Message from the CEO
Regulation During a Pandemic
by VAHHS President and CEO Jeff Tieman

Last week brought some good developments in the COVID battle. Dr. Anthony Fauci predicted there will be “open season” on vaccines—enough to reach anyone in America who wants to be inoculated—as early as April. By the end of summer, said the chief medical adviser to President Biden, 75 to 85 percent of our nation is likely to be vaccinated. This is terrific news and I hope it becomes reality.

Now, however, we are still in the midst of the pandemic, with confirmed virus variants found in Burlington wastewater and a growing likelihood that one or more of the dangerous strains have made their way to Vermont. Meanwhile we have a few hot spots in the state, including Bennington, Franklin and Rutland Counties, where community transmission is concerning and hospitals have been in surge status or close to it.

As the reality and threat of growing case counts and hospitalizations continue, we cannot afford to let down our guard. Of course this applies to mask wearing and social distancing. But it also applies to health care providers focusing their time and resources on the urgent and demanding work it takes to manage COVID-19.

To emerge from the pandemic strongly and smartly, hospitals cannot afford to be distracted by activities that do not support the core mission of delivering outstanding care to Vermonters during a still-raging public health crisis. For this reason, we have asked that our regulator, the Green Mountain Care Board (GMCB), exercise authority granted to it by the legislature to simplify hospital regulation this year.

Hospitals in Vermont are very thoroughly regulatedso much so that no other state in the union comes close to the level of oversight and scrutiny involved here. In fact, I was recently asked if I could find other examples where hospital regulation has been relaxed to allow for greater flexibility during the pandemic and the answer was a swift “no,” because no other state is regulated as we are.

Here in Vermont, every hospital’s annual budget is publicly disclosed and reviewed. Voluminous data spanning operations, expenses, quality, access and revenue growth is shared with the regulator and posted for public consumption. Exhaustive hearings on each hospital’s financial and operational status take place every year, at great cost to both hospitals and the state.

Regulation is important, and hospitals comply honorably. For so many reasons obvious to all of us, this year is simply different. Hospitals are not asking for a pass on regulation, but a simplified version that will provide regulators and the public with a clear picture of hospital budgets and not compromise clinical care, slow down vaccine clinics, interfere with surge planning or inhibit systemwide coordination.

Through the analysis of key data indicators, the GMCB can still carry out its obligation to review and approve budgetsand hospitals support this work. What we need to avoid is a lengthy, costly process that would be minimally informative during such an unpredictable year and would stress hospitals at a time when they cannot afford more stress.

If Dr. Fauci’s prediction is true, and sometime this summer we can finally bask in that light at the end of the tunnel, we must maintain total focus on patient care and pandemic response at least until then.

I have never been prouder of our non-profit hospitals. They have stepped up at every turn to serve Vermont and Vermonters, to protect the public and help us all move through and past the pandemic.
Legislative Update
by Devon Green
VAHHS Vice President of Government Relations

Last Week

Audio-Only Telehealth: The House Health Care Committee came to consensus to extend the current coverage and reimbursement of audio-only telehealth until January 1, 2025. This means that an audio-only office visit will be covered and reimbursed in the same way as an inpatient office visit after the patient provides proper informed consent.

Nurse Licensure Compact: The Senate Health and Welfare Committee took testimony on S.48, the Nurse Licensure Compact. The bill has broad support from VAHHS, the Coalition of Health Care Associations, the Vermont Health Care Association, the Board of Nursing, the Vermont Nurses Association, The Organization of Nurse Leaders and the Office of Professional Regulation. VAHHS Board Member Carol Conroy testified on behalf of the Organization of Nurse Leaders and enumerated multiple benefits of the Nurse Licensure Compact, including coordination of treatment via telemedicine, access in rural areas, improved safety through finger-print background checks and support for more rapid staff responses during disasters or public health emergencies.

Nurse Tax Incentives and Workforce Development: The House Health Care Committee heard AHS’s Director of Health Care Reform and the Tax Department present the Administration’s proposed nurse tax incentive that would exempt recent graduates from Vermont nurse education programs from 100 percent of state income taxes in the first year, 70 percent the second year and 50 percent in the third year after graduation. Laura Pelosi testified on behalf of the Health Care Provider Association Coalition in support of the incentive, noting that 33 percent of graduates from Vermont nursing programs leave the state. Pelosi also provided compelling testimony summarizing the workforce needs of Vermont’s health care providers and supporting ongoing funding for nursing and physician scholarships, as well as one-time funding for developing provider and higher education partnerships to increase nurse education programs.   

Regulation of Stem Cell Therapy Not Approved by the FDA: The Senate Health and Welfare Committee heard a summary of S.22, a bill that requires stem cell therapy that is not approved by the FDA to disclose to patients and in its advertising that the therapy is not approved. The committee will act quickly on this bill.

This Week

Health Care Budget: The House Health Care Committee started digging into its budget priorities last week and will continue their discussion this week. Topics for potential discussion include funding positions for health equity, suicide prevention, health care workforce and how to spend one-time federal funding related to
COVID-19.  

