September 19, 2011

 
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L.D. 1501 Work Group to Survey Prescribers of Controlled Substances

The work group established by the legislature and charged with the task of reviewing options for improving Maine's efforts to reduce opioid abuse and diversion will hold its fourth meeting this coming Friday (Sept. 23) and review questions for a survey to be sent electronically to all prescribers of controlled substances.  The survey is intended to provide the work group with critical information concerning current practices in the state.

The survey is expected to take about 10 minutes for each prescriber to complete online.  Survey responses will be aggregated and no information identifying individual prescribers will be released. Survey questions will be in multiple choice format.  Results will be tabulated and results posted on the following website:  http:www.maine.gov/dhhs/osa/about/resolve1501.htm.

MMA will be encouraging physicians to complete the survey in hope that the data collected can be used to advocate against some of the more draconian approaches being considered in the effort to reduce prescription drug abuse and diversion.

 

Resolution Addressing Prescription Drug Abuse Passed at Annual Meeting

At the Association's Annual Meeting last week in Bar Harbor, members endorsed a resolution aimed at reducing the amount of prescription drug abuse and diversion in the state.  Introduced by the Executive Committee, the Resolution directs the Association to:

  • Continue its efforts to educate all prescribers concerning the tools available to identify diversion, including the Prescription Monitoring Program (PMP). 
  • Encourage all physicians who prescribe controlled substances for chronic pain to enroll in the PMP and access it when appropriate.
  • Encourage the Office of Substance Abuse to improve the interface and website portal for the PMP, to eliminate the requirement that applications be notorized, and to provide adequate staff to respond to inquiries about the PMP and educate potential users.
  • Continue to support programs and projects aimed addressing the problem of diversion, such as the Chronic Pain Project funded by the Board of Licensure in Medicine, and seek funding from additional sources for such programs.
  • Review the impact of amending Maine law to allow the public use of opioid antagonist agents (such as naloxone) in order to reduce the risk of death from accidental overdose in collaboration with other interested parties; and
  • Participate in efforts by the Maine Attorney General's Office, the Office of Substance Abuse, the Department of Public Safety and the U.S. Attorney's Office to address the problem of diversion and inform members and non-members of these efforts.

MMA offers confidential consultations at no cost to practices needing assistance with treatment of chronic pain patients and prevention of diversion.  To schedule a consultation, contact Gordon Smith, Esq., at gsmith@mainemed.com. [return to top]

Primary Care Practice Managers Needed as Volunteers for Focus Group, Sept 22nd in Bangor

As part of the Association's efforts to improve health coverage opportunities for patients, MMA is conducting a series of focus groups with practice managers of primary care practices.  The intent is to learn about how MMA can be more effective in assisting practices with finding better coverage and increased benefits for patients. Certain messages will be tested to see if the practice managers think that patients will react favorably and take action on them. The effort is funded through a grant from the Maine Health Access Foundation (MeHAF).  A successful session was held in Portland in August. 

Thursday, September 22, 2011 ~ 12:30 pm - 2:30 pm 

Hilton Garden Inn, Bangor, Maine

Eight to ten individuals are needed

Lunch and $100 gift card provided to each participant. 

The focus groups will be conducted professionally by Sam Surprise of Surprise Advertising, a MMA Corporate Affiliate.

If you or a colleague are interested in participating, please contact Jessa Barnard at jbarnard@mainemed.com or 207-622-3374 x 211.  

 
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Obama Proposes $320 Billion in Medicare & Medicaid Cuts

President Obama announced today a proposal to reduce Medicare spending $248 billion over 10 years and Medicaid spending $72 billion over the same time period as part of a $3.2 trillion deficit reduction package that did not include raising Medicare's eligibility age.

In a White House speech, the president also said he would veto any deficit reduction plan produced by Congress that included Medicare cuts but not tax increases on wealthy Americans and corporations. The proposal was submitted to the congressional Joint Select Committee on Deficit Reduction, which is hoping to reach agreement on a $1.5 trillion deficit reduction plan this fall.

The savings would be achieved through a number of mechanisms, including:

  • Changes for beneficiaries such as requiring prior authorizations for advanced imaging and Medicare Part B premium surcharges 
  • Reducing bad debt payments to providers
  • Reducing graduate medical education payments
  • Changing Medicare payments to rural providers 
  • Strengthening the Independent Payment Advisory Board (IPAB)
  • Changing post-acute care payments to skilled nursing facilities, long-term care hospitals, rehabilitation facilities and home health 
  • Targeting fraud, waste and abuse in Medicaid 
  • Limiting provider taxes
  • Accelerating State innovation waivers and 
  • Prioritizing prevention and public health fund investments 

The White House fact sheet is available at http://op.bna.com/hl.nsf/r?Open=bbrk-8lul7s. The full plan is available at http://op.bna.com/hl.nsf/r?Open=bbrk-8lul9w.

