November 22, 2010

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Senate Delays SGR Cut; House Expected to Act November 29th

Physicians and other providers of services to Medicare and Tri-care patients are likely to continue to be reimbursed at existing rates through the end of the year, because of action by the United States Senate this past week.  On a voice vote, the Senate extended the date of the proposed 23% reduction in rates to December 31st in order to give Congress time in December to negotiate the "pay-fors" required to cover an anticipated 12 month extension through 2011 at a cost of approximately $15 billion.

The MMA, the Maine Chapter of the AARP, and many other organizations representing medical providers, military personnel, and seniors flooded Congressional offices with calls last week, including calls last Wednesday which had been the day the AMA had called "White Coat" day.  MMA staff was in regular contact with the offices of Senators Snowe and Collins, both of whom have supported eliminating the reductions in reimbursement so long as the legislative action was paid for rather than increasing the national debt.  The House is expected to take up the legislation on November 29th when it returns from its Thanksgiving recess.  Action must be taken prior to December 1st.  Then in December, Congress must enact a statutory payment update that lasts at least through the end of 2011, providing time for Congress and the physician community to develop a long term solution to ensure that seniors can count on finding physicians to care for them and that physicians will not view Medicare as a threat to the financial viability of their practices.

The cost of the 30-day extension was approximately $1 billion and was funded through changes to the multiple procedure payment reduction policy for therapy services.  For background, the ACA required the Centers for Medicare and Medicaid Services (CMS) to re-adjust the payment for multiple services delivered on the same date.  As a result of that directive, CMS issued a final rule earlier this month that would reduce by 25% the practice component of the second and subsequent therapy service furnished by a provider to the same beneficiary on the same date.  The 25% reduction would only apply to the practice component of the reimbursement - providers would still receive full reimbursement for the labor component of the Medicare fee.  The temporary SGR delay would reduce the scheduled reduction in the practice component from 25% to 20% for multiple therapy procedures.  However, it would also remove the budget neutrality provision in the regulation - meaning the budgetary savings would be returned to the federal government (to pay for the SGR extension), rather than reallocated to other components of the physician fee schedule.

Until the full 12-month extension is accomplished in December, the MMA and the Maine Chapter of the AARP will continue these advocacy activities.  MMA President Jo Linder, M.D. will join AARP officials in a TeleTown Hall call at 10:00 a.m. on December 6th.  A tele-Town Hall is very much like a call-in radio show where AARP places calls to thousands of AARP members and asks them to stay on the line to discuss this important Medicare issue.  The members are then provided with a  brief statement about the urgency of the issue and are given the opportunity to ask any questions they have.  Dr. Linder and AARP officials then would have an opportunity to answer these questions.  The call concludes with a request for action to be taken,  including calls to Congress asking for a long term fix to the SGR problem.

Throughout 2010, Congress enacted short-term, stop-gap measures for durations as short as one month.  On three occasions, Congress failed to act in time and Medicare payments were cut by more than 20%.  The Centers for Medicare and Medicaid Services (CMS) then reacted by ordering carriers to hold payments until legislation was passed.   These steps by no means protected physician practices from all the consequences of the repeated Congressional delays.  On the contrary, payment uncertainties and delays were highly disruptive with many practices in Maine forced to seek loans to meet payroll expenses.  Furthermore, when payments resumed, many physicians experienced long delays in receiving retroactive adjustments.  Congress must act to avoid a repeat of these disruptive cuts that occurred earlier this year.

Further, Congress must break the cycle of forestalling a crisis in patient access to medical care for only a few months at a time and take steps in 2011 to permanently repeal the SGR formula and replace it with a payment system that is fair, predictable, and keeps pace with the cost of caring for seniors.  The MMA will work with the AMA and all other medical organizations and the AARP and other senior advocates to ensure that further harm is not done to the access to medical care that seniors have enjoyed since the establishment of Medicare.

For more information on the Medicare SGR issue, please go to the AMA web site:







REMINDER: MMA Legislative Committee Meets Monday, November 29th

The MMA Legislative Committee Chair, Lisa Ryan, D.O., a Bridgton pediatrician, would like to invite all Committee members, specialty society officers or legislative liaisons, and any interested physician to the organizational meeting of the Legislative Committee for the 125th Maine Legislature on Monday, November 29th from 6:30 to approximately 8:30 p.m.  Dinner will be available at 6 p.m.  The agenda for the meeting will include a review of the remarkable 2010 election results, decisions about Committee work for the session, discussion of legislation anticipated from other interest groups, and consideration of the MMA's & specialty society legislative agendas for the next 2 years.  All are welcome, but please RSVP your attendance to Maureen Elwell, Legislative Assistant, at 622-3374, ext. 219, or so we can plan for food.  

