November 21, 2011

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Super Committee Running Out of Time; SGR Fix Uncertain

The so-called super committee has only a day left to agree on a package of revenue increases and spending decreases amounting to at least $1.2 trillion in order to reduce the rapidly increasing federal deficit.  The legislation establishing the Committee requires that their report be scored by the Congressional Budget Office by November 23rd and that now appears unlikely.  If no agreement is reached, the legislation provides for an automatic reduction by means of sequestration.  The AMA, MMA and other medical organizations continue their advocacy regarding the need for the Committee to include in its recommendations a permanent fix to the Medicare Sustainable Growth Rate formula.

With Congress facing a historically low approval rating of 9%, the Congress would face an even more hostile electorate if a bipartisan agreement is not reached.  It was hoped that this prospect would be enough to promote a bipartisan solution.  But apparently not.

Watch future editions of the Update to stay informed on this important topic.  If a 30% reduction takes place due to the SGR formula, it would cost each physician in Maine or their employer approximately $30,000 per year.  If the automatic sequestration takes place, an additional 2% reduction would occur in 2013.

1501 Work Group Begins to Finalize Recommendations

The work group appointed by the Maine Substance Abuse Services Commission as required by L.D. 1501 met again on Friday (Nov. 18) to continue work on its report to the Legislature regarding efforts to be taken to reduce the diversion and misuse of prescription drugs, particularly opioids.  Several physicians and MMA representatives again participated and reviewed draft recommendations.  Two additional meetings will occur on December 2nd and 9th.  The date for reporting to the legislature has been extended to mid-December.

Many thanks to Drs. Mark Cooper, Steven Hull, Scott Davis and Kevin Flanigan for their continued contributions to the report.  Thanks also to Noel Genova, PA, who has provided input on behalf of the Downeast Association of Physician Assistants.

Based upon discussions Friday, it does not appear that the work group will recommend mandatory use of the Prescription Monitoring Program or mandatory education, although mandated education may soon be required by the federal government.  But the work group will make a number of recommendations aimed at reducing the terrible toll that prescription diversion and misuse is taking on the state.  MMA's goal during the discussion has been to prevent actions that could make it more difficult for legitimate patients who suffer chronic pain to access adequate treatment, while at the same time acknowledging the problem and recommending actions that could be helpful in preventing diversion. [return to top]

Primary Care Physicians Needed for Focus Group on Health Information Exchange, Dec. 6, 5:00pm

The Maine Medical Association is making space available for NORC, an independent research organization at the University of Chicago, to hold a discussion group about physician experiences with health information exchanges (HealthInfoNet in Maine).  The group discussion will be held on Tuesday evening, December 6th at 5:00 p.m. in Manchester and will last about 90 minutes.  Each physician participating will receive a $75 honorarium for participating and dinner will be available.

NORC is leading an evaluation of the State Health Information Exchange (HIE) Cooperative Agreement Program, which is funded by the federal Office of the National Coordinator for Health IT (ONC).  The goals of the State HIE Cooperative Agreement Program are to facilitate and expand secure exchange of health information within and across states according to nationally recognized standards and ensure that providers and hospitals meet meaningful use requirements.

As part of the evaluation, NORC is conducting a series of case studies in five states.  Maine was selected based on the progress that has been made in implementing the program.  Through the case studies, ONC is particularly interested in gathering lessons from states that can be shared with and benefit other states.  NORC plans to speak with various stakeholders involved in the state's program in addition to holding discussion groups with physicians.

Any primary care physician who would like to participate should contact Kate Quirk at or by calling her at 301-634-9384.  NORC hopes to include two to three physicians each from small, medium and large primary care practices.

For additional information about NORC, please visit [return to top]

MaineCare Physician Advisory Committee to Discuss PMP, Suboxone, Dec. 8

The Physician Advisory Committee (PAC) is a core group of six MaineCare physicians facilitated by the MaineCare Medical Director.  Presently this group meets on a quarterly basis.  MaineCare would like to open its Physician Advisory Committee meeting to wider participation.  Any provider interested in MaineCare initiatives may attend the meeting in person or by phone. 

During the first half of the PAC meeting, current MaineCare initiatives are presented.  For the second half of the meeting, MaineCare providers are invited to present issues in the community they would like MaineCare to address.

The next meeting will be held on Thursday, December 8, 2011 from 3-5 p.m. at the Augusta MaineCare Office located at 442 Civic Center Drive.  The topics for this meeting will be the Prescription Monitoring Program and upcoming changes to MaineCare coverage of Suboxone.

The conference call line is 1-800-394-6604, with passcode 959468#.  If planning to attend in person, please reply to Charyl Malik at 207-287-3320 or .   [return to top]

DHHS Seeks Comments on Value Based Purchasing Strategy

The Maine Department of Health & Human Services last week released a request for comments regarding certain aspects of the Department’s Value Based Purchasing (VBP) Strategy, focusing on:

  1. The planned Accountable Communities Initiative, under which MaineCare will enter into alternative, risk-based contracts with qualified provider organizations that will align financial incentives for those providers to work together with the community to improve value and decrease avoidable costs.

  2. The Department’s plans to take advantage of Section 2703 of the Affordable Care Act, establishing Health Homes to serve MaineCare and Medicare-Medicaid dual enrollees with chronic care needs. 

The RFI and more information on the Department’s Value Based Purchasing Strategy, can be found here:

Any individual or entity may respond to the RFI, including individual health care practices. 