 
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ACA Exchange Advisory Council Holds Final Meeting

At its final meeting September 14th, the Governor-appointed Accountable Care Act (ACA) Exchange Advisory Council decided to house Maine’s insurance exchange at the Department of Professional and Financial Regulation.

The Council was created to craft legislation to establish the Insurance Exchange required by the Federal Affordable Care Act (ACA).  The legislation will be considered by the Legislature in 2012.

Most issues had been decided before last week's meeting; the significant remaining issue was the governance structure for the Exchange.  The Council finally settled on a governance structure that will be similar to that of the Bureau of Liquor and Lottery Operations. 

The Council had long-since decided that the Exchange should be housed within the Department of Professional and Financial Regulation (PFR).  The Bureau of Insurance is within PFR and it made sense to keep the new Exchange closely aligned with the Bureau of Insurance.

The Council also felt that an oversight board (of some kind) should exist to help guide the Exchange.  The debate had been whether that board should be advisory and provide input but have no real power, or a true governing board with actual power.

The decision was to recommend a hybrid structure using the term “commission” rather than “board” along the lines of the Bureau of Liquor and Lottery Operations which has a five-member commission.  The hallmark of this model is that major policy issues are delegated to the Commission (which would be appointed by the Governor subject to legislative confirmation) but administrative and operational issues are delegated to a Bureau Director (also appointed by the Governor subject to legislative confirmation).

The Council felt it did not have time to specifically list which Exchange issues constitute “major policy” matters more appropriately delegated to the Commission.  But, it is anticipated that issues such as whether to merge the individual and small group insurance markets (which is permitted but not required under the ACA) are the kind of major policy issue to be left to the Commission.

The latest drafts of the legislation and report are available here.  The Legislature’s Insurance and Financial Services Committee will receive an in-person presentation on the report when it meets on September 26th, the day before the Legislature’s one-day special session.

As a reminder, the Dirigo Health Agency has created a Web page where all relevant documents are posted. 

** Thank you to the Maine Hospital Association and MHA Vice President of Government Affairs and Communications, Jeffrey Austin, for allowing us to reprint this article **  [return to top]

Certificate of Need Stakeholder Group Holds First Meeting Today

The Certificate of Need Stakeholder Group, established in P.L. 2011 Chapter 424, met for the first time this morning at the DHHS Offices for Licensing and Regulatory Services in Augusta.  The new law required the Department of Health and Human Services to review ways to improve the Certificate of Need process and its accompanying rules.  The law also required that a stakeholder group, including MMA, be convened in accordance with the provisions of the statute.

Specifically, Sec. C-2 of the new law required the Department to convene the stakeholder group no later than October 15, 2011 to review ways to improve the CON process.  The department was required to include representatives from MMA, the Maine Hospital Association, the Maine Health Care Association, private attorneys experienced in CON law and practice, long-term care providers of services to the elderly and a physician owned multi-specialty medical practice based in Portland. 

Today's meeting was convened by Catherine Cobb, Director of the Division of Licensing and Regulatory Services.  Meeting for two hours this morning, the group did not accomplish much other than to review the current Chapter 10 of the Maine CON Procedure Manual which contains the current Principles Governing Reviews.  The Group is expected to review the processes associated with the law, rather than to re-hash the scope of CON which was changed significantly in the last Session of the legislature through the provisions in Chapter 424.

The group expects to hold two or three more meetings prior to making any recommendations to the legislature.  The dates of future meetings have not yet been set.  MMA's EVP Gordon Smith is MMA's representative on the Group. The multi-specialty practice is represented by Spectrum Medical Group.  Any questions from members or practice staff about the scope of this work or what is expected to emerge from it should be directed to attorney Smith at gsmith@mainemed.com. [return to top]

Martin's Point Announces New Health Insurance Program

Martin's Point Health Care and the Maine Wellness Association announce the creation of MaineSense, a new health insurance program, owned by employers.  According to their press release, the new product will engage providers, employers, patients, and members, and utilize technology to make meaningful changes to the health care system. The program, which was created in close partnership between the Maine Wellness Association and Martin’s Point, focuses on promoting good health outcomes, creating a better health care experience, and lowering overall costs.

