Message from the CEO

by Jeff Tieman
VAHHS President and CEO

However long it may seem, it was only 10 months ago that our state went into a state of emergency to protect Vermonters from a new, scary and highly contagious virus. At the onset of COVID-19, it felt like we were driving through a furious snowstorm and our windshield wipers failed. Visibility was limited and the road was winding, unknown and potentially very dangerous.

Every week since has been a challenge, and this one will be no exception. The difference is now our windshield wipers are working and we can see both the road and the destination, which is a vaccinated Vermont. In fact, according to a leading COVID-19 data scientist, Youyang Gu, Vermont is the first state to vaccinate more people against COVID-19 (6%) than were infected with the virus (4.4%).
We are clearly headed in the right direction.

On Wednesday, Vermonters aged 75 and older will begin to receive COVID-19 vaccines throughout our state. By expanding vaccinations to those 75 and over, we take a few important steps: 

1) protect those who are most vulnerable to COVID, 
2) move beyond health care workers to include the first segment of the general public, and 
3) prevent our hospitals and health system from becoming overwhelmed.

In short, this is great progress! It is an exciting week for Vermont and a victory in the war against COVID-19. Hospitals are proud to have helped get the state to this point and will continue to be part of vaccinating Vermonters both this week and beyond. And, that’s not all our hospitals continue to do. We are testing, treating and caring for Vermonters with COVID-19 and, at the same time, delivering the routine and necessary quality care we depend on.

As we look to the road ahead, here are ways to keep us moving in positive direction:  

  • Advise relatives and friends 75 and older to use the state’s online enrollment system, beginning later today, to sign up for their vaccine appointments.
  • Assist parents, grandparents and others in using the website to keep the phone lines open for those who need it.
  • Keep scheduled appointments; the likelihood of wasting vaccine increases if appointments are missed or canceled.
  • Limit signup attempts to those over 75 years old. More age groups will be added in time, but it will only slow the pace of vaccinations if others try to jump the line.
  • Be patient – with the website, with health care providers, with call takers, and with each other. There is still a long road ahead.

And on that note, vaccines are welcome and wonderful news, but our blizzard rages on. Even though visibility is improved, COVID-19 is still present, with a significant case count—so we have to continue the critical safety measures: masks on faces, six-foot spaces, uncrowded places.

We will not need these practices forever, but we do now. The best way through the storm is twofold: broad-base vaccination as quickly, effectively and fairly as possible, and following the guidance that has made Vermont a leader in responding to the pandemic. To see this metaphor through to the end: know the snow will subside, the clouds will part, the sun will shine and we will see blue skies together again.

Have a good week, stay safe.
Jeff Tieman
VAHHS President and CEO
Legislative Update
by Devon Green
VAHHS Vice Preident of Governmental Relations

As testimony was winding down on Wednesday morning, I could not appreciate one senator more when she abruptly announced she needed to leave. I assumed she had another meeting, but she proclaimed that the first female Vice President was being sworn in, and she was not going to miss this piece of history!

As historic as the inauguration was, it also marked a return to normalcy during these extraordinary times. Similarly, the legislature started diving into issues in a way that feels both familiar and normal despite the pandemic—mainly focusing on COVID-19, but also looking at some broader areas.
 
Last week
COVID-19 regulatory flexibilities: The House Health Care Committee revisited the regulatory flexibilities afforded to health care providers at the start of the state of emergency (incredible summary by legislative council can be found here). Over the summer, VAHHS and other health care providers advocated extending the flexibilities to the end of June 2021 to give health care providers flexibility. The resulting legislation created a patchwork of dates for when the flexibilities end, with some ending on March 31, 2021, some ending on June 30, 2021 and some ending at the end of the state of emergency (or even six months afterwards). The House and Senate health care committees will examine these provisions and determine if further extensions are required.  

COVID-19 federal funding: The health care committees heard testimony on federal funding related to COVID. The federal government extended the timeframe for using Vermont’s remaining $10 to $30 million in coronavirus relief funds from December 30, 2020 through December 2021. The legislature will evaluate how these remaining funds will be spent. In addition, Vermont is receiving the following federal funding:
  • A Federal Medical Assistance Percentages (FMAP) bump of 6.2 percent, which will be in effect as long as the public health emergency is in effect (and that has been extended until the end of June 2021)
  • $5.6 million for vaccination administration from the Centers for Disease Control and Prevention (CDC)
  • $35.9 million for testing and contact tracing, COVID 19 mitigation from the CDC
 
Green Mountain Care Board introduction: The Green Mountain Care Board provided an overview and discussed their 2021 priorities with the Senate Health and Welfare Committee, including the following:
  • Implementation of the all-payer model (APM) and APM 2.0 planningincludes robust oversight of the ACO and ensuring the ACO adds more value to the system than cost
  • Regulatory integration
  • Transparency through data & VHCURES 3.0—Board Chair Kevin Mullin noted a priority is to update rules to require data reporting on race and ethnicity, so GMCB is looking for funding that initiative in the budget.
  • Update of the Health Resource Allocation Plan (HRAP)
  • Health care workforce
  • Hospital sustainability   


This week
Budget address: The governor will be giving his budget address at 2 p.m. on Tuesday. VAHHS will be following any health care-related proposals carefully.  

Audio-only telehealth: House health care will hear about a Department of Financial Regulation working group's recommendations on audio-only telehealth. VAHHS supports extending reimbursement for audio-only telehealth until 2024 to ensure greater access to care in rural areas and to encourage providers to expand their telehealth practice in preparation for value-based payment.  

