January 3, 2011

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New Governor to be Sworn In on Wednesday; Affordable Care Act May Be Target of New Republican Leadership

Governor-elect Paul LePage will become Governor this week, following an inauguration at 11:30 a.m. on Wednesday at the Augusta Civic Center.  Two days later, on Friday, January 7th, pro-health reform advocates and organizations calling for Maine to join a lawsuit calling for repeal of the Affordable Care Act had planned to hold competing rallies at the State House.  Governor-elect LePage and in-coming Attorney General William Schneider have already stated their desire to have Maine join the lawsuit, but many health related organizations, including MMA, will be encouraging state leaders to support the positive aspects of the law and work to change those provisions which may against the interests of Maine citizens.  As of 2:00 p.m. today, the Maine Heritage Policy Center canceled its anti-ACA rally apparently because an invited speaker could not attend.  The MMA has no information about the rescheduling of the events.

Much of the controversy surrounding the Affordable Care Act (ACA) relates to the so-called individual health insurance mandate which will require most citizens to purchase health insurance by the year 2014.  Subsidies are provided in the law for individuals earning less than 400 % of the federal poverty level.

In an article published in both the Washington Post and the Bangor Daily News this past week, journalist Ezra Klein noted that the individual mandate in the law was based largely on the Massachusetts health reform law signed into law by former MA Governor Mitt Romney in 2006.  Remarkably, recently released figures show that the law has resulted in more than 98% of the state's residents now being insured, including more than 99% of the state's children.

MMA has endorsed the individual mandate since 2003 when an ad hoc committee of the Association prepared a position paper endorsing the goal of universal coverage.  An update of the 2003 paper can be found on the MMA website at www.mainemed.com.


Governor Baldacci Reappoints David Nyberg and appoints Meg Baxter to BOLIM

Governor John Baldacci in mid-December reappointed retired professor David Nyberg and appointed Meg Baxter as public members of the Board of Licensure in Medicine (BOLIM).  Ms. Baxter is retired from a career that included serving as Executive Director of the United Way of Greater Portland for more than twenty years.  She has previously served on a number of boards of health care organizations, including a term as Chairman of the Board of Maine Medical Center.

The Board is made up of six physicians and three public members.  Sheridan Oldham, M.D. of Rangeley currently chairs the Board.  Dr. Oldham is a retired general surgeon.  Other physician members include Maroulla Gleaton, M.D., a practicing ophthalmologist in Augusta, David Jones, M.D., a family physician who currently provides emergency medical services in Fort Kent, Gary Hatfield, M.D., an internist from Auburn, David Dumont, M.D., a family physician who serves as Director of the Emergency Department at Penobscot Valley Hospital in Lincoln, and George "Joe" Dreher, M.D., a psychiatrist practicing at the Maine Medical Center in Portland.  Cheryl Clukey of Augusta, a former public school administrator, serves as the other public member.

The Board meets the second Tuesday of each month at its offices in Augusta.  Randal C. Manning is the Board's Executive Director.  Mr. Manning also serves on the Board of the Federation of State Medical Boards.  MMA staff monitors the work of the BOLIM and regularly attends the public portions of the monthly meeting.

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Rx Requests May Rise Under New OTC Drug Rule for Flex Spending Accounts

One of the lesser known provisions of the Affordable Care Act (ACA) taking effect January 1, 2011 may lead more patients to ask physicians to prepare prescriptions for medication which is available over-the-counter.  The law imposes new restrictions on tax-exempt purchases of such medication which will impact holders of flexible spending accounts, health reimbursement accounts, and similar accounts, unless the purchase is supported by a prescription.  The law exempts insulin and does not apply to medical devices and other non-drug items, such as crutches, eyeglasses, and blood glucose test kits.

The most likely requests will involve medications to stop smoking and fight allergies and pain.  Another possible impact may be patients requesting prescription versions of over-the-counter analgesics and nonsteroidal anti-inflammatory drugs.

The provision in the ACA is expected to offset the cost of the health reform law by approximately $5 billion over ten years by lowering the tax exemptions for spending on drugs.  The new law also limits annual spending in flexible spending accounts to $2500 beginning in 2013, down from $5,000.

