October 24, 2011

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L.D. 1501 Work Group Continues Work to Address Prescription Drug Abuse

The Work Group established by legislative action on L.D. 1501 met again on Friday (Oct. 21) to consider recommendations to be included in its report back to the Legislature in December.  The Work Group was formed under the auspices of the Substance Abuse Services Commission and has met six times with two additional meetings scheduled for Nov. 18 and Dec. 2.  Three sub-groups have been formed which will bring draft reports to the next meeting.  The work of the Group took on added significance with the publication this past week of a week-long series of articles in the Portland Press Herald highlighting the State's experience with prescription drug abuse.

The three subgroups have the following tasks:

Subgroup - Task 1 & 2 - Review of current efforts in the State aimed at preventing addiction and diversion; examination of similar efforts in other states.

Subgroup -Task 3- Consideration of additional tools that could lead to decreased abuse while not unduly restricting access to adequate pain control.

Subgroup - Task 4 - Consideration of enhancements to the Controlled Substances Prescription Monitoring Program established in the Maine Revised Statutes, Title 22, section 7248.

Physicians attending Friday's meeting included Steven Hull, M.D., from Mercy Hospital, Kevin Flanigan, M.D., Medical Director of MaineCare, Scott Davis, M.D. of Penobscot Community Health Center and Mark Cooper, M.D., Medical Director for the Board of Medicine.  MMA EVP Gordon Smith also sits on the work group.

The work of the Group took on more significance this past week with the publication by the Portland Press Herald and its related daily papers of the six-part series by veteran staff reporter John Richardson entitled, Pain-killers in Maine; A cure with a curse.  Anyone who missed the series can review all of the articles online at www.pressherald.com

MMA to Respond to Editorial Calling for Prosecution of Physicians Not Participating in Prescription Monitoring Program

MMA will respond aggressively this week to the recommendation in an editorial in the Portland Press Herald on Friday (Oct. 21) calling for the criminal prosecution of physicians who don't check the Prescription Monitoring Program database prior to prescribing controlled substances for chronic pain.  Specifically, the editorial stated;

If there are doctors who won't slow the supply on their own, their cooperation should be required.  Doctors who don't check the database or who hide patients who are diverting medication should be treated as lawbreakers, just like the dealers who distribute these pills. 

While the editorial goes on to state that the problem of prescription drug abuse is not just a problem for physicians but is, indeed, a societal problem that will require a team effort to fix, the language above is damaging and shows a profound lack of understanding of the obligations of physicians relative to treating pain and preserving patient confidentiality, and further demonstrates a lack of knowledge of the limitations of the PMP database and the problems associated with its use.

While the PMP is a very valuable tool in the fight to prevent diversion, its modest staffing, its difficult interface and its limitations regarding methadone clinics and the VA must all be fixed before any type of mandatory use could be considered.  At this point, continuing education of all prescribers and patients regarding the risks and benefits of all treatment modalities should be increased rather than taking steps that could discourage health professionals from treating pain.
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Final 2011 First Friday Programs (Nov. 4, Dec. 2) Focus on Minors and Supervising 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 ext. 210 or via e-mail to gbegin@mainemed.com.  
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Free ACA & Maine Health Insurance Reform Law Webinar, Nov 1.

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

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 

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. 

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.

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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Medicare eRx Payment Adjustment - November 1, 2011 Deadline Approaching

The Centers for Medicare & Medicaid Services (CMS) released the final regulation on the 2012 Medicare Electronic Prescribing Incentive (and penalty) Program on August 31, 2011. If you have not successfully e-prescribed and reported G8553 at least 10 times for applicable Medicare office visits between January 1, 2011 and June 30, 2011, you should apply this week for an exemption or face a penalty.

The penalty for not successfully participating in the e-prescribing program or for not filing for an exemption by November 1, 2011 is a 1% payment reduction for all Medicare claims based on the 2012 fee schedule amounts. The penalty increases to 1.5% in 2013 and 2% in 2014.

The final regulation identifies the exemption categories to avoid the 2012 e-prescribing penalty. You can select one or more of the following exemptions that apply to your particular hardship situation:

  • Your practice is located in a rural area without high speed internet access.

  • Your practice is located in an area without sufficient available pharmacies for e-prescribing

  • You are registered to participate in the Medicare or Medicaid electronic health record (EHR) Incentive Program and you adopted Certified EHR Technology by October 1, 2011 and prior to the time you request an exemption.

