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Marie Beatrice "Bea" Grause
President and Chief Executive Officer

 March 2002

I've seen a lot of new places and new faces in Vermont this month. VAHHS hosted six regional trustee/legislator meetings during Town Meeting week. The primary purpose of these meetings was to create the opportunity for our trustees to speak directly with legislators about the challenges facing their hospitals. As a conversation enhancer, I gave a short presentation that included health policy trends, facts about Vermont's health care system and a state and federal legislative update. The conversations that followed were lively, diverse and candid. I certainly learned a lot. Some of the highlights I walked away with included:

The value of home-based advocacy. As Tip O'Neill said, "All politics is local." Regional meetings, as part of an overall advocacy strategy, help reinforce the relevance of policy decisions made in Montpelier and Washington D.C. Smaller meetings create a better opportunity for relationship building and health policy discussions that make it easier for everyone to "connect the dots." In a world as complex and controversial as health care, enhanced understanding by all parties is an important step toward making better health policy decisions

A recognition of the diversity of viewpoints on key health care issues. Many participants suggested that the Association and others create a common "vision" for health care reform. Opinions on what this vision should look like however, ranged from a single payer system to Medicaid vouchers. The Association members posed the idea of creating a vision for health care reform in Vermont during our interview discussions last summer. Even in the abstract, their "vision" idea became part of why I chose to come to Vermont. Now, these regional meetings have begun to make that vision a reality. Creating a common vision for health care reform is an enormous undertaking - one that requires both broad consensus among stakeholders and a process that will require them to decide the parameters of their collective health care future. As a direct result of these regional meetings, discussions are now underway to begin building this process and consensus.

The broad agreement on the need for Medicaid changes. Whether participants supported the cigarette tax or not, all seemed to agree that Vermont's Medicaid program was headed toward a crisis. The Association supports a cigarette tax as a short-term measure. Revenues from this tax would "buy" the Medicaid program enough time for stakeholders and legislators to engage in a much needed discussion on Medicaid reform. In just a few short years, legislators will have to make very tough decisions on Medicaid. In the Association's view, they would benefit from in-depth Medicaid discussions before those decisions must be made.
Now, legislators are back in Montpelier and will focus on budget, health and many other issues for the next several months. More VAHHS regional meetings are definitely part of this session's strategy to continue a dialogue on our top health care priorities. Maybe by the next round of meetings, I won't even need my Gazetteer.

Vermont Explor: Data Developments

NHVSHIP: Please mark your calendars for our next meeting on April 19th at the VA in White River Junction. This meeting will have a different format: All participants will hear Mindy Hatton, Vice President and Chief General Counsel from the American Hospital Association, a national expert on HIPAA, talk about what's happening with HIPAA regulations in Washington. We will also hear updates from the work group co-chairs on all the work each group has been doing over the past year. A more detailed agenda will soon be available at www.nhvship.org. Please plan on attending this important NHVSHIP meeting.

DIABETES COLLABORATIVE: We have continued to refine a database for hospitals to use in their data collection as part of VPQHC's Diabetes Collaborative. So far, three hospitals have installed the database, with more on the way. Entering patients' clinical information into the database allows providers to track change over time and to aggregate results in a variety of ways.

For more information contact Greg Farnum.

Hospitals Invited To Take Advantage of CMS Open Door Conference Calls

As part of the "open door" policy of Health and Human Services Secretary Thompson, the Center for Medicare and Medicaid Services (CMS) has scheduled a series of open door conference calls on various health topics. CMS Administrator Tom Scully quite often participates on these calls. The Dial-In number for all of these calls is: 800-837-1935. If you are unable to participate, recordings of the calls are available for 72 hours after the call at: 800-642-1687. The access code for this Encore Feature is the call ID number of the meeting. Over the next few weeks, the following calls are scheduled. All calls are Eastern standard time:

Hospital Open
ID 2813694 Wednesday, 4/10/02 at 10:00 AM
ID 2813695 Wednesday, 5/8/02 at 10:00 AM

Home Health Open
ID 2813184 Tuesday, 4/9/02 at 10:00 AM
ID 2813796 Tuesday, 5/7/02 at 10:00 AM

