The pandemic has put unprecedented strain on Vermonters and families as well as our health care facilities and their workforce…  Our fragile health care system needs stability today and sustainability for the future… In this challenging environment, we have to do the best we can with what we have and balance our priorities as required by Vermont law. The challenges this year underscore the need for Vermont to envision a sustainable health care system for years to come.”

With the Board’s busy summer schedule, Executive Director Barrett’s update includes a timeline summarizing the Board’s rate review and hospital budget review activities and opportunities for public comments.  The Board is also actively undertaking its work as defined by Act 167, to consider options for a more sustainable health care system through community and provider engagement, in collaboration with Vermont’s Agency of Human Services and will be sharing more updates on this work.



In case you missed it … FIVE COVID-19 Therapeutics Updates

Refer to https://river.svhealthcare.org/cms/covid19/infolinks for the latest information and recommendations

1. Vermont is revising recommendations for COVID-19 therapeutics

2. First choice:

  • Paxlovid is the preferred treatment unless there is a valid contraindication
  • Paxlovid should be given in a lower dose for renal insufficiency with a GFR between 30 and 60
  • Use the following resource to search for drug-drug interactions: https://www.covid19-druginteractions.org/checker

3. The FDA authorized pharmacists to prescribe Paxlovid independently

4. Second choice:

  • Remdesivir is an option when Paxlovid is contraindicated or not available
  • However, remdesivir requires 3 consecutive days of 60-minute IV infusion and is offered as an outpatient in only a few locations in our region
  • My neighbor has one of those cool chair lifts to get up the stairs. I offered her $5 for me to try it out.

5. Third Choice

Thank you to Trey Dobson, M.D., VMS Board Member, for this update and information.

Foundational Health Equity Trainings from VPQHC

Join Maria Mercedes Avila, PhD, MSW, MED in a Foundational Health Equity Training that addresses structural competence and cultural humility to address disparities and inequities. These trainings are available at no cost and offer three CME or CEU credits. The trainings available from 9am – 12:30 pm on the following dates: July 25, August 5, August 12 and August 15th. For more information click here.

FDA Provides Educational Resources to Support Confidence for Imported Infant Formula Products

Last week, the FDA announced the availability of educational resources for parents and caregivers with questions about using the hundreds of millions of bottles worth of imported infant formula headed to the U.S.

Read more here.

Medicaid Implements Per Diem Rate for Mental Health Extended Stays in Emergency Departments

Effective 07/01/2022, the Department of Vermont Health Access (DVHA) will reimburse for extended Emergency Department (ED) stays in which a Vermont Medicaid member meets clinical criteria for inpatient psychiatric level of care (LOC) AND there are no beds available for placement. After a Vermont Medicaid member meeting inpatient psychiatric LOC has had an initial 24 hour stay in an ED, hospitals may submit a prior authorization (PA) request to the DVHA to seek reimbursement. This per diem rate is a temporary payment that will expire at the end of the Federal Public Health Emergency. For additional information and directions please refer to Per Diem for Mental Health Extended Stays in Emergency Departments found at http://www.vtmedicaid.com/#/resources.

Make Medicare Better for Vermonters: Speak Up with this Quick Survey

If you have Medicare, the Vermont Department of Financial Regulation (DFR) needs to hear your voice in their survey.

People have choices when they first qualify for Medicare. They can choose to add extra insurance that pays for costs Medicare doesn't cover, like Medicare Supplement ("Medigap"), or Medicare Advantage ("Medicare Part C"). Some people choose not to add extra insurance to Medicare. They want to hear about your choice.

If you need help with this survey please call 1-800-917-7787 to speak with a health care advocate.

Take the survey by August 15th here.


Join us for the next conversation with the Commissioner - Thursday, August 4th @ 12:30!

Join us the 1st and 3rd Thursdays of each month from 12:30pm to 1pm as Commissioner of Health, Mark Levine provides us with the most pressing 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 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 summer.  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. 

NYSARH/NERHA Presents "Syphilis: Not Just an Urban Legend"

July 21, 2022, 1pm EST

Adverse childhood experiences (ACEs) are one of the largest public health crises of our time. The short and long-term impact of exposure to ACES can be profound, and can negatively affect all facets of life. Healthcare and social service organizations provide a vital role in supporting those who have experienced ACEs. Becoming a trauma-informed organization is essential to offering care to survivors of ACEs. There are concrete tools and skills that can be implemented to provide a safe and healing environment for the community.

Register here.

Providing Healthcare to Refugees: Domestic Health Assessment

July 28, 2022, 12:15pm to 1pm EST

This webinar will discuss strengths and challenges of refugee resettlement in Vermont and both general refugee culture as well as cultural considerations applicable to providing health care.

This webinar is a part of a series of webinars on Health Care for Refugees hosted by the Vermont Medical Society. Anyone interested is encouraged to attend. Registration is required here.

To learn more about what other topics will be included in this series, click here.

Vermont ACP Chapter Annual Scientific Meeting

October 14, 2022

Trapp Family Lodge, Stowe, VT

The Vermont ACP Chapter's Annual Scientific Meeting will occur on Friday, October 14, 2022. The ACP is optimistically planning for an in-person meeting. The ACP will host a virtual poster competition for resident and student members.

Update your medical knowledge, engage with colleagues, and receive CME credits and MOC points.

Meeting details and agenda forthcoming.

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

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