December 27, 2010

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Season's Greetings from the Maine Medical Association

MMA President Jo Linder, M.D., the Executive Committee, and staff wish all of the members and other regular readers of the Weekly Update all the best for a healthy and happy new year in 2011.  We appreciate your support and promise to keep you well informed of what is going on in the complex world of health care throughout the year.  It promises to be a busy year and there will no shortage of material.


Maine Medicine Weekly Update is sent electronically every Monday of the year to more than 4,000 individuals and has a regular readership approaching 1,000.  Back issues can be accessed on the MMA website at  If you know individuals who would like to be receiving the publication but are not, please communicate with Lisa Martin at MMA at or via phone at 622-3374, ext. 212.

The Association's printed newsletter, Maine Medicine, will be published four times in 2011 with the first issue of the year reaching your desk in early March.  Any questions about Maine Medicine including advertising rates may be directed to Shirley Goggin at or by calling 207-445-2260.

The Association's current website is scheduled for a comprehensive re-design during the first quarter of 2011.  Watch for further information on this project.  We are enthusiastically exploring new means of communicating with members and their staffs and know it is important to reach you in ways that are convenient for you.  If you have suggestions, please contact MMA's Executive Vice President Gordon Smith, Esq., at or call him at 622-3374, ext. 212.  Mr. Smith will be working with the Association's Committee on Technology & Communications on this project.  The Committee is chaired by Paul Klainer, M.D. of Owl's Head.

We wish you all the best for the holidays and the new year.






Avoid 2012 e-Rx Penalties by Reporting in 2011

CMS announced in the final Medicare physician fee schedule rule that it plans to use 2011 data to determine 2012 penalties for e-prescribing (e-Rx).  The American Medical Association has opposed this approach.  In order to avoid a penalty for e-prescribing in 2012, physicians must now engage in claim-based reporting of G-code G8553 ten times between January 1st and June 30th.  Penalties will not apply to physicians (or group practices) where less than 10% of their allowed charges for this timeframe are comprised of codes in the 2011 e-Rx measure.

Physicians should be cautioned that participating in the electronic health record (EHR) incentive program in 2011 will not protect them from the e-Rx penalty despite the fact that e-prescribing is a component of the EHR program.  Individual physicians can avoid the e-Rx penalty if:

  1. they are not a physician as of June 30, 2011;

  2. they do not have prescribing privileges prior to June 30, 2011 (use G8644 at least once during reporting period);

  3. they do not have at least 100 cases containing an encounter code in the measure denominator (2011 e-Rx measure specifications are available in the "Downloads" section of the E-Prescribing Measure section of the CMS website located at:; or

  4. they become a successful e-prescriber (reporting G8553 at least 10 times during reporting period).  Group practices that are participating in the Group Practice Reporting Option (GPRO) I or GPRO II during 2011 must become a successful e-prescriber.  Depending on the group's size, they must report the e-Rx measure for 75-2,500 unique e-Rx events for patients in the denominator of the measure.

CMS may, on a case by case basis, exempt an eligible professional from the application of the e-Rx payment adjustment if compliance would result in a significant hardship.  This exemption is subject to annual renewal.  For the 2012 e-Rx payment adjustment, the following circumstances would constitute a hardship:

  1. the eligible professional practices in a rural area with limited high-speed internet access; or
  2. the eligible professional practices in a area with limited available pharmacies for electronic prescribing. 

To request a hardship exemption for 2012 payment adjustment an eligible professional must report the appropriate G-code on at least 1 claim prior to June 30, 2011.  A group practice must submit this request at the time it self-nominates to participate an e-Rx GPRO i or GPRO II.  G-codes have been created to address two hardship circumstances (G8642 and G8643).

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125th MaineLegislature Announces Committee Assignments

The presiding officers of the 125th Maine Legislature announced committee assignments last Wednesday.  Senator Earle McCormick (R-Kennebec) and Rep. Meredith Strang Burgess (R-Cumberland) were appointed as co-chairs of the Health & Human Services Committee.  Rep. Strang Burgess is serving her third term in the House and has extensive background in health care including a term as chair of the Maine Cancer Foundation.  She has fought a very public and successful battle against breast cancer and has raised substantial funds for prevention and treatment through the annual Breast Cancer Luncheon held each Fall in Portland.

