August 15, 2023


Green Mountain Care Board Finalizes 2024 Insurance Rates; Begins Hospital Budget Hearings

The Green Mountain Care Board (GMCB) issued decisions last week finalizing 2024 individual and small group premiums for Blue Cross Blue Shield of Vermont (BCBSVT) and MVP Health Plan (MVP). In 2023, these plans covered just over 68,000 individuals.   The premium increases requested by BCBSVT and MVP were driven by a number of factors, including increases in hospital and prescription drug costs.  The approved rates were reduced by the GMCB from the increases initially requested by payers, but still range from an 11.4% increase for MVP individual rates to a 14.0% increase for BCBSVT small group rates. 

The GMCB also began hospital budget reviews last week, launching on Wednesday with an introductory overview by staff and hearings for Southwestern Vermont Medical Center and Brattleboro Memorial Hospital.   Grace Cottage Hospital, Northwestern Medical Center and Rutland Regional Medical Center presented on Monday.   The GMCB has set a benchmark for Net Patient Revenue growth from FY22 to FY24 of no more than 8.6%; submitted budget proposals include increases ranging from 7.2% to 28.4%.  In press releases and a press conference by Vermont Association of Hospital and Health System leaders, VAHHS emphasizes that these budgets are needed to support necessary staffing and services and reflect only a 2% operating margin.  At Tuesday’s press conference, SVMC CMO Trey Dobson, MD, and VMS Past President emphasized the impact on clinicians when hospitals don’t have adequate resources (minute 17:45).  The full hospital budget hearing schedule can be found here, budget materials for each hospital can be found here.   Public comments can be submitted through August 25th here.   Hospital budget decisions must be made by September 15th with written orders issued by October 1st.

As reported last week in the Rounds, the GMCB has also announced the start of the statewide community engagement project to support hospital transformation. Vermonters are encouraged to sign up for emails about community meetings in their region by visiting GMCB’s Hospital Sustainability webpage.

Vermont Department of Health Finalizes Emergency ALS Registry Rule – Diagnoses Must be Reported

The Vermont Department of Health recently finalized an emergency rule to create a Vermont Amyotrophic Lateral Sclerosis (ALS) Registry.  The registry was required by recent legislation codified at 18 V.S.A. chapter 4A that requires the Commissioner of Health to establish an ALS incidence registry system for the collection of information determining the incidence of ALS. The registry will require health care professionals who screen for, diagnose, or provide therapeutic services to patients with ALS to report to the Department all individuals diagnosed as having ALS within 180 days from the date of diagnosis. The rule can be found here. VMS provided feedback to VDH regarding the rule, including concerns with patient choice regarding being reported to the registry and coordinating reports if multiple clinicians were involved in a diagnosis, however the timeline with an emergency rule did not allow for incorporation of this feedback.  VDH is beginning full rulemaking (vs emergency rulemaking) soon and VMS will continue to share feedback in that process.  Since reports are not due for 180 days, there is time to incorporate changes into the rule before compliance is ultimately required.  Contact with questions or to provide further comments on the rule. 

Updates to Reportable and Communicable Diseases Rule

The Department of Health today (August 15) adopted emergency changes to the Reportable and Communicable Disease Rule.  The rulemaking does the following: 1) Removes the requirement to report negative and indeterminate SARSCoV-2 results to the Department of Health, the lab test to determine if someone has COVID-19; 2) Changes the required reporting period for positive SARS-CoV-2 results from "immediately" to "within 24 hours"; 3) Adds the virus Mpox to the list of reportable diseases and the associated laboratory finding, Non-variola Orthopoxvirus, to the list of reportable laboratory findings; 4) Clarifies that immediate reporting for identified diseases and laboratory findings means they must be reported by telephone to the Department; and 5) Clarifies the difference between the laboratory finding that causes the virus SARS and the laboratory finding that causes the virus COVID-19.  The rule with changes tracked can be found here.

CCB Holds First Meeting on Medical Cannabis Study 

The first meeting on Vermont's medical cannabis registry study, as required by Act 65, was held last Tuesday, August 8th50 stakeholders participated including dispensary owners, medical cannabis patients, medical cannabis caregivers, medical professionals and members of Vermont's Academic Detailing program. The Chair of the Cannabis Control Board (CCB) started the meeting by setting ground rules, recognizing disagreements on the medical efficacy of cannabis as treatment, stating the goal is to create a bill for the 2024 legislative session. He is hopeful the workgroup can agree on recommendations for improvement of the medical cannabis program and will work to get a placeholder bill filed before the medical cannabis report's deadline on January 15th, 2024.

The Chair said there will be three subsequent meetings focused on addressing these specific topics: 

  • Meeting 2 - Quality and Education - how emerging science can be reviewed to add new qualifying conditions
  • Meeting 3 - Access and Affordability
  • Meeting 4 - Review recommendations

A common claim from medical cannabis advocates on the working group was that it is getting more difficult to get clinicians to sign medical registry forms. Therefore there is a push for the removal of the requirement of a bona fide health care professional, for qualifying conditions to be expanded to all conditions, and for the removal of the annual registry renewal requirements.  