COVID-19 Regulatory Flexibilities: The Senate Health and Welfare Committee will likely incorporate the House Health Care’s consensus on audio-only telehealth into a bill that would extend current COVID-19 regulatory flexibilities.
In the News
How Vermont hospitals are faring nearly a year into the pandemic
WCAX

Last year, hospitals in our region had to stop everything to deal with the pandemic. It meant temporarily shutting down nonessential treatments and surgeries, things that normally make the margins for the hospitals. Our Ike Bendavid takes a look at how hospitals in Vermont are now faring financially.

As an independent hospital in rural Franklin County, Northwestern Medical Center says things are operating as normally as they can be during the pandemic.

“It’s been a remarkable response,” said Jonathan Billings, vice president of the Northwestern Medical Center.

Billings says like most hospitals, NMC had to quickly adapt to the pandemic. All nonessential surgeries and daily operations were shut down last spring for COVID precautions.

“Our services are essentially back to normal,” Billings said.

While that shutdown only lasted a matter of weeks, it added to an already difficult financial situation. The medical center was coming off a $9.3 million loss for the fiscal year 2019.

Should Vermonters wear two masks in public?
WCAX

The CDC recommends you wear two masks to better prevent the spread of the coronavirus, especially the new more contagious version, which has been found in Burlington’s wastewater. Christina Guessferd finds out if Vermonters are following the advice.

“I’d like more information about it, before I start double masking,” said Burlington resident Gina Scafa.

“When it starts getting worse, I definitely would consider it,” said Thomas Francis of Burlington.

Reporter Christina Guessferd: Do you know how to double mask?
Bennington Opioid Response Team offers updates, opens communication
Vermont Business Magazine

The Bennington Opioid Response Team, which formed in the spring of 2018, is eager to share recent updates on its work and to gather feedback from the community.

“More than ever, the opioid crisis is at the forefront of our minds and our actions,” said Kristi Cross, DNP, RN; project director, Bennington Opioid Response Team. “Our efforts are focused, and we are reaching out to let the public know that we are committed to helping our community overcome this epidemic.”

The group is comprised of over 40 individuals from community organizations, including health care, mental health, recovery, government, law enforcement, housing, transportation, and prevention. It’s mission is to improve quality of life by reducing the adverse effects of opioid use in the community.

Nursing home employee vaccination rates trail those of other health care workers
VTDigger

About 60% of workers at Vermont’s skilled nursing facilities have been vaccinated — a far cry from the vaccination rate at other types of health care facilities, where up to 90% of workers have received the vaccine.

State health officials said Vermont has enough vaccine for all staff members and residents in nursing homes statewide, and the low vaccination rate is just a result of vaccine hesitancy among nursing home workers.

Health department spokesman Ben Truman declined to identify which of the state’s nursing homes have the lowest vaccination rates — though he said that around a third of Vermont’s skilled nursing facilities have less than 60% of their staff vaccinated. He said those facilities aren’t concentrated in any particular area of the state.
New COVID clinic opening in St. Albans
VTDigger

Starting on Wednesday, qualifying Vermonters in Franklin County will have another spot to get a COVID-19 vaccine.

The Northwestern Medical Center is setting up a vaccination site at the new Congress and Main building in downtown St. Albans.

This is the second location for people who are eligible for the current rollout of the vaccine, those 75 and older. The Collins Perley Sports Complex is already vaccinating Vermonters.

The hospital says it’s unclear how many doses of vaccine they will be administering but they say it’s another sign that there is light at the end of the tunnel.

Vermont Department of Health continues vaccinating refugees and immigrants
Local 22

There is a push to vaccinate Vermont’s most vulnerable, and for some, this means extending the vaccines to anyone that lives in the same household.

The Vermont Department of Health set up pop-up clinics with UVM Medical Center to vaccinate refugees and immigrants who are 75 and older. Members in their immediate households are also eligible.

“Many household members who live with elders, in refugee and immigrant communities are generally their caregivers so it makes sense to extend it to household members,” Dr. Mercedes Avila, with UVM Medical Center said. 

To address concerns, educational sessions have occurred.

“We have held vaccine education outreach sessions, to answer any questions that communities might have or concerns related to accessing the vaccine,” Dr. Avila said. 

Rutland County seeing increase in COVID-19 cases
NBC 5

While a majority of counties in Vermont are seeing a decline in COVID-19 cases, three counties are seeing an increase, including Rutland County.

According to the state, Bennington and Rutland counties combined have seen a 76% increase in new cases since mid-January. Dr. Rick Hildebrant, chief medical information officer at Rutland Regional Medical Center said COVID-19 cases are the highest they've seen.

"The COVID cases in Rutland are at the highest level that we've ever seen them," Hildebrant said.

In an email to Town Health Officers in Rutland County from local health director from the Department of Health office in Rutland, it said in part,

  • "Rutland City and some surrounding towns now have evidence of increased rates, multiple household clusters and workplaces with cases"
  • "Surrounding towns with increased rates include Benson, Pittsford, Castleton, West Haven and Fair Haven."

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