Prohibition of guns in hospitals: VAHHS will be testifying in support of S. 30, legislation, which prohibits possession of a gun inside a hospital. If you work in a hospital and have thoughts on this issue, please e-mail me at devon@vahhs.org.
In the News
Vermont will debut vaccine registration for those 75 and over
on Monday
VT Digger

The state will debut a website and phone number Monday morning for Vermonters age 75 and older to register for Covid-19 vaccine appointments starting Wednesday.

There will be guaranteed available slots for every eligible Vermonter to get an appointment in the next five weeks, Mike Smith, head of the Agency of Human Services, said Friday at a press conference.

“We expect some bottlenecks in the first few days of registration, but you’’ll be able to get an appointment during the weeks we are scheduled,” he said.

The slots are based on the best projections of the state’s ability to administer the vaccine, but Gov. Phil Scott said Vermont is still dependent on the federal government to distribute enough doses to make it work. New York was recently forced to cancel some clinics because of federal government supply issues.
Hospitals, doctors willing to give the vaccine — but say they’re operating blind
VT Digger

Every day, patients at Evergreen Family Clinic in Williston pepper Dr. Paul Reiss with questions about when they’ll be able to get the Covid-19 vaccine.

When and where will they get it? Can they get it at Evergreen?

Reiss’s answers, he admitted sheepishly, feel woefully inadequate. He wants to offer the vaccine to his 10,000 patients, but couldn’t say whether that will happen, or when he will find out.

“We really don’t know much of anything,” Reiss said. “It’s hard to be optimistic or even critical, because we don’t seem to be in the loop. It’s really just a waiting game.”

Doctors and hospital officials say they’re ready and willing to offer vaccines to their patients as the state prepares to roll out the next phase of vaccinations to Vermonters age 75 and over, starting this week.

But they say they remain in the dark about even the most basic components of that process — who’s eligible to administer the vaccine, for instance, and how the state decides. And, for those who will help vaccinate people, how much vaccine they’ll receive and how they should prepare.
Vt. hospital to offer home care for COVID
Times Argus

Medical staff at Rutland Regional Medical Center are developing a plan that would allow patients with COVID-19, if they are willing and if they have someone who can help support their care, to recover at their homes rather than in the hospital.

Kathleen Boyd, a registered nurse and senior director for care management and population health at Rutland Regional, said she and other health care provider like VNA & Hospice of the Southwest Region and Bayada Home Health Care, developed the discharge option for a select group of patients.

Boyd added that those patients will have access to “significant wraparound services” such as home care, skilled nursing and telehealth visits with a medical provider.

“It was designed to allow patients to have the option to recover safely and comfortably at home without the fear that they’re not going to have the care or the support needed if questions or concerns arise,” she said.

Get to know Northwestern Medical Center's new CEO Dr. Dean French
St. Albans Messenger

At the end of November, Dr. Dean French started as the new CEO of Northwestern Medical Center.

French is many things — a board-certified physician, an army veteran, an avid outdoorsman and a motorcycle repairman — but above all, he’s an experienced hospital administrator with a passion for supporting community-based, not-for-profit healthcare.

“NMC has the potential to be the highest quality, safest facility in the state of Vermont,” he said. “Becoming that is where our focus is as an organization right now.”

According to NMC, French was selected from a pool of 75 applicants. He comes to NMC after spending five years as the CEO of Community Medical Center in Missoula, Montana.

Prior to becoming a physician, French served in the U.S. Army Special Forces.

“I was an underperformer in high school, and I had lots of interests and dreams and goals, but none of them were very focused, so joining the military was a very smart decision,” he said.

It was while serving overseas, after a co-worker fell acutely ill and didn’t receive medical attention in time, that French realized he wanted to become a doctor.

“I wanted to go to medical school, because I felt like I wasn’t able to exert the influence I wanted to at that moment,” he said. “I felt like I needed to go — that it was my calling. I told my unit commander that’s what I wanted to do, and he was a farsighted person who allowed me in my last seven months of my enlistment to go full time to college.”

Incentivizing vaccine adherence could be key to achieving herd immunity
Vermont Business Magazine

As the United States struggles to control record-breaking increases in COVID-19 infections and hospitalizations, the roll-out of two approved vaccines offers tremendous hope for saving lives and curbing the pandemic. To achieve success, however, experts estimate that at least 70 to 90 percent of the population must be inoculated to achieve herd immunity, but how can we ensure folks will voluntarily receive a vaccine?

Both vaccines require two injections. Pfizer-BioNTech's second dose must be given 21 days after the first and Moderna's second dose must be administered 28 days after the first. While public health and infectious disease experts have discussed strategies to enhance adherence, including the potential use of financial incentives, an examination of the scientific evidence on incentivizing vaccine adherence has not been discussed.

A new Commentary in Preventive Medicine by a team led by Stephen Higgins, Ph.D., director of the Vermont Center on Behavior and Health (VCBH) and professor of psychiatry at the University of Vermont's (UVM) Larner College of Medicine, addresses that gap.

See how many ICU beds are available at Vermont hospitals
St. Albans Messenger

As cases of COVID-19 continue to quickly rise across the country, and as state officials say Vermont is experiencing a post-holiday surge in the virus, hospital occupancy is becoming more of a concern.

To that end, The New York Times has created an interactive map showing how many intensive care unit (ICU) beds are occupied at hospitals across the country. The map uses a dataset released weekly by the U.S. Department of Health and Human Services, and can be found here.

According to the map, Northwestern Medical Center in St. Albans, as of the most recent batch of data Monday, was housing one COVID-19 patient, and has nine ICU beds available. NMC’s ICU occupancy is 49%, far below both the national and state averages of 79% and 60%, respectively.

A little further south, University of Vermont Medical Center in Burlington appears to be dealing with a slightly larger caseload. According to the data, the hospital is housing 13 COVID-19 patients, and has 12 ICU beds available. Its ICU occupancy is at 71%, according to the data.

Hospitals in the News