MaineSense will accomplish this in part by making the health care system easier to navigate. The program focuses on prevention by providing incentives to members for taking care of their own health and by paying providers for high-quality care and health outcomes. These efforts help reduce the rate of increase in health insurance premiums and help fundamentally change the way health care is delivered and funded.

MaineSense aims to reinforce and incent greater accountability and positive behavior changes from providers, members, and employers that will play a role in transforming care and its costs.

Understanding the True Costs of Care

Currently in health care, most patients and members, and even providers to a certain extent, have no idea what the true costs of care are.  Many are also unaware that there is an extremely wide range of variation in costs for the same tests depending on where you go. A big part of MaineSense is access to transparent information, that is readily available and easily accessible, that will help members and providers make informed choices and will help to keep costs of tests and procedures competitive and manageable.

New Primary Care Physician Compensation Model

Under MaineSense, providers are paid for the quality of care they deliver, the health outcomes of their patients, and the patient satisfaction scores they receive. These incentive payments are combined with a partial capitation and fee-for-service model in a payment structure that gives providers the potential to earn significantly more than they have in the past. But they will receive these additional payments only if they meet the program’s high quality standards and keep their patient populations healthy.

Creating a Culture of Wellness

As part of MaineSense, employers also become active participants promoting the health and well-being of their employees. Employers  are expected to promote a “culture of wellness” within their organization, which includes forming employee health committees, actively communicating with employees about the importance of health and wellness, requiring all employees to have a Primary Care Provider (PCP), and to complete a Personal Health Assessment (PHA)including biometrics and a follow up call with a health coach.

The MaineSense program launched with Hutchins Trucking/Atlantic Great Dane on August 1, 2011. It will gradually ramp up to over 30 employers across Maine by January 2012. To participate in MaineSense, employers must first become part of the the Maine Wellness Association (MWA), a group of over 100 leading Maine based employers who work together to improve the health care delivery system based on the principles of Triple Aim: improving the patient experience, improving health outcomes, and lowering the costs of care.


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Workers' Compensation Board Holds Public Hearing on Medical Fee Schedule Rule

The Maine Workers' Compensation Board held a public hearing this morning in Augusta on a revision to its Rule Chapter 5:  Medical Fees; Reimbursement Level; Reporting, a matter that has been in debate before the Board and subject to litigation for more than 5 years.  The MMA, MEMIC, the Maine AFL-CIO, and the physical therapists' association all spoke in favor of the proposed revisions.  The proposal updates the fee schedule to the current Medicare RBRVS and CPT, and retains the $60 conversion factor for professional fees.  The proposal also establishes a facility fee schedule that largely reflects the methodology developed by the Board's consultant, Eric Anderson with Ingenix, that was the subject of 2009 rulemaking before the Board that was never completed.  In this proposal, the Board includes a provision for payment of up to $30 for each 10 minutes spent by a practitioner in preparing a narrative report or an M-1.  At the hearing this morning, MEMIC acknowledged that the practitioner should be compensated for completing the M-1, but argued that the proposed amount is too high.  

The MMA seeks your feedback on this rule and will be submitting further written comments before the comment deadline on September 29th.  

You can find the complete rulemaking documents on the Workers' Compensation Board web site at:  http://maine.gov/wcb/rules/proposed.htm.

If you have furtther questions or comments about the WCB medical fee schedule, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

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New HIV Testing Law Effective September 28th

The MeCDC is reminding clinicians that 5 MRSA §19203-A, Maine's HIV testing and consent law, was amended this past legislative session to include a sixth subsection on the “protection of newborn infants,” which goes into effect on September 28th. 

The amended section of the law requires health care providers caring for pregnant women to include HIV tests in the standard set of medical tests performed, subject to the consent and procedure requirements of 5 MRSA §19203-A, sub-§ 1.  That sections requires that a patient must be informed orally or in writing that an HIV test will be performed, unless the patient declines.

Under the new law, health care providers caring for newborn infants are also required to test the infant for HIV and ensure that the results are available within 12 hours of birth if the health care provider does not know the HIV status of the mother or the health care provider believes that HIV testing is medically necessary.  There is an exception if a parent objects to the test on the grounds that it conflicts with the sincere religious or conscientious beliefs and practices of the parent.  The full text of the new law is available here: http://www.mainelegislature.org/legis/bills/bills_125th/chappdfs/PUBLIC229.pdf 

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MaineCare Tobacco Treatment Benefits Reminder

MaineCare - Working With You To Stop Tobacco Use

While overall smoking rates in Maine have been on the decline, certain subpopulations continue to smoke at rates that far exceed state and national averages.  According to 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey data, 41.4% of MaineCare members smoke; a rate that is more than double that of the general adult population (17.2%). 

