2024 Progress on Primary Care Policy Platform
Government Payments:
- The FY25 Vermont Budget includes proposed methodology for the RBRVS fee schedule: By January 15th, 2025, the Department of Vermont Health Access must report back to the legislature on a Medicaid RBRVS fee schedule methodology for 2025 that considers a floor to the “conversion factor” used so that the Medicaid fee schedule does not decrease if the Medicare fee schedule decreases;
Administrative Burden:
- Groundbreaking Prior Authorization & Insurance Practice Reform bill, H.766/Act 111, passed into law: H. 766/Act 111, was signed into law in May of 2024. The legislation, a VMS priority, reduces prior authorization, step therapy & insurer billing requirements for State insurance plans. This legislation also allows primary care providers to order tests, imaging and procedures with no prior authorization. To learn more about the various stages of implementation of Act 111, click here.
- Permanent Payment Parity for Telehealth Services passed into law in 2024: Act 108 makes permanent commercial payer payment parity for audio-visual and audio-only telehealth services. Effective Jan. 1, 2025.
Payment Reform:
- Primary care practices would recieve an enhanced PBPM payment for patients in Medicare in new AHEAD model: In March 2024, Vermont’s Agency of Human Services applied to participate in the CMS' States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a new federal program that would allow Medicare to join Vermont’s health care reform efforts. If approved, the Model would begin in 2026 and replace Vermont’s All-Payer Model. Learn more about the AHEAD model and VMS advocacy for continued enhanced payments for primary care.
2025 - Still more to accomplish:
- Primary Care Workforce, Payment Reform and Administrative Burden will be front and center in 2025 legislative session: The VMS needs your help to advance the 2025 Primary Care Platform linked above;
- Click here for the full 2025 VMS Policy Priorities
- Click here for the VMS 2022 Primary Care State Workforce Shortage data set
- Click here for the VMS 2022 Primary Care County Workforce Shortage data set
Ashley Miller, pediatrician and owner of South Royalton Health Center - The Doctor is in for Kids in the Middle of the Night
I am originally from southern NH, moved to VT in 2004 and never looked back. I left a large multispecialty practice affiliated with an academic medical center in 2014, where I often had never seen the patient or family I was providing care for while on call, or in the office, to be able to provide more connected care to a smaller group of patients at South Royalton Health Center. Now, as a small business owner I am thrilled with my choice. At SRHC we work very hard to embody the patient-centered medical home, we feel strongly that it improves the health of our children and their communities, which is why I am highlighting why Vermont needs to invest in primary care now. Click to read more.
Katie Marvin, M.D., FAAP, Stowe Family Practice, "A day in family medicine, 8am-5pm:"
(just to be clear, these are not actual patients, just a common representation of a typical day, clearly with respect to HIPAA and patient privacy):
1). A 4-day old baby boy, to check on his weight, color (jaundice) and how the family is doing. We’ll see him and mom back in a few weeks.
2). A 12-year old with a broken foot. We take some x-rays and get her in a walking boot. One week follow up. Click here for the full story
The Power of Primary Care - Fay Homan, M.D., Little Rivers Health Care
Little Rivers Healthcare in northeastern Vermont serves a cluster of remote towns that exemplify the Vermont adage that “you can’t get there from here.” These are small, economically stressed towns that have been hit hard by the opiate crisis. People from more populated areas might be surprised at the scope of healthcare that is provided at Little Rivers: complete health care from birth to geriatrics, including complex chronic medical problems and mental health. You can get all your prenatal care here and have your delivery with your family doctor. Skin biopsies, ultrasounds, joint injections, and substance abuse treatment are all part of our usual office days. My husband even had his chainsaw injury stitched up here last summer. Click to read more
This commentary is by Judy K. Orton, M.D., whose practice is at Green Mountain Pediatrics in Bennington.
"I was planning on working into my late 60s but will likely call it quits in five years, as will the practice I have built. I sincerely hope that the state will make a financial commitment to sustain primary care, so that Vermont patients and their families will have independent practices available to help them live their healthiest lives."
I have been a solo, independent pediatrician for 32 years at Green Mountain Pediatrics, located in Bennington. I have always strived to use best practices with some healthy common sense in the care of my kids.
I love being a part of these children’s growth and maturity, helping their families navigate parenthood. I am into a second generation, taking care of my “kids’” kids. There is a certain satisfaction and pride when they attend school, college, take a job, celebrating the next generation when they call and say they are pregnant and ask if I would be the pediatrician for the new baby. Click here to read the full VTDigger Commentary.