Representative Linda Sanborn, M.D. (D-Gorham), the only physician in the new legislature, was assigned for her second term to the HHS Committee. 

All committees are joint committees with three senators (two Republicans and one Democrat) and ten house members (either split 5-5 or 6-4 in favor of the Republicans).  The HHS Committee as well as the Appropriations Committee have a 6-4 split on the House side between the Republicans and Democrats. 

A complete list of committee assignments may be found online at the Legislature's website at:     

The legislature begins regular sessions on Wednesday, January 5th when Governor-elect Paul LePage will be sworn in and give an inaugural address at the Augusta Civic Center at 11:30 a.m.  Tickets are required for the event.

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Websites You Should be Viewing Regularly

While the MMA website at contains links to many websites that members and their staffs use frequently, below are a list of our favorites that we encourage you to check out on a regular basis:

Join the Quality Counts Learning Community to share best practices and learn about improving care at

Share your health care story or read the stories that others have told - at Healthcare for ME (

Learn more about Maine's hospital community at the website of the Maine Hospital Association at




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New CMS Home Health Certification Requirement (Face-to-Face Encounter) Given Slight Reprieve

Editors note:  See last paragraph of this article regarding the slight reprieve CMS has granted on this requirement.

A new Medicare home health law goes into effect on January 1st that affirms the role of the physician as the person who orders home health care based on personal examination of the patient.   Effective in January, a physician who certifies a patient as eligible for Medicare home health services must see the patient.  The law also allows the requirement to be satisfied if a non-physician practitioner (NPP) sees the patient, when the NPP is working for or in collaboration with the physician. 

As part of the certification form itself, or as an addendum to it, the physician must document that the physician or NPP saw the patient, and document how the patient’s clinical condition supports a homebound status and need for skilled services. The face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care.   While the long-standing requirement for physicians to order and certify the need for home health remains unchanged, this new requirement assures that the physician’s order is based on current knowledge of the patient’s condition.

A more detailed announcement on this subject will be available within the next few days, on the home health agency website at:, under the Spotlight section.  Additional guidance will be available next week via a Special Edition article on our Medicare Learning Network website at:  Questions and answers regarding this requirement will be available the week of December 13th via Medicare’s home health agency website,  Finally, we expect a video training module describing this new requirement to be released within the next few weeks.

A number of organizations, including the AMA, have expressed concern that CMS has not conducted adequate outreach to physicians about this requirement and have requested that enforcement of this provision be delayed.  CMS has announced that the provision will not be enforced immediately, in order to give more time for outreach and education.  In a communication to the National Association for Home Care & Hospice (NAHC), CMS announced last week that it has instructed its contractors to allow home health agencies and hospices to use the first three months of 2011 to implement procedures to meet the face to face encounters requirement.

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Leaders of Key Congressional Committees Named for New Congress

The U.S. House and Senate have named leaders for most of the key health care committees for the upcoming 112th Congress.  In the House, current leaders of the House Committee on Ways & Means will switch positions, with Rep. Dave Camp (R-MI) serving as the Chairman and Rep. Sander Levin (D-MI) becoming the Ranking Minority Member.  Rep. Wally Herger (R-CA) will be Chairman of the Ways & Means Health Subcommittee and Rep. Pete Stark (D-CA) will serve as ranking member.

Rep. Fred Upton (R-MI) won the race for Chairman of the House Committee on Energy & Commerce, and Rep. Henry A. Waxman (D-CA) will become its Ranking Member.  Rep. Joseph R. Pitts (R-PA) will serve as Chairman of the Energy & Commerce Subcommittee on Health.  Rep. Cliff Stearns (R-FL) was selected to be Chairman of the Energy & Commerce Oversight and Investigations Subcommittee.

In the House Committee on Education & Labor, Rep. John Kline (R-MN) was re-elected to his 5th term and will serve as Chairman, having served as the Ranking Member on the Committee in the 111th Congress.  The new ranking member of the committee has not been finalized yet.