In an effort to reduce tobacco use by MaineCare members, the Office of MaineCare Services and Partnership For A Tobacco Free Maine continue to collaborate to increase access to tobacco treatment options, including pharmacotherapy and counseling services.  MaineCare’s tobacco treatment benefit is both comprehensive and affordable for MaineCare members, and providers are strongly encouraged to participate in efforts to help patients end their addiction to tobacco.

MaineCare allows reimbursement to providers who screen for tobacco use.  MaineCare also pays for  preventive and intensive counseling services to patients who use tobacco.  Codes 99401, 99402, 99403, 99406, and 99407 can be used to bill for counseling services provided through your practice, with limits of up to three session per member, per calendar year.  In addition, patients can be referred to the Maine Tobacco HelpLine at no cost where they can  receive counseling treatment from certified tobacco treatment specialists.  MaineCare sent out a mailing to primary care providers last spring which included fax referral forms to the help line.  The fax referral form can be used when your patient has given permission for the tobacco helpline to reach out to them by telephone to provide tobacco treatment counseling and support.

Tobacco addiction places an extreme burden on MaineCare members, and the State of Maine as a whole.  Each year, tobacco use costs the MaineCare system more than $216 million  due to treating the chronic conditions that result from long-term tobacco use.  By working with your patients and providing support and motivation to quit, you can help MaineCare members live longer, healthier, more productive lives while saving millions of dollars in the process. 

MaineCare thanks you for your participation in this effort. 

Below is a list of services for which MaineCare reimbursement is available.  Do not hesitate to contact the Office of MaineCare Services, Health Care Management for fax referral forms or if you need more information by calling Valoree Berlan at (207) 287-4827.

MaineCare Tobacco Cessation Coverage:

NRT Gum (P)

Limit: up to three (3) months duration per year.  May be used in combination or with bupropoin tablets for cessation.

Varenicline- chantix (P)

Covered with Prior Authorization

NRT Patch (P)

-Limit: up to three (3) months duration per year.  May be used in combination or with bupropoin tablets for cessation.

Bupropoin (P)

Bupropoin SR 100 and 150mg instead, which is the generic form of Zyban.

NRT Nasal Spray

Covered with Prior Authorization, if gum and patch tried and failed, or if presence of a condition that prevents usage of preferred drug or interaction with another drug and preferred drug exist.

Tobacco Screening

Covered when provided in a physician’s office

NRT Inhaler

Covered with Prior Authorization, if gum and patch tried and failed or if presence of a condition that prevents usage of preferred drug or interaction with another drug and preferred drug exist.

Individual Counseling

Members are covered for three (3) individual counseling appointments per year

NRT Lozenge

Covered for members not able to tolerate the patch or gum. May be used in combination or with bupropoin tablets for cessation.

Group Counseling

(not covered)

All tobacco cessation products require a visit and prescription from the member’s primary care provider, as well as a $3.00 member co-pay. Individual tobacco counseling is a reimbursable measure on the incentive payment for private physicians. 


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Upcoming Events & Conferences

Fall is conference season!  Take advantage of the many upcoming learning opportunities, including: 

 

Maine Medical Group Management Association Half Day Educational Session

Tuesday, September 27, 2011 ~ 8:00 a.m. to 12:00 p.m.

Maine Medical Association, 30 Association Drive, Manchester, Maine 

Trends in Prescription Drug Diversion by DEA agent Tony Milligan &

The Healing Power of Humor by Maine Humorist Gary Crocker

For questions or registration, please contact Karen Wheeler at (207) 873-6173 or by email: kwheeler@mmimvw.com

 

8th Annual International Symposium on Safe Medicine

The world’s oldest continuous drug disposal conference and Maine’s oldest prescription drug abuse conference

Sunday-Tuesday, October 2-4, 2011

Holiday Inn by the Bay Hotel and Conference Center, Portland, Maine

Registration information available at: 
http://benzos.une.edu/2011conference.htm

 

Chemicals, Obesity & Diabetes: How Science Leads Us to Action 

Friday, October 14, 2011 ~ 8:30 a.m. - 6 p.m. 