  • You are unable to electronically prescribe due to local, State or Federal law or regulation (CMS clarified that physicians who mainly prescribe narcotics but due to certain limitations cannot submit these prescriptions electronically can apply for this exemption category).

  • Limited prescribing (You do not prescribe on a regular basis).

  • There were too few opportunities to report the e-prescribing measure due to limitations of the measure's denominator (You do e-prescribe but your e-prescriptions are not related to qualifying services/visits).

You must use the CMS on-line web-based tool to apply for the exemption(s). Application for exemptions can only be made online at: https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234 

You will be asked for your TIN, NPI, business name (as enrolled in PECOS), and contact information. If your exemption claim is that you have enrolled in the Medicare and Medicaid EHR Incentive Program, you should also be prepared to give your registration ID and the ONC Certification number of your product.  You will also need to submit a 250 words or less justification for your hardship. If submitting more than one exemption request, have your statement reflect all of your exemption requests. Each hardship exemption must be submitted separately.

CMS has posted more information on the 2011 specifications at http://www.cms.gov/ERXIncentive.

See also the FAQs.

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CMS Releases Final ACO Rule

The Centers for Medicare & Medicaid Services Oct. 20 released a final rule governing the formation of accountable care organizations that takes into account stakeholder comments and makes a number of changes from the proposed rule.

Among other changes, CMS in the final rule:

  • changed the beneficiary assignment process from retrospective to prospective;
  • reduced the number of quality measures providers are required to report;
  • established a rolling admissions process; and
  • made the one sided-model completely risk-free for the entire length of the agreement.

It also allowed the participation of rural health providers and federally qualified health centers (FQHCs) by letting them become their own ACOs, or by letting them join an ACO as a participant with other organizations. They had been excluded from the proposed rule.

Also released was a new Advanced Payment initiative specifically for physician organizations (for potential ACOs in need of prepayment of expected shared savings to build their capacity to provide high quality, coordinated care and generate cost savings); a final  FTC-DOJ Policy Statement on Antitrust Enforcement for Medicare ACOs, and an Interim Final Rule on fraud waivers for Medicare ACOs

Physician groups welcomed changes made by CMS in the final rule. While noting the 696-page final rule will require a thorough review, the American Medical Association said it was pleased that the final rule allows ACOs to share in every dollar of cost savings and that it includes an option that limits financial risk, which is important for many physician practices.

“Other changes should also allow for greater physician participation in ACOs, including a rolling application process that allows more time for practices to prepare and removing the requirement that 50 percent of primary care physicians in an ACO must be ‘meaningful users’ of electronic health records,” AMA said. AMA also praised CMS for reducing the number of quality measures but added it “would have preferred even greater flexibility on which measures practices are required to report.”

The final documents can be found here: 

http://www.ftc.gov/opa/2011/10/aco.shtm (FTC/DOJ Statement) 

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Are You Ready for Version 5010 and ICD-10?

Summer is coming to an end, and the Version 5010 transition deadline is now only 90 days away! As the January 1, 2012 deadline approaches, the Centers for Medicare & Medicaid Services (CMS) has created an interactive timeline widget that is now available on the CMS ICD-10 website. This user-friendly tool can help you and your organization:

  • Understand what you should be doing right now to prepare for the switches to Version 5010 and ICD-10
  • Know the steps you'll need to take in the future and when
  • Stay on top of approaching transition deadlines to help manage the implementation process

The content of the widget is tailored with specific information for large and small provider practices, payers and vendors. Also available are printer-friendly versions of the timeline information to download and use as check lists. 

Please visit the CMS website athttp://www.cms.gov/ICD10/11a_Version_5010.asp or more information and resources about Version 5010. The American Medical Association (AMA) has developed a toolkit for physicians. Additionally, free archived webinars are available at http://www.getready5010.org/. [return to top]

Public Health Committee Reminds Members of MMA Position on Casinos

In anticipation of November 8th votes that would allow the development of a cacino and two racinos, the Maine Medical Association Public Health Committee reminds members that the MMA opposes the development, creation and maintenance of casinos in the State of Maine.  The MMA adopted this policy in 2003 due to the the issue of problem and pathological gambling.  Studies consistently show that problem gambling is associated with other risky behavior such as drug use, juvenile delinquency, family problems, and an increased likelihood of drinking alcohol and smoking cigarettes. The American Medical Association encourages physicians to advise their patients of the addictive potential of gambling.  