The deadline for submitting questions to the Department is 5:00 p.m. on November 21, 2011 and the deadline for final submission of comments is 5:00 p.m. on December 14, 2011.  [return to top]

OCR Begins Pilot HIPAA Audit Program; Version 5010 Enforcement Delayed

The Department of Health and Human Services Office for Civil Rights, which enforces federal health care privacy rules, is set to begin a pilot program in November designed to audit entities covered under the regulations, according to the agency.  OCR is overseeing an audit of about 150 covered entities to ensure compliance with the Health Insurance Portability and Accountability Act privacy and security rules.  The agency explained in a statement on its website that outside consultant KPMG is conducting the pilot phase of the audits. The pilot is to run from November 2011 through December 2012.

The audits are not intended to duplicate OCR's enforcement of the privacy and security regulations, Susan McAndrew, deputy director of health information privacy at OCR, said earlier. They are designed to identify weaknesses in covered entities' compliance with the HIPAA rules.

OCR designed the audits to have three stages.  In the first stage, protocols were designed. The second and current stage involves about 20 audits.  The results of the initial audits will inform how auditors conduct the remainder of the audits during the third and final stage, OCR said.

OCR will inform entities they are being audited between 30 and 90 days before the audit is to take place, depending on the entity's complexity.

Auditors will ask the covered entities to provide documentation of their privacy and security compliance efforts. They are expected to interview key personnel and observe processes and operations to help determine the level of compliance, OCR said.  All audits in the pilot phase will include a site visit of between three days and 10 days and result in an audit report.

More information on the audits is available at

In a second announcement, the Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS) stated November 17th that it would not initiate enforcement actions regarding the switch to ASC X12 Version 5010 transaction standards until March 31, 2012.  However, the compliance date for implementation of these standards remains Jan. 1, 2012.

Please visit the CMS website at for 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

The MMA has three attorneys available to train your staff on HIPAA requirements.  For more information, contact MMA Associate General Counsel Jessa Barnard at or 207-622-3374 x 211.

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MGMA Collection Law & Confidentiality Updates, Nov. 30

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 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

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Final 2011 First Friday Program on Dec. 2 Focuses on Supervising Mid-level Providers and Delegation

MMA concludes its 2011 educational programs on Friday morning, December 2nd when health lawyers, risk managers, regulators and physician assistants will discuss the requirements of supervising mid-level providers and the standards and risks associated with delegating medical tasks to medical assistants. Standards of practice will be addressed from the point of view of risk management, state regulations and payor requirements.  This three hour program will 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 this week for a flyer on the program, which will also be included as an insert with the Fall issue of Maine Medicine.

Any questions about the program should be addressed to Gail Begin at MMA.  Gail can be reached at 622-3374 ext. 210 or via e-mail to  
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Final Results of MMA Survey Monkey Poll

Thanks to those MMA members who took the two minutes required to complete the survey monkey sent out several weeks ago, asking for answers to four short questions. We plan to send out similar short surveys every three moths.  The final results are as follows:


1.  Two other New England states are now considering the prospect of legalizing physician-assisted suicide.  Is It time for MMA to reconsider its opposition to this practice?

Yes     46.7%

No      53.3%


2.  Governor LePage announced that he intends to require drug testing or welfare recipients.  Would you support such testing?

Yes     44.2%

No       55.8%


 3.   The recent summit on prescription drug abuse sponsored by Attorney General Schneider explored a number of potential requirements before a physician can prescribe narcotics?  Please check any of the following requirements that you would support. 

Require a portion of CME requirements to be devoted to the topic of prescription drug abuse, diversion and addiction.   39.9%

 Require that physicians prescribing above a fixed threshold enroll in the prescription monitoring program.  61.6%

 Require that all patients receiving a controlled substance for treatment of chronic pain sign a treatment contract containing elements recommended by the Maine Board of Licensure in Medicine.   85.1%


4.  A proposal has recently surfaced which would provide a two-year limit for Suboxone users on Maine Care, unless a prior authorization is obtained.  Would you support or oppose such a requirement?

Support  59.9%

Oppose  40.1%


Thanks for your participation.        [return to top]

Save the Date: MMA Legislative Committee Meeting, Dec. 6

Save the Date: MMA Legislative Committee Meeting 

Tuesday, December 6, 2011

6:30-8:30 p.m. 

MMA Headquarters, Association Drive, Manchester

All MMA members, specialty society leadership and legislative liaisons, and interested parties are welcome to join.  The Committee will discuss priorities for the second session of the legislature, MMA advocacy work related to the Affordable Care Act and Maine's health insurance reform law (Chapter 90) and organizational issues.  Dinner will be served. 

RSVP to Maureen Elwell, or (207) 622-3374x 219.


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FDA Releases Draft Blueprint for Opioid Prescriber Education

November 7th, the Food and Drug Administration announced the availability of a draft document entitled “Blueprint for Prescriber Education for the Long-Acting/Extended-Release Opioid Class-wide REMS." The draft Blueprint contains core messages intended for use by continuing education providers to develop educational materials to train prescribers of long-acting and extended-release opioids under a required risk evaluation and mitigation strategy (REMS) for these products.

The FDA has required all companies that market long-acting and extended-release opioids to submit a risk evaluation and mitigation strategy.  The central component of the strategy is education program for prescribers so that the medications can be prescribed and used safely. The FDA expects the education to be conducted by accredited, independent continuing education providers funded by unrestricted grants from the companies. 

FDA seeks stakeholder input on the Blueprint. After comments are received, FDA will revise the Blueprint as appropriate, incorporate it into the Opioid REMS when it is approved, and post it on FDA’s Web site for use by continuing education providers. 

Links of interest:

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