Colby College, Waterville, Maine 

Keynote Speaker: Bruce Blumberg, PhD, University of California-Irvine, Department of Developmental and Cell Biology 

The Environmental Health Strategy Center (EHSC) and the Goldfarb Center at Colby College are bringing together national and state scientific and public health scholars, practitioners, and advocates, as well as national and state policy-makers, faculty and students, to explore the environmental links to obesity.

Click here for a full agenda; Registration available here

 

The American Lung Association in Maine: 2011 Annual Meeting Awards Ceremony & Luncheon

The Clean Air Act -  40 Years Protecting Public Health

Friday, October 14, 2011 ~ 11:00 a.m. to 2:00 p.m.

Sable Oaks Marriott, South Portland, Maine

Keynote: Curt Spalding, Administrator, New England (Region I), US Environmental Protection Agency

Registration information available here.

 

Maine Public Health Association Pre-Conference Reception 

Perspectives From the Front Line: Top Public Health Achievements in the 21st Century

Monday, October 17, 2011 ~ 5:30 p.m. - 7:00 p.m. 

Peter A. McKernan Hospitality Center, Southern Maine Community College, 2 Fort Road, South Portland

An opportunity for public health and primary care professionals in Maine to hear from a panel comprised of national and local experts on the importance and successes of partnerships between public health and primary care. 

Registration information available here

 

Maine Public Health Association 27th Annual Conference

Facing Public Health Challenges Today for a Healthier Tomorrow 

Tuesday, October 18, 2011 ~ 8:45 a.m - 3:45 p.m. 

MaineHealth, 110 Free Street, Portland, Maine 

Keynote: Dr. Georges Benjamin, Executive Director, American Public Health Association 

Registration information available here

 

2011 Infectious Disease Conference 

Tuesday, November 15, 2011 ~ 8:30 a.m. - 4:00 p.m. 

Augusta Civic Center, Augusta, Maine 

Since 1983, the Maine Center for Disease Control and Prevention, Division of Infectious Disease, Department of Health and Human Services has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the State.

For more information, or to register, click here


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MMA Seeks Academic Detailer

SEEKING CONTRACT ACADEMIC DETAILER

Job Description:

The Maine Medical Association, on behalf of the Maine Independent Clinical Information Service (MICIS), is seeking a clinical health professional to serve in the role of a contract “academic detailer.”  Academic detailing entails offering independent, scientific evidence on prescription drugs at the request of prescribers working in primary care.

The part-time contract academic detailer will conduct face-to-face educational outreach visits to discuss the current evidence on best clinical prescribing practices.  The candidate will be available to do one-on-one consultations with prescribers and group teaching sessions in practices, hospitals and at conferences, per request, across the state.

Hours required will vary from month to month, based on demand, and may range anywhere from 5 to 35 hours a month. Flexibility is required.

Training:

Candidates must be available to attend a two-day training session on the principles and techniques of academic detailing, including small-group sessions with current academic detailers and videotaped detailing sessions with practicing physicians.

Location: Boston                  Date: November 7 and 8

Additional trainings on specific clinical topics to be detailed will take place in Maine or Boston periodically, dates to be determined.

Requirements:

Clinical background: MD, PA-C, RN, CNP, or PharmD or similar.

Two or more years of clinical experience.

Therapeutic competency.

Strong interpersonal skills including service-orientation.

Excellent presentation and public speaking skills.

Ability to travel throughout state as well as to occasional overnight trainings in Boston.

Ability to attend monthly work group meeting in Manchester (mornings) and quarterly advisory committee meetings in Augusta (evenings).

Pay:

The contractor will be paid on an hourly basis commensurate with the candidate’s background and skills.

Contact:

Please send cover letter and resume by September 30th to Jennifer Reck, MA, MICIS Program Manager, at jreck@mainemed.com. [return to top]

NNEPC Bath Salts Webinar Available

The Northern New England Poison Center (NNEPC) is offering recorded webinar presentations regarding the new synthetic drugs known as “bath salts.”

The webinar is a slide and audio presentation recroded by Dr. Karen Simone, NNEPC Director, and Dr. Tamas Peredy, NNEPC Medical Director.  The presentation is available for viewing at any time.  It can be accessed through our website, www.nnepc.org, or directly at http://www.surveymonkey.com/s/Bath_Salts.  

The presentation is given in two parts.  The first is a general overview of bath salts appropriate for all audiences.  The second is aimed at health care professionals and gives information related to treating bath salts patients.

NNEPC is currently able to offer continuing education credits for Maine and New Hampshire EMS personnel for the bath salts recorded webinar.  They expect to be able to offer other types of continuing education credits in the near future.

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