Medical professionals on the call pointed out that the body of research on the efficacy of cannabis as treatment is "thin," at best, as it remains a Schedule 1 drug. They also cited psychosis and cannabis use disorder as some of the risks of widespread use of cannabis. With the next meeting focused on the evidence base for medical cannabis treatment, if you have comments or suggestions for peer-reviewed studies the Board can use in its recommendations please email or Jill at Click here for more information.



Volunteer Opportunity in Honduras

Cape Cares is a nonsectarian nonprofit organization that has been sending medical-dental teams to rural Honduras for about 30 years. Volunteers (physicians, NPs, PAs, nurses) are needed for a trip from October 21-28th this fall.  The destination is San Marcos, a remote mountain village that is visited twice yearly by a Cape Cares team.  Visit for more information, or contact Dave Coddaire, MD, of Morrisville, the team leader for this trip: 802-798-2496, 802-888-5650 or

Commissioner of Health Public Health Notes from Update and Next Call on Thursday, September 7th

The Commissioner of Health, Mark Levine, MD, joined the VMS for a public health update on August 3rd. You can find the notes here.

The next Public Health Update will be Thursday, September 7th at 12:30 pm. Hear about the the most pressing public health information affecting the state and nation and have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting.

You can join the zoom meetings here.

Free State Park Passes for Your Patients

In our 10th Year for this program, the Vermont Governor’s Council on Physical Fitness and Sports and the Vermont Department of Forests, Parks, and Recreation proudly offer free day use State Park Passes for your patients.

The prescriptions are distributed to physician offices. The purpose is to give physicians and their colleagues a meaningful way to discuss with their patients the importance of outdoor exercise and the obvious connection between exercise and good health. This year we hope to reach as many diverse groups as we can. 

If you have questions or if you are interested in participating this year, please let us know at Please let us know how many prescription pads of 50 each you think you will be able to use when you reach out and if you are interested in posters that we may be able to send you.

The prescriptions are numbered and we hope to be able to tell which of your prescriptions were turned in at a State Park if you ask in the fall.

Mildred Reardon Medical Student Scholarship Open for Applications

Do you dream of becoming a Vermont doctor? See below to apply for a $10,000 scholarship by August 25th for a rising 3rd year student committed to practicing medicine in Vermont.

The Vermont Medical Society’s Education and Research Foundation (VMSERF) is now accepting applications for the Mildred Reardon scholarship, which awards $10,000 to a University of Vermont Larner College of Medicine third year student committed to practicing medicine in Vermont. The scholarship is made to a student interested in any specialty, with a preference for specialties in high need in Vermont.  The scholarship is tuition-linked and is paid directly to the College of Medicine towards tuition. This year the award will be made at the VMS Annual Meeting, being held at Topnotch in Stowe and virtually on November 3, 2023. 

Click here for more information and details on applying for the scholarship.


Save the Date: Vermont ACP Chapter Annual Scientific Meeting

September 29, 2023 at Trapp Family Lodge, Stowe, VT

The Vermont ACP Chapter's Annual Scientific Meeting will occur on Friday, September 29, 2023. We are planning for an in person meeting. We will again host a poster competition for resident and student members.

Update your medical knowledge, engage with colleagues, and receive 5 AMA PRA Category 1 CME credits and 5 MOC points.

Meeting details, agenda and registration information will be forthcoming.

Primary Care Sports Medicine and

Wilderness Medicine Conference

October 15 – 17, 2023

Delta Hotel in South Burlington, Vermont

The 2023 Primary Care Sports Medicine and Wilderness Medicine is designed to update knowledge and skills in the diagnosis and management of common sports medicine and wilderness medicine problems. Topics will include discussions of medical and orthopedic issues. There will be ample opportunity for participants to ask questions and interact with faculty, who hail from the University of Vermont Health Network and local community. The teaching program includes lectures and workshops.

For more information, go to the website here.

Save the Date: 210th Annual and Collaborative Meeting Taking Place from November 3-4, 2023

The 210th VMS Annual Meeting will be held on November 3rd and 4th in person at Topnotch Resort, Stowe, VT, with virtual options. The weekend will be filled with educational content, time spent with colleagues, policy-setting meetings, and the opportunity to honor physicians and other health care leaders across the state.

Stay up to date on details here and nominate Vermont leaders who have provided outstanding contributions to the medical profession, to health organizations and to the welfare of the public for a VMS Leadership Award here.

CPT & RBRVS 2024 Annual Symposium

November 15-17, 2023

CPT & RBRVS 2024 Annual Symposium is the world's only medical coding conference where attendees learn about the upcoming changes to the Current Procedural Terminology (CPT) code set and payment policies directly from members of the AMA-convened CPT Editorial Panel, AMA/Specialty Society Relative Value Scale Update Committee (RUC), and CPT and RUC Advisors.

Join virtually to get the first look at the 2024 CPT code set with guidance from the experts, earn continuing education credits, and join over a thousand of your peers for premier coding education at the CPT & RBRVS Symposium!

Register with early bird discounted rates through September 30th here.

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


Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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