Any member interested in the work of the Committee can contact Jessa Barnard at jbarnard@mainemed.com or 207-622-3374 x 211. 

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Congratulations to MMA Member Carl Flynn, M.D. Recipient of MPCA Physician Excellence Award

MMA representatives were pleased to be present this past week at the Maine Primary Care Association Annual Conference in Bar Harbor where Carl Flynn, M.D. of Pines Health Services received the Association's Physician Excellence Award.  Open to all community health center physicians practicing at an MPCA member organization, the Physician Excellence Award is presented to the clinician who exemplifies the best of primary care medicine for the underserved, reaches high standards of quality care, adopts innovations, promotes greater access, and demonstrates leadership to advance primary care for all.

MMA congratulates Dr. Flynn on receiving this award and thanks him for all he does for the patients of northern Maine and for his contribution to his community through coaching and numerous other activities.

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Week-long T.R. Reid Speaking Tour on Finding Better, Cheaper & Fairer Healthcare

Bestselling author, journalist, and NPR correspondent T.R. Reid is coming to Maine to talk about what we can all do to find and receive better, cheaper and fairer healthcare!  We encourage you to read his book, The Healing of America, and to join in the discussion by attending one of his public appearances around the state.  For more information, visit:  http://www.getbettermaine.org/tr-reids-speaking-schedule-maine

Monday, November 7th
University of Maine, Augusta *
Jewett Hall
7:00 PM - 8:30 PM 

Tuesday, November 8th
Husson University Business Breakfast *
Bangor, ME
8:00 AM - 9:00 AM
Email greenj@husson.edu to sign up

Tuesday, November 8th
Portland Public Library *
Rines Auditorium
Portland, ME
5:30 PM - 6:30 PM

Wednesday, November 9th
Greater Portland Chamber Commerce
Eggs and Issues Business Breakfast
Portland, ME
7:30 AM - 8:30 AM

Thursday, November 10th
Androscoggin Chamber of Commerce Business Breakfast
Martindale Country Club Inc
Auburn, ME
7:15 AM - 8:55 AM
Click HERE to register

Thursday, November 10th
MHMC Annual Symposium
Abromson Center, USM
Portland, ME
8:00 AM - 3:00 PM

* Denotes free programs

TR Reid's week-long visit to Maine is being sponsored by the Maine Health Management Coalition Foundation, the Daniel Hanley Center for Health Leadership and the Maine Health Access Foundation, with support from Aligning Forces for QualityMaine Medical AssociationMaine Osteopathic AssociationAARPMaine Quality Counts and the Maine Development Foundation.

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New MaineCare Preferred Drug List Portal

The MaineCare Rx Portal is a new MaineCare web application for providers to electronically search and review drug status on the MaineCare Preferred Drug List (PDL), review MaineCare Prior Authorization (PA) requirements and submit PA's electronically.

Access to the MaineCare Rx Portal requires registration; prescribers, pharmacists, and members will have to self register prior to accessing information.  Once the registration process is complete, depending on role type, the user will have web based access to the MaineCare PDL. The Portal is available at https://www.mainecarerxportal.org.

Providers with questions should contact Goold Health Systems at 1-888-445-0497 or, to request training, contact their MaineCare provider representative. [return to top]

Upcoming Events & Conferences

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

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. - 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.

Drugs, HIPAA & Safety Concerns

Wednesday, November 9, 2011 ~ 12:30 p.m - 4:00 p.m. 

Maine Medical Center, Dana Health Education Center, Portland, Maine 

Hospital health care providers and hospital security staff may be faced with issues related to contraband substances brought to the hospital with the patient.  In this session participates will learn about common drugs and the legal responsibilities when caring for the addicted patient. 

$10 registration fee (non MMC staff). CME Credit & Contact Hours available. 

For more information or to register, contact:  Beth Turner at (207) 622-2734 or turneb@mmc.org 


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


Maine Medical Group Management Association Half Day Educational Session 

Wednesday, November 30, 2011 ~ 8:00 a.m. - 12:00 p.m. 

Maine Medical Association, 30 Association Drive, Manchester, Maine or via Webex 

Collection Law presented by William Lund & Confidentiality in the Office presented by Medical Mutual 

$25 for MEMGMA members and $40 for all non-members

For for information, contact:

 Karen Wheeler at (207) 873-6173 or kwheeler@mmimvw.com

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