October 11, 2011

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Survey for Prescribers of Controlled Substances - Urgent Need for Your Feedback by 10/14

It is critically important that all prescribers of controlled substances in the state take the ten minutes required to complete the survey monkey instrument from the link below.  Please complete by October 14th if possible but survey responses will continue to be collected beyond that date.

This survey is being offered by a task force created by the Maine Legislature which is reviewing options for improving the prevention of opioid abuse and diversion in Maine.  The task force would greatly appreciate the completion of the survey by all Maine prescribers of controlled substances.

The task force has been organized by the Maine Substance Abuse Services Commission and has a number of physician participants including Drs. Mark Publicker, Steve Hull, Kevin Flanigan, Scott Davis, Linda Sanborn and Steve Gressitt.  Representatives of nurse practitioners and physician assistants also attend the meetings, as does MMA EVP Gordon Smith, Esq.  The task force held its fourth meeting last Friday and will meet again on October 21st.

The survey should take 10 minutes to complete online using the Survey Monkey tool.  Survey responses will be aggregated and do not ask for individually identifying information.  Survey responses are in multiple choice format and you should select one response per question unless otherwise noted.

Please complete this survey at your earliest convenience (but no later than October 14th).  Thank you for your participation.

Please click this link for the survey: http://www.surveymonkey.com/s/D5NYYGR

A bill was reviewed by the Maine Legislature in 2011 that would have further regulated the prescription of opioids for patients experiencing chronic, non-cancer pain.  The Legislature chose not to enact the bill but did create a stakeholder group to review the issue and make recommendations for changes.  This survey is designed to help that group. 

For those of you who are concerned with legislative changes that would impact the manner by which you conduct your practice we cannot over-stress the importance of completing this survey.   Participation in this survey is a good chance for you to help influence the legislative process.

Responses will be tabulated and results will be posted on the following website:  http://www.maine.gov/dhhs/osa/about/resolve1501.htm

Report on MMA Board of Directors Meeting Last Wednesday (Oct. 5)

The Maine Medical Association Board of Directors held its first meeting pursuant to the recently enacted changes to the MMA Constitution and Bylaws last Wednesday at the Frank O. Stred Building in Manchester.  The Board, which is expected to include between twenty-five and thirty members once the new Nominations Committee completes its work, is chaired by Kenneth Christian, M.D. of Holden. 

The Board took the following actions:

  • Supported the Maine Hospital Association in requesting that Maine Quality Partners withdraw its protest of CMS action awarding the three year QIO contract to the Northeast Health Care Quality Foundation.
  • Supported the request for federal financial support for a Consumer Oriented Health Plan (Co-op) authorized under the provisions of the Affordable Care Act.
  • Elected two at-large members of the Executive Committee:  Lisa Ryan, D.O. and Challa Reddy, M.D. Dr. Ryan practices pediatrics in Bridgton and Dr. Reddy is a family physician with an office in Dexter.
  • Elected a new alternate delegate to the American Medical Association:  Charles Pattavina, M.D. of Winterport.

The Board meets again on Wednesday, December 7th at 4:00pm.  Board meetings are open to any MMA member. [return to top]

Final 2011 First Friday Programs (Nov. 4, Dec. 2) Focus on Minors and Superving Mid-level Providers

MMA concludes its 2011 educational programs with two popular topics.  On Friday morning, November 4th, health lawyers and practicing pediatricians will present a three-hour CME program on medical legal issues in a pediatric practice.  The program will be of particular interest to pediatric practices and family physicians.  The program will run from 9:00am to noon and will be available live in Manchester or via webex.  The cost is $65 per person. 

On Friday morning, December 2nd, health lawyers, regulators and practicing physicians and physician assistants will discuss the requirements of supervising mid-level providers.  Standards of practice will be addressed from the point of view of risk management, state regulations and payor considerations.  This three hour program will also be available live and via webex.  The cost is $65 per person and the program will run from 9:00am to noon.

Watch your e-mail later this month for a flyer with a full agenda and faculty for each program.

Any questions about these two programs should be addressed to Gail Begin at MMA.  Gail can be reached at 622-3374 et. 210 or via e-mail to gbegin@mainemed.com.  
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MMA 2012 Dues Statements Going in the Mail this Week

Maine Medical Association dues statements for 2012 will be mailed this week.  There is no increase in the dues which remains $480 for an active member.  There are a number of discounts available.  Dues can be paid by check or credit card.

Dues can also be paid on the MMA website at www.mainemed.com.

Members are also encouraged to voluntarily donate $25.00 to the Maine Medical Education Trust.  

Any questions about the dues can be directed to Lisa Martin, Membership Coordinator.  Lisa can be contacted at 622-3374 ext. 221 or via e-mail to lmartin@mainemed.com.  

 We appreciate your membership! 
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MMA Health Care Reform Webinars: The Medicare Wellness Visit & ACA Updates (Begin Oct. 21)

The MMA is pleased to announce a series of webinars covering health care reform updates. 