Rural Health Open
ID 2813445 Tuesday, 3/26/02 at 2:00 PM
ID 2813446 Tuesday, 4/30/02 at 2:00 PM

Long-Term Care
ID 2813539 Tuesday, 3/26/02 at 6:00 PM
ID 2813540 Tuesday, 4/30/02 at 6:00 PM

Pharmacy
ID 2813937 Wednesday, 4/3/02 at 2:00 PM
ID 2813938 Wednesday, 5/1/02 at 2:00 PM

Nurses and Allied Health
ID 2813952 Thursday, 4/11/02 at 10:00 AM
ID 2813953 Thursday, 5/9/02 at 10:00 AM

End Stage Renal Disease
ID 2815667 Friday, 5/17/02 at 1:00 PM

Physician
ID 1639819 Monday, 4/15/02 at 2:00 PM
ID 1639820 Monday, 5/20/02 at 2:00 PM

For further information about these meetings, contact Peter Holman at VAHHS, or Bill MacKenzie of the CMS Boston office at 617-565-1696. Meetings on each topic are scheduled through the end of 2002, and VAHHS will continue to update these listings in future editions of this newsletter.

MedPAC Makes Positive Recommendations

The Medicare Payment Advisory Commission (MedPAC) advises Congress on Medicare payment issues. On March 1, 2002, MedPAC submitted a report to Congress with some positive recommendations for hospitals. Congress, however, is currently pursuing a more negative approach. Legislators have been discussing budget neutral Medicare changes. Budget neutrality would likely result in pitting provider against provider.

Key MedPAC recommendations include:

VAHHS supports the MedPAC recommendations with the exception of the large urban hospital update. VAHHS' position would include a full market basket update for large urban hospitals as well as for those in rural areas and small cities.

For more information contact Erica McNamara.

Lawsuit: Medicaid Upper Payment Limit

Section 1902(a)30(A) of the Social Security Act and 42 CFR Part 447 set Medicaid aggregate payments to hospitals at the estimated payment under Medicare payment principles. (One hundred percent of the estimated Medicare payment.)

In a final rule published in the January 12, 2001 federal register, an exception to the UPL was made for payments to non-State government-owned or operated hospitals that set the UPL at 150% of estimated Medicare payments. The intent was to provide additional funding to those public hospitals because of their important role in serving the Medicaid population.

In November 2001, CMS released a proposed rule eliminating this exception. A final rule eliminating this exception was published in January 2002 with an effective date of March 19, 2002.

The elimination of the exception was the result of the CMS belief that the additional funds were being reallocated back to states through intergovernmental transfers and not being used by the intended recipients.

On March 7, 2002, The American Hospital Association joined a number of health care associations in filing suit against the Department of Health and Human Services seeking an injunction on the final UPL rules.

As there are no non-State government-owned or operated hospitals in Vermont, both the original exception and the current elimination of the exception would not have an impact on Medicaid payments to Vermont hospitals.

For more information contact Erica McNamara.

Recruitment Issues: Loan Repayment

Every state offers a loan repayment program. Some states have significant rural remote areas and are very aggressive with the amounts offered, making it hard for Vermont to compete with the amount we have to pass out. It is very exciting that each year the legislature grants more funds to the Department of Health for the loan repayment budget. The VRC has placed 214 providers (162 physicians and 45 NP/PA candidates), of whom 97% needed loan repayment.

Since 1995, the inception of the VRC, loan forgiveness has assisted Vermont in being able to compete for the physicians that fit the Vermont Placement Profile. Before this, Vermont had to wait up to four years to attract that person because they signed in a state that offered more loan monies and had to fulfill their obligation. This put Vermont behind in the number of physicians per service area needed, which in turn places a large and unwanted burden on the existing physicians. Most physicians choose Vermont for quality of life reasons and time with their family. Having loan repayment and the amount increasing every year has allowed Vermont to compete head-to-head, making competitive offers and being able to retain the providers once they are practicing here.

The VRC has outlined, as follows, some yearly physician loan debt history (average per physician):

VRC has tracked the debt load of the 162 physicians placed since 1995 through January of 2002 at more than $9.6 million.

Vermont is fortunate to have the AHECs managing the loan repayment program each year and the gift from the Freeman Foundation.

For more information contact Dee Rollins.