A coalition of organizations representing pharmacists, pharmacies, makers of over-the-counter medicines, and others is asking Congress to repeal the ban.  The Allergy and Asthma Foundation of America said it hopes Congress will consider amending the law to exempt allergy medications.  Up to 50 million Americans have allergies. [return to top]

Save the Date: MMA Webinar on Health Care Reform Opportunities, Jan 28th

MMA Webinar

What Health Care Reform Means for You and Your Patients

Friday, January 28, 2011

12 pm – 1 pm

  • Learn how the Affordable Care Act (ACA) impacts Maine patients and physicians
  • Learn about efforts to educate patients regarding coverage opportunities
  • Know where to refer you patients for more information
  • Receive handouts to provide your patients

For more information or to preregister, contact Jessa Barnard at 207-622-3374, ext. 211 or jbarnard@mainemed.com

This program is associated with a grant MMA has received from the Maine Health Access Foundation.  The purpose of the grant is to inform patients of coverage opportunities in the Affordable Care Act.  For more information about the grant and how it can help you inform your patients,  contact either Jessa Barnard or Gordon Smith (gsmith@mainemed.com). [return to top]

Medical Marijuana Law Effective January 1, 2011; Applications Increasing

The State Department of Health & Human Services has been receiving many applications leading up to the January 1st deadline under the state's medical marijuana law.  Now, the possession of marijuana under the previous (1999) is invalid.  As of December 31, 2010, DHHS had issued patient ID cards to approximately 300 Maine residents and an additional 100 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 60 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 www.mainemed.com.  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 gbegin@mainemed.com 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 gsmith@mainemed.com.

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CMS Releases New Crosswalk Information for ICD-10 Codeset

The Centers for Medicare & Medicaid Services (CMS) recently released an ICD-10 crosswalk codeset for 2011, intended to help the transition from ICD-9 to ICD-10 by the October 1, 2013 deadline.

The crosswalk allows practices to translate a code from ICD-9 into ICD-10 whenever possible. However, because of the increased number of codes in ICD-10, a full translation is not possible.

ICD-10, which stands for International Classification of Diseases, is a code set used for diagnosis classification that will supplant the existing ICD-9 code set, used for 30 years. All Health Insurance Portability and Accountability Act-covered transactions, including outpatient and inpatient claims, will be required to use ICD-10 codes by the 2013 deadline.

The 2011 ICD-10 crosswalk codesets are available at: https://www.cms.gov/ICD10/01_Overview.asp#TopOfPage [return to top]

Transition to New PMP Service Provider Imminent

The Maine Office of Substance Abuse (OSA) has announced that the Prescription Monitoring Program (PMP) web site will be changing hosts in early January.  The tentative date for the "cutover" between the current service provider, Goold Health Systems (GHS), and the new service provider, Health Information Designs (HID), is January 10, 2011.  The database is likely to be unavailable much of that day, and the downtime may be as much as 24 hours. 

The web address, http://www.maine.gov/pmp, will remain the same.  However, if you have added the current log in page to your "Favorites" menu, or if you have saved a shortcut on your computer desktop, you should change the URL under the "Properties" so that it points to http://www.maine.gov/pmp, rather than any URL containing "mainepmp.org."  The http://www.maine.gov/pmp URL is both the current and future web address for the online OSA/PMP database.  Please note that the the change of host will require a password reset when you log into website for the first time after the transition. 

Other technical issues may arise after the transition to the new web site.  Attempting to log on to the new site before you actually need it for clinical use is highly recommended.  In preparation for the transition, OSA recommends that you make any queries that you can anticipate needing prior to January 10, 2011 (especially Prescriber History reports).  You should also inform OSA of any recent change in your contact information so that they can provide you with the most up-to-date information related to the transition. 

The new service will be called RxSentry®. More details related to the transition to the new service provider, HID, will be forthcoming in the days and weeks ahead and will be posted on OSA's web site, http://www.maine.gov/dhhs/osa/data/pmp/news.htm.  If you have any questions regarding the upcoming changes to the PMP web site, please contact Daniel Eccher at the Office of Substance Abuse at 207-287-3363 or daniel.eccher@maine.gov [return to top]

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:  http://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage; 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 Maine Legislature Announces Committee Assignments

The presiding officers of the 125th Maine Legislature announced committee assignments just before the holidays.  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:  http://www.maine.gov/legis/house/jtcomlst.htm.     

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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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 medicare.gov.

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 (gsmith@mainemed.com or jbarnard@mainemed.com).


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CMS, ONC Announce January 3rd Registration For EHR Medicare Incentives

Eligible health care professionals and hospitals can register for the Medicare electronic health record incentive program beginning today, January 3rd, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology announced in late December.