The 125th Maine Legislature will be seated in early December.  Legislators must have bill requests submitted by December 17th.  The new legislature will return to work in Augusta on Wednesday, January 5th & is expected to conclude its First Regular Session in mid-June 2011.

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MaineCare PAG/TAG Express Concern About MaineCare MeCMS Claims Submission Deadline

Last week, DHHS issued an emergency rule notice that makes January 31 2011 the last day on which claims for MaineCare services provided before September 1, 2010 may be filed through MeCMS, the claims management system adopted by the State and aborted just before pursuing the current MIHMS.  The Department is taking this action as part of the process of decommissioning the MeCMS program.  For services provided on or after September 1, 2010, providers will have up to one year to correctly file their claims into MIHMS.  The proposed rule includes accommodations for claims involving coordination of benefits and retroactive eligibility.  Adjustments will continue to be accepted for 120 days from the date of the remittance statement.

The proposed rule amendment is to MaineCare Benefits Manual, Chapter I, Section 1.10-2, Time Limits for Submission of Claims.

Members of the Provider Advisory Group and Technical Advisory Group expressed strong concern about this deadline and many claimed they felt it was unfair and contrary to previous signals sent by the Department. Deputy Commissioner Geoff Greene did his best to calm concerns about the proposed rule, said the Department would work with the provider community on these issues, and said the Department would consider amendments to the rule to make providers more comfortable. 

Department officials and Molina Health representatives also provided an update on MIHMS implementation.

The next scheduled PAG/TAG meeting is December 16th.

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ACHSD Begins to Consider ACA Implementation Recommendations to LePage Administration & New Legislature

At its regular meeting on Friday, November 19th, the Advisory Council on Health Systems Development (ACHSD) heard presentations from two researchers from the the Center for Health Law & Economics at the UMASS Medical School entitled, The Affordable Care Act:  Opportunities for Maine, Implications for the Dirigo Assessment, Quality Improvement, & Public Health.  The presenters were Robert W. Seifert, Principal Associate an Andrew P. Cohen, Sr. Research Policy Analyst.  The ACHSD expects to have a draft report with recommendations on ACA implementation available to the public on December 8th.  The ACHSD is planning a public hearing on the draft report for December 14th in the morning with a Committee work session in the afternoon.  The Committee plans a meeting to finalize its report on December 17th.  You can find the ACHSD meeting materials on the web at:

The MMA will publicize the report in the Maine Medicine Weekly Update when it is available.

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MQF Advisory Council Gets Update on New Director Search & Various Initiatives

The Maine Quality Forum Advisory Council, a multi-stakeholder advisory group to the Maine Quality Forum (MQF) and the Dirigo Health Agency chaired by Robert Keller, M.D., held a regular meeting on Friday, November 12th.  

DHA Director Karynlee Harrington provided an update on the work of the Agency, particularly in light on the new political landscape.  She reported lots of positive energy within the Agency and several pieces of good news, including the conclusion of a 3-year agreement with Harvard Pilgrim Healthcare and small group rate increases considerably lower than competitors.  The MQF staff also provided members with an update on the status of various MQF projects, including the MRSA Prevalence Study, the Patient Experience of Care Project, the Maine Multi-Payer Advanced Primary Care Practice Demonstration, and the MONAHRQ initiative.  Ms. Harrington and Dr. Keller reported that the Agency is beginning its search for a new MQF Director following the resignation of Dr. Cutler.  The Agency may consider a non-physician for the position, but if the leadership does move in this direction, they will ensure continued physician input through a Medical Director who likely would be part-time.

The next meeting of the MQF Advisory Council will be Friday, January 14, 2010 from 9:00 a.m. to noon.

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Physicians Invited to Meet with Aetna Officials on December 13th to Discuss Medicaid Managed Care

The Maine Medical Association and Aetna will host a dinner meeting at the offices of MMA in Manchester on Monday evening, December 13th, beginning at 6:00 p.m.  Aetna officials would like input from Maine physicians regarding MaineCare's plans to move patients into a managed care contract in 2011.  Aetna is providing managed care under contracts in other states, along with United, Wellpoint, and other insurers.