Senator Max Baucus (D-MT) will continue to chair the Senate Finance Committee.  However, because of the Senate Republican Caucus rules, Senator Charles Grassley (R-IA) will relinquish the ranking member position on that panel and be replaced by Senator Orrin Hatch (R-UT).  The leadership of the Senate Committee on Health, Education, Labor & Pensions will remain the same, with Senator Tom Harkin (D-IA) continuing as Chairman and Senator Mike Enzi (R-WY) serving as the Ranking Member.

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Maine Moves Forward in Addressing Chemicals in Children’s Products

Maine has continued to move forward with implementation of the Safer Chemicals in Children’s Products law passed in 2008.  On December 17th, the Board of Environmental Protection adopted the Department of Environmental Protection’s proposed rules designating Bisphenol A (BPA) and Nonylphenol and Nonylphenol Ethoxylates (NPs) as “priority chemicals.”  The rules on BPA now allow the Department to ban its use in reusable food and beverage containers, require manufacturers to report on its use in toys and child care articles, and conduct an assessment of possible alternatives for uses in infant formula and baby food containers.   While applauding the developments, advocacy groups had been pushing the Department to ban the use of BPA in infant formula and baby food containers without requiring an additional assessment.  The Board also took a step forward on NPs, chemicals with estrogenic effects, by requiring manufacturers to report the extent that these chemical are used in children’s products.  Brominated Flame Retardants are likely to be the next chemical taken up by the Board.  For more information on the law and rules, see: [return to top]

Interested in Running for Office? AMPAC Announces 2011 Political Education Programs

On February 18-20, 2011, AMPAC (the AMA's political action committee) will host the annual Candidate Workshop in Pentagon City, Virginia.  The Workshop is designed for AMA members and their spouses who are considering a run for public office, and includes training on campaign strategy and media advertising, as well as hands-on sessions in public speaking and fundraising.

AMPAC will conduct its annual Campaign School from April 13-17, 2011, also in Pentagon City, for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates.  The School is organized around a simulated congressional campaign, where participants are put on campaign "staff" teams and attend daily lectures on campaign strategy, media advertising, and political fundraising.  Each team participates in nightly exercises such as creating a campaign strategy, taping a radio commercial, and writing a political fundraising letter.  For both programs, all costs for AMA members, except transportation to the Washington, D.C. metro area, are borne by AMPAC.  For more information on these programs or an application, please see AMPAC's new online registration form at: or contact Jim Wilson, Political Education Programs Manager, at

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Medicare Enhanced Benefits for Preventive Services, Effective January 1st

One of the more concrete benefits of the federal health reform law (Affordable Care Act or ACA) is the enhanced Medicare coverage of preventive benefits.  Under the existing law, Medicare has covered a number of preventive health screenings such as mammograms and colonoscopies but with varying levels of cost-sharing (including, as applicable, deductibles, coinsurance or co-payments).  Typically, this meant that the Medicare beneficiary would pay 20% of the cost of the service, after he or she had met the $155 Part B deductible.  But beginning on January 1, 2011, your Medicare patients will no longer have to pay any out-of-pocket costs for most preventive health services, including annual wellness visits that are being added to the program.

In addition to the wellness visits (these are different from the one-time "welcome to Medicare physical"  that is available only to beneficiaries in the first year of their enrollment in Part B), CMS has announced the following list of preventive services subject to this provision:

  •  Breast cancer screening.  Yearly mammograms will be offered to women age 40 and older with Medicare;

  • Colorectal cancer screening.  This includes a flexible sigmoidoscopy or colonoscopy for all beneficiaries age 50 or older;

  • Cervical cancer screening.  Pap smear and pelvic exams are available every two years or annually for those at high risk;

  • Cardiovascular screenings.  Free blood test to check cholesterol, lipid and triglyceride levels offered every five years to all Medicare recipients;

  • Diabetes.  Twice-a-year screening for those at risk;

  • Medical Nutrition therapy.  Available to help people manage diabetes or kidney disease;

  • Prostate cancer screening.  An annual digital rectal exam and PSA test for all male beneficiaries age 50 or older; 

  • Bone mass measurements.  This osteoporosis test is available every two years to those at risk, or more often if medically necessary;

  • Abdominal aortic aneurysm screening.  Available to men ages 65 to 75 who have ever smoked;

  • HIV screening.  Available to those Medicare beneficiaries who are at increased risk or who ask for the test;

  • Vaccinations.  An annual flu shot, a vaccination against pneumococcal pneumonia and the hepatitis B vaccine;

For more information, look on-line at

Beneficiaries covered through a Medicare Advantage plan may not have all these benefits or may have them all and more, depending upon the plan.  Most Medicare Advantage plans do presently offer Medicare-covered preventive services without cost-sharing.