The Medicare Wellness Visit

What practices need to know about billing and coding for the new Medicare Wellness visit.  Make sure your office is taking advantage of the opportunity to bill for this new service. 

October 21st, 12-1 pm 


December 16th, 12-1 pm 

Speaker: Laurie A. Desjardins, CPC, PCS

Laurie joined Baker Newman Noyes in 2006. She is a Senior Manager in the Healthcare Management Consulting Division specializing in revenue management including physician coding, provider based implementation, chargemaster analysis, fee schedule analysis, chart review, and coding and billing education.


The Affordable Care Act and Maine's New Health Insurance Law (Chapter 90) 

Hear from MMA staff attorneys about important updates impacting Maine patients and physician practices from the national Affordable Care Act and Chapter 90, Maine's new health insurance law. 

November 1st, 12-1 pm 


November 18th, 12-1 pm 

For more information or to register for any of the sessions, contact Jessa Barnard, MMA Associate General Counsel, at jbarnard@mainemed.com or  207-622-3374 x 211 

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Wendell Potter Visit Highlights Heath Care for Maine Alliance Conference

Health insurance industry whistle-blower Wendell Potter keynoted a conference in Hallowell last Wednesday organized by Health Care for Maine, an advocacy organization in which the MMA participates along with the AARP, the American Cancer Society and several other organizations.  The purpose of the Alliance is to advocate for improved health insurance coverage for all Mainers.  

Potter told attendees that the federal Affordable Care Act is an important step in the right direction and that its supporters must be well-informed and speak with one voice in defending it against powerful groups that seek to overturn it or undo its key provisions.  Potter noted a number of the ACA provisions that are already "making improvements in the lives of Americans."  He noted, for example, ACA provisions prohibiting insurers from refusing to cover children with pre-exisitng medical conditions, allowing young adults to stay on their parents policies until age 26 and improvements in the so-called "donut hole" provisions of the Medicare Part D prescription drug law.

In 2007, Potter left Cigna after having what he now considers "an epiphany" about misguided focus of the health plans on short term profits.  Since leaving the industry, he has been in demand as a speaker and has written a book titled Deadly Spin.

In his presentation, Potter also stated that he believed that the health plans supported the Affordable Care Act because they wanted the millions of new customers that would come as a result of the individual mandate but that they were also working actively to weaken several consumer-related provisions in the law, including the requirement for mandated loss ratios which require the companies to pay out at least 80% of revenue for health care expenses.     
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Medicare eRx Payment Adjustment - November 1, 2011 Deadline Approaching

Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment byreviewing the MLN Article SE1107 .   If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule.  A Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program.  As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit  a significant hardship exemption request and rationale.  Individual eligible professionals must submit their hardship exemption requests through the  Quality Communications Support Page and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS.  

Additional information and resources are available at www.cms.gov/erxincentive

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New Affordable Care Act Initiative to Strengthen Primary Care - Conference Call Oct. 13

Last Wednesday, the U.S. Department of Health and Human Services (HHS) launched a new initiative made possible by the Affordable Care Act to help primary care practices deliver higher quality, more coordinated and patient-centered care. Under the new initiative, Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for their patients. This collaboration, known as the Comprehensive Primary Care initiative, is modeled after innovative practices developed by large employers and leading private health insurers in the private sector.

“Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our health care dollars more wisely,” said HHS Secretary Kathleen Sebelius.

The voluntary initiative will begin as a demonstration project available in five to seven health care markets across the country. Public and private health care payers interested in applying to participate in the Comprehensive Primary Care Initiative must submit a Letter of Intent by November 15, 2011. In the selected markets, Medicare and its partners will enroll interested primary care providers into the initiative.

Primary care practices that choose to participate in this initiative will be given support to better coordinate primary care for their Medicare patients.
This support will help doctors: 

  • Help patients with serious or chronic diseases follow personalized care plans; 

  • Give patients 24-hour access to care and health information; 

  • Deliver preventive care; 

  • Engage patients and their families in their own care; 

  • Work together with other doctors, including specialists, to provide better coordinated care. 

CMS will pay primary care practices a monthly fee for these activities in addition to the usual Medicare fees that these practices would receive for delivering Medicare covered services. This collaborative approach has the potential to strengthen the primary care system for all Americans and reduce health care costs by using resources more wisely and preventing disease before it happens.

To hear an in-depth overview of the initiative and an opportunity to ask questions, there will a conference call on Thursday, October 13th with CMS Innovation staff, including Director of the Seamless Care Models Group, Dr. Richard Baron. 