Attending the meeting will be Judith Chamberlain, M.D., Virginia Cate, Senior Network Market Lead, and Lynda Grajeda, Network Operations Market Head.

Physicians wishing to attend may RSVP to Diane McMahon at [return to top]

Free In-Office Hypertension Education Available Through MMA's Academic Detailing Program

The Maine Medical Association and the Maine Independent Clinical Information Service Present: 

Academic Detailing Visits at No Cost

NEW Hypertension Module Available Now!  

Schedule your visit today: 207-622-3374 or 

The "Silent Killer" - Still at Large 

Most Americans over age 60 have hypertension.  Even among those whose blood pressure are normal at age 55, the lifetime risk of hypertension is 90%.  Despite the availability of dozens of effective treatments and decades of data, less than two-thirds of patients in the U.S. with hypertension are receiving treatment, and less than half are adequately controlled.

Effective hypertension control is one of the best ways a physician can make a real difference in patients' health by preventing myocardial infarction, stroke, renal damage, and premature death.  

Meet with our academic detailers to learn more about key steps that can improve current management, such as: 

  • Low-dose thiazides should play a central role as initial therapy for many patients, and as part of combination treatment for others; 
  • Choose other medications based on compelling indications; 
  • Combination therapy will often be needed;
  • When choosing agents, consider cost and compliance. 

For more information, visit  Three academic detailers have been trained in the new hypertension model and they are ready to go!  Put them to use in your practice. [return to top]

DEA Issues Policy Statement on Prescribing for LTC Patients

The AMA recently responded to a request for information from the DEA on delays in dispensing controlled substance medications for patients at long term care facilities.  The AMA also worked with other medical societies on a "tip sheet" for physicians to help expedite dispensing.  Both the tip sheet and the AMA letter are available by selecting "DEA issues" at

On October 6th, the DEA published in the Federal Register a statement of its policy at on the role of authorized agents in communicating controlled substance prescriptions to pharmacists.  The policy statement includes a sample written agreement between a DEA-registered physician and an agent, such as a nurse at the long term care facility.  It provides clarification that communication by facsimile or oral communication of a valid prescription for a Schedule III, IV, or V controlled substance may be delegated to an authorized agent, and that an agent may not call in an oral prescription for a Schedule II controlled substance on behalf of a practitioner, even in an emergency situation.  However, for patients in a hospice program or a long term care facility, a practitioner or a practitioner's authorized agent can transmit a valid practitioner-signed prescription for a Schedule II controlled substance to a pharmacy via facsimile.  The DEA statement of policy is helpful but it does not fully address the AMA's concerns about dispensing delays for urgently needed Schedule II drugs that may occur when physicians are neither available to sign a written prescription nor able to get in touch quickly with the pharmacist by phone. 

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Medical Marijuana Patients Need State ID Card by January 1st; 50 Physicians have Completed Medical Certificates

The State Department of Health & Human Services reported this week that 50 different physicians have completed medical certificates for patients under the new medical marijuana law.  Twenty-nine of these physicians were family physicians with the remaining physicians representing a mix of other specialties. Several hundred patients are expected to have ID cards issued by the state by January 1, 2011, although the first state-licensed dispensaries are not likely to be open before March. 

The MMA and the Maine Osteopathic Association are soliciting names of physicians interested in serving on the state mandated advisory board.  To be eligible to serve on the board, which is likely to meet only once or twice a year, a physician must be board certified and have a current Maine license and a DEA license.  One position each is available in family medicine, pediatrics, psychiatry, addictionology, pain management, neurology, palliative care, gastroenterology, medical oncology, infectious disease, gynecology, and internal medicine.

The MMA has resources on its website at for physicians desiring more information on the law and the risks and benefits of physicians and patients participating.

The MMA also has a one-hour course on the law, certified for CME, delivered by one of our three health lawyers.  If your medical staff, group practice, or specialty society would like a presentation, contact Gail Begin at the MMA at  There is normally a $200 charge to cover travel and copying costs.  The Powerpoint presentation is located on the MMA website.