MMA and nine other organizations in the state have one-year funding from the Maine Health Access Foundation (MeHAF) to educate patients about the enhanced coverage opportunities available through the ACA.  If you would like to have some of the materials developed as part of this grant for use in your office, please contact Gordon Smith or Jessa Barnard at MMA ( or


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CMS Hosting PQRS Town Hall Meeting on February 9th

The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall Meeting to discuss the Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative, or PQRI).  The purpose of the Town Hall Meeting is to solicit input from participating stakeholders on individual quality measures and measures groups being considered for possible inclusion in the proposed set of quality measures for use in the 2012 Physician Quality Reporting System and key components of the design of the Physician Quality Reporting System.  The opinions and alternatives provided during this meeting will assist CMS develop the Physician Quality Reporting System for 2012.

Interested parties are invited to participate, either onsite at CMS headquarters in Baltimore, Maryland, or via teleconference.  The meeting is open to the public; however, attendance is limited to space and teleconference lines available.

CMS anticipates posting an audio download and/or transcript of the Town Hall meeting on the CMS Web site,, on the CMS website and, on the internet following the meeting.

The Town Hall Meeting will be held on February 9, 2011, from 10 a.m. until 4:00 p.m. Eastern Standard Time (E.S.T.) in the main auditorium of the Central Building of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244–1850. 

Meeting Registration and Request for Special Accommodations Deadline:

Registration opens on Monday, December 20, 2010.  For security reasons, registration and requests for special accommodations must be completed no later than 5 p.m. E.S.T. on Friday, January 28, 2011.

Anyone interested in attending the meeting or participating by teleconference must register by completing the online registration at http://www.usqualitymeasures.orgon the internet. 

For more information, please see the Federal Register meeting notice posted at on the internet.

To learn more about the 2012 Physician Quality Reporting System Call for Measures, please visit on the CMS website.  

PLEASE NOTE: The CMS Measures Management System Web site link in the Federal Register meeting notice has been updated.  The correct link is on the CMS website.

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CMS Posts Implementation Guide for 2011 Medicare PQRS

CMS has posted the 2011 Medicare Physician Quality Reporting System Implementation Guide.  This guide, along with other 2011 quality measurement reporting participation tools, are available in the "Downloads" section of the CMS physician quality reporting web site located at:  These educational materials can help prepare physicians and their medical staffs for participation in the 2011 program, which kicks off January 1, 2011. [return to top]

Medical Marijuana Law Effective January 1, 2011; Applications Increasing

The State Department of Health & Human Services is receiving many applications because of the looming January 1st deadline under the state's medical marijuana law.  At that time, the possession of marijuana under the previous (1999) law will be invalid.  As of December 17th, DHHS had issued patient ID cards to 215 Maine residents and an additional 173 applications were pending.  28 individuals had received cards authorizing them to be "caregivers" which allows them to grow marijuana for up to five registered patients.  About 53 physicians have prepared a medical certificate for use by one or more patients.

MMA's one hour CME course designed to inform physicians about the new law is still available for presentation to your medical staff, specialty society, or group practice.  The materials for the course can also be found on the MMA website at  Normally a fee of $200 is charged to cover travel and the cost of materials.  The course is delivered by one of MMA's attorneys, Gordon Smith, Andrew MacLean, or Jessa Barnard.  To schedule a presentation, contact Gail Begin, CME Coordinator, at or by phone at 622-3374, ext. 210.

The Maine Medical Association and the Maine Osteopathic Association also are still seeking volunteers for the Advisory Committee established under the law.  Members are still needed in the specialties of gastroenterology, medical oncology, infectious disease, hospice medicine, and gynecology.  To be considered for appointment to the committee, a physician must be board certified in the specialty and be "knowledgeable about medical marijuana."  To volunteer, contact Gordon Smith at

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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]

For more information or to contact us directly, please visit l ©2003, Maine Medical Association