What: Open Door Forum on the new Comprehensive Primary Care Initiative 

When: Thursday, October 13, 2011 at 1:00 p.m. ET

Dial in: 1-800-837-1935 (Conference ID 17242137) 

For more information, please see the Comprehensive Primary Care initiative web site at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/cpci/

For an overview fact sheet about the Comprehensive Primary Care initiative, visit: http://www.healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html

Interested parties may obtain answers to specific questions by e-mailing CMS at: CPCi@cms.hhs.gov
For more information about the CMS Innovation Center, please visit: http://www.innovations.cms.gov.
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MaineCare Announces Accountable Communities ACO Initiative

In a presentation October 7th, MaineCare Services updated stakeholders on the current administration's plans for improving quality and reducing the cost of care.  In place of managed care, MaineCare is pursuing a Value Based Purchasing strategy that includes three components: 

  1. An emergency department care management collaborative.  This project provides team-based care management to MaineCare's highest emergency department users.  MaineCare has successfully piloted this program with MaineGeneral and met with all hospitals to discuss the model this summer.  

  2. The Accountable Communities Program.  Based on the Accountable Care Organization (ACO) model created by the federal Affordable Care Act, MaineCare seeks to contract with provider groups with tiered levels of risk-sharing agreements.  MaineCare expects that the ACOs will be provider-owned and driven, structured with strong consumer input and local governance, and have shared accountability for both cost and quality.  In order to attract applicants, MaineCare plans to offer multiple "tiers" of risk and reward sharing.  Qualified providers will be determined through an RFP process.  The methodologies for payment (such as fee for service, capitated rates or bundled payments) and attributing patients to the ACO, along with other details, are still to be determined through more input from stakeholders.  MaineCare plans to issue a Request for Information seeking feedback later this month, hold a public forum in November and issue the RFP in January 2012. 

  3. Leveraging opportunities such as patient centered medical homes, health homes and reformed primary care provider incentive payments.

For more information, including a slide presentation on the Value Based Purchasing plan, see: http://www.maine.gov/dhhs/oms/mgd_care/mgd_care_index.html 

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CMS Adopts Medicine's Recommendations in Medicaid RAC Program

The Centers for Medicare & Medicaid Services (CMS) recently released the Medicaid Recovery Audit Contractor (RAC) final rule.  In January, the AMA and 80 state and specialty societies submitted comments to CMS on the Medicaid RAC proposed rule and, while the AMA is currently analyzing the final regulation, an initial review reveals that many of medicine's specific recommendations were accepted.  These include:  1) a 3-year maximum claims look-back period, 2) RACs are required to employ a full-time physician medical director, 3) states must set limits on the number and frequency of medical record requests, 4) RACs must hire certified coders, 5) RACs must provide outreach and notify providers of audit policies and protocols, 6) RACs must accept submission of electronic medical records by fax or CD/DVD, 7) RACs cannot audit claims that have already been audited or are currently being audited by another entity, 8) RACs must return the contingency fee if an overpayment determination is reversed at any level of appeal, 9) states must adequately incentivize the identification of underpayments, and 10) states must coordinate the efforts of the RACs with other auditing entities.  The final rule sets an implementation deadline of January 1, 2012. [return to top]

Essential Benefits Should Be Based on Typical Small Group Offerings, IOM Says

The principal intent of the federal Patient Protection and Affordable Care Act (ACA) is to enable previously uninsured Americans to obtain health insurance. To accomplish this, in part, subsidized plans will be offered to low- and moderate-income individuals and small employers through health insurance exchanges. Plans qualified to be offered through exchanges must at minimum include “essential health benefits” (EHB). The ACA is not very specific on thedefinition of EHB, except that such benefits shall include at least ten enumerated general categories and that the scope of the EHB shall be equal to the scope of benefits provided under a typical employer plan. The ACA requires the Secretary of the Department of Health and HumanServices to define the essential health benefits.

The Institute of Medicine (IOM) was asked by the Secretary to make recommendations on the methods for determining and updating the essential health benefits. Notably, the request was to focus on criteria and policy foundations for the determination of the EHB, not to develop the list of benefits. To address the request, the IOM formed a committee of volunteers with varied perspectives and professional backgrounds.  

Last Friday, the committee released its findings. It concluded that it was best to begin simply by defining the EHB package as reflecting the scope and design of packages offered by small employers today, modified to include the ten required categories. This package would then be assessed by criteria and a defined cost target recommended by the committee. The committee considered how four policy domains—economics, ethics, population-based heath, and evidence-based practice—could guide the Secretary in determining the EHB package in general. From these policy foundations, the committee developed criteria to guide the aggregate EHB package; criteria to guide specific EHB inclusions and exclusions; and criteria to guide methods for defining and updating the EHB.

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Upcoming Events & Conferences

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


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 Maine Medical Education Trust designates this activity for a maximum of 5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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


Spotlight on Coding and Compliance with National Speaker Margie Vaught!

MaineGeneral Medical Center 2011 Fall Coding & Compliance Conference

Friday, November 4, 2011 ~ 8 a.m. to 4 p.m.

Augusta Civic Center, North Wing, Augusta/Capital/PIne Tree Room

Starring Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR


$125 (includes breakfast, lunch, & breaks); registration deadline is October 24th.

For more information:  Lisa Beeckel, CPC, Physician Liaison; lisa.beeckel@mainegeneral.org; 626-1094.

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