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Maine Named as One of Eight States to Receive Medicare Patient Centered Medical Home Pilot Grant

The Obama Administration last Tuesday announced new initiatives intended to improve the quality of care received by Medicare and Medicaid patients.  The 10-year, $10 billion effort was announced at a press conference attended by the AMA, business leaders, the American Nurses Association, insurers, and consumer advocates.

Through the efforts of Quality Counts, the Maine Health Management Coalition, and the Dirigo Health Agency's  Maine Quality Forum, Maine will be one of the eight states participating in the Medicare Patient Centered Medical Home pilot. The PCMH pilot in Maine is already up and running for Medicaid and commercial payers and the addition of Medicare will boost the effort considerably.  Physicians in the pilot will receive an additional seven dollars per Medicare patient per month in exchange for providing services aimed at better coordination of care.  Twenty-five medical practices are participating in the Maine program.

The other seven states awarded grants in the PCMH program are Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. [return to top]

Maine House Democrats Elect Emily Cain as Floor Leader; Terry Hayes as Assistant

Pledging to rebuild their depleted ranks, House Democrats in Maine on Thursday elected Rep. Emily Cain (D-Orono) to serve as minority floor leader and Rep. Terry Hayes (D-Buckfield) as assistant minority leader.  House Democrats lost 23 seats in the November election and control of the House chamber to the Republicans.  

Representative Cain was elected to her fourth term in November and had expected to run for House Speaker had the Democrats retained control.  In the current session, she had served as House Chair of the Appropriations & Financial Affairs Committee and is widely credited with achieving a bipartisan culture in that committee that unanimously recommended five different adjustments to the state budget.  She is a 30-year-old educator and is currently pursuing a doctorate in higher education administration at the University of Maine where she also works part-time as coordinator of the University's Honors College.   She is a graduate of Lawrence High School in Lawrenceville, N.J and earned a BME in vocal music education from the University of Maine and an Ed. M. in higher education from the Harvard Graduate School of Education.

Terry Hayes was elected to her third term in November, representing District 94 consisting of the rural towns of Buckfield, Hartford, Paris, and Sumner.   She was born and raised in Portland and is a graduate of Bowdoin College.  She is a small business owner who created her own guardian ad litem agency to give voice to children in custody disputes.  

All 151 House members will convene on Wednesday, December 1st to formally elect the House Speaker and to participate with the Senate in electing the state's four constitutional officers, the Attorney General, Secretary of State, Treasurer, and Auditor.

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MMA Website to be Re-designed; Proposals Welcome

Recognizing the need to continually improve the various means by which the Association communicates with our members and the public, the Executive Committee has authorized a re-design of the current website at  The work is being overseen by an ad hoc Committee on Technology and Communications, chaired by Paul Klainer, M.D. of Owl's Head.  The primary goal is to have a website that is more interactive, less focused on content, and more visually appealing.  Any regular readers of the Update who have had good experiences with a web-site designer who might be interested in the work are encouraged to share that contact information with Gordon Smith, Esq., the Association EVP.  Gordon would then forward to the design firm the specs for the work.  Gordon's e-mail address is  [return to top]

"Current Topics in the Medical-Legal World" is Final 2010 First Fridays Topic on December 3rd

On December 3, 2010, MMA presents the final First Friday presentation of 2010 with a program entitled, "Current Topics in the Medical-Legal World."  The program runs from 9:00 a.m. to noon and features presentations from five health lawyers on the following topics:

  • The 2010 Physicians Guide to Maine Law;

  • Maine Laws on Informed Consent;

  • The Federal Trade Commission "Red Flag" Rules, effective January 1, 2011;

  • The 2007 Medicare law requiring reporting of waiving of co-payments; and

  • The Maine Health Security Act.

Attorneys Stephen Johnson and Benjamin Townsend of the Augusta health law firm of Kozak & Gayer and MMA lawyers Andrew MacLean, Jessa Barnard, and Gordon Smith will all participate.  The program promises to be a fitting conclusion to a very successful series of programs in 2010.  The program can be attended live in Manchester or via WebEx.  There is a $65 fee and anyone interested can register on the MMA website at  Those individuals interested in attending through WebEx may register by e-mailing

Watch for an insert in the November-December Maine Medicine that will list all the First Friday programs for 2011.  The series begins on Friday, February 4, 2011 with a program on the future of health system reform.  Nine programs have been scheduled, not including the 20th Annual Practice Education Seminar being held on Wednesday, May 18, 2011 at the Augusta Civic Center. [return to top]

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