 While some states also opened registration for their Medicaid EHR incentive program today, registration for Maine's Medicaid EHR incentive program will likely begin during the spring or summer of 2011, the agencies explained.  Eligible providers seeking to participate in the Medicaid program must still initiate registration at CMS's registration site but must complete the process through an eligibility verification site maintained by their state Medicaid agency.

 CMS and ONC encouraged broad participation and outlined online and in-person resources that are in place to assist eligible professionals and eligible hospitals who wish to participate. Registration and detailed information on the incentive programs are available online at: http://www.cms.gov/EHRIncentivePrograms/.   Hands-on assistance is available across the country through 62 Regional Extension Centers. The Regional Extension Center in Maine is HealthInfoNet: http://www.hinfonet.org/REC.html

 Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

 Professionals who meet the eligibility requirements for both the Medicare and Medicaid programs must select which program they wish to participate in when they register.  They cannot participate in both programs; however, after receiving payment, they may change their program selection once before 2015, CMS and ONC said.


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Maine Gastroenterology Society Winter Meeting March 4-6, 2011, Rangeley Inn, Rangeley Maine

Please contact Gail Begin to register at gbegin@mainemed.com or 207-622-3374 ext. 210


Friday, March 4:

6:00-7:30pm             Welcome Reception

Saturday, March 5:

7:30-8:00am             Continental breakfast

8:00-8:45am             Advances in Endoscopic Therapy for Barrett's Esophagus

8:45-9:00am             Coffee break

9:00-10:00                 Case Presentations

Adjourn for day's activities

5:00-5:45pm             Serologies in IBD--Any benefit?

6:00-6:45pm             Dinner reception

Sunday, March 6

7:30-8:00am              Continental breakfast

8:00-8:45am              New Therapies for Hepatitis C

8:45-9:30am              Health care reform: What it means for us  Gordon Smith, J.D., Maine Medical Association

9:30-9:45am              Coffee break

9:45-10:15am            Medical Malpractice  John Doyle, Medical Mutual Insurance Company of Maine

10:30-11:00am          Maine GI Society Business Meeting


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Topics in Gastroenterology Update 2011 - April 9, 2011, Harraseeket Inn, Freeport, Maine

Harraseekett Inn  April  9th, 2011

“Topics in Gastroenterology- Update for 2011”

Please contact Gail Begin for registration materials at gbegin@mainemed.com or 207-622-3374, ext. 210


Course co-directors:  Jay Bosco MD,  Gilbert Wilcox MD


7:30-8:00 Registration

8:00-8:15 Opening remarks Dr. Bosco

Session I- Esophagus- Moderator Dr. Erkinnen

8:15-8:45 Esophageal reflux- diagnosis, and management –Dr. John Erkinnen

8:45-9:15 Esophageal testing what’s new? –Dr. Chris Kleeman

9:15-9:45 Esophageal reflux complications and treatments – Dr. Bosco

9:45-10:00 Questions and Answers, panel discussion

10:00-10:15 Break, visit exhibits.

Session II-Pancreatic Cancer symposium-  Moderator Dr. Stefan

10:15-10:45 Coordinated statewide strategies for management in Maine,–Dr Rutstein

10:45-11:15- Chemotherapy in the era of neo-adjuvant treatment.- Dr. Hertler

11:15-11:45- Radiation therapy – what and when. Dr. McGinn

11:45-12:00 Questions and Answers, panel discussion

12:00-12:45 Lunch (provided)

State of the Art Lecture- “MGS distinguished Lectureship  Award”

12:45-1:30- Hemostasis in the 21st Century- Dr. Jensen

AGA interactive learning symposium- Moderator Dr. Wilcox

1:30-3:30 – Agenda to be determined, per Dr. Wilcox/AGA.

3:30- Adjourn Drs. Bosco and Wilcox [return to top]

Doug Jones Named Permanent CEO of Downeast Community Hospital

Following more than a year of service in an interim capacity, Doug Jones has been named the permanent CEO of the Downeast Community Hospital (DECH) in Machias.  Mr. Jones has previously served as CEO of Maine Coast Memorial Hospital in Ellsworth.  Mr. Jones is an experienced health care executive in Maine in whom the DECH board has great confidence to move the hospital forward following a period of receivership under the oversight of Eastern Maine Healthcare Systems.  The MMA leadership congratulates Mr. Jones on this permanent appointment. [return to top]

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