May 14, 2012

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Political Pulse: Appropriations Committee Votes on Party Lines to Approve Budget Proposal

In a strict party-line vote, the Republican majority on the Legislature's Appropriations and Financial Affairs Committee reported out a budget last week that books significant savings for the Department of Health and Human Services, by, among other things, ending MaineCare coverage for young adults and some parents; reducing or ending Fund for a Healthy Maine dollars and MaineCare coverage for certain preventive services; and redesigning MaineCare coverage for opiates.  The Maine Medical Association Legislative Committee will be meeting this Tuesday, May 15th at 8:00 p.m. to discuss the budget developments. 

After meeting in partisan caucuses earlier in the week, last Thursday the Appropriations and Financial Affairs Committee met publicly to consider the Fiscal Year 2013 budget for the Department of Health and Human Services.   Stating that they had been unable to reach a bipartisan solution, Republicans on the Committee presented a set of proposed savings initiatives within DHHS to fill a $78.5 million budget gap.  The Republican plan also finds savings in other areas of government outside of the DHHS and proposes some spending initiatives as well as some income tax reductions. Following discussion, the Committee proceeded to adopt the proposal along party lines.  The Democrats released a competing plan that proposes fewer cuts to DHHS programs and seeks to pay for these services through better-than-anticipated revenues.

The savings approved by Republicans on the Committee are achieved through a number of mechanisms.  Of most interest to physicians they include: 

  • Eliminating MaineCare Coverage for children age 19-20 ($4.3 million, 7000 people) and for parents from 100-133% of the federal poverty level ($3.3 million; 14,500 people) 
  • Eliminating MaineCare Coverage for Ambulatory Surgical Centers ($77,697) 
  • Eliminating MaineCare Coverage for Services provided at STD Screening Clinics ($163,463) and for smoking cessation products ($179,095) 
  • Raising income limits for participation in the Medicare Savings Plan & Drugs for the Elderly programs ($2.9 million) 
  • Reducing or eliminating Fund for a Healthy Maine funding for oral health, home visiting, family planning, child care services, and community school grants (Healthy Maine Partnerships and school based health clinics)($8.1 million) 
  • DHHS reorganization ($842,932)
  • Imposing a 2 year limit on Methadone without prior authorization ($1.4 million) 
  • Creating a Medicaid Stabilization Plan or 9 member task force to create a Medicaid program redesign ($5 million) 
  • Primary Care - Mental Health integration through case managers at hospitals ($500,000)
  • Opiate Benefit Redesign - no additional savings budgeted but replaces the savings estimated in the 1st supplemental budget - please see more information on this proposal in the article immediately following. 
The  full legislature is expected to vote on the competing Republican and Democrat proposals when they reconvene tomorrow, May 15th. For the two proposals, please see the Maine Legislature's homepage.  For a summary of the Republican proposal, click here

If you which to comment about any aspect of the proposed budget, now is the time to contact your legislator.  You can find your legislators by clicking hereA coalition of consumer and other organization is holding an event at the statehouse tomorrow at 9:30 a.m. in opposition to the cuts.  For more information, please click here

NOTE:  THERE IS A LEGISLATIVE COMMITTEE CONFERENCE CALL THIS WEEK, TUESDAY, MAY 15TH AT 8:00 PM.  We will largely be discussing the budget proposals and implications for physicians.   Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Conference call number:  1-877-669-3239

Passcode:  23045263

For more information, please contact Andrew MacLean at or 622-3374 x 214.

Proposed Changes to MaineCare Opioid Coverage Approved by Appropriations Committee

The budget proposal voted out of the Appropriations Committee last Thursday (see article above) contains a redesign of the MaineCare opiate benefit.  The changes are made in response to the concern that proposals to restrict opiate coverage contained in the first supplemental budget were in conflict with federal law.  The Department of Health and Human services does not expect additional savings from the current proposal but did book savings in the first supplemental budget that the Department still expects to achieve. 

This proposal for the opiate benefit came from Dr. Kevin Flanigan, the MaineCare Medical Director and a working group of physicians.  The concepts have been vetted and indeed, endorsed, by several medical organizations.  But it is difficult to impose these new limits in a way that will meet the medical needs of each MaineCare recipient, so the MMA is seeking input from all interested physicians. 

The proposed changes include: 

  • Acute pain: The Department shall provide limits for MaineCare reimbursement of opioid treatment in response to a new onset of acute pain not to exceed 45 days per year without prior authorization excepting surgical procedures for which a medical standard of care includes the use of opioids.  Each prescription shall not exceed 15 days and shall require a face-to-face visit between the prescriber and the member.  The department shall provide a separate 60-day limit for MaineCare reimbursement for opioid treatment following surgical procedures for which the medical standard of care includes the use of opioids. 

  •  Chronic pain: The Department shall provide for a MaineCare member receiving opioid treatment beyond that allowed above by prior authorization if the member participates in one or more alternative interventions established by the Department through rulemaking, such as Cognitive Behavioral Therapy, Physical Therapy (up to 6 visits) or Osteopathic Manipulation Treatment.    To qualify for opioid treatment, the member must have (1) failed to have an adequate response to the prescribed treatment; or (2) Have completed the treatment and show signs of regression; or (3) Have completed at least 50% of pain treatment protocol after which the prescriber recommends that adequate control will not be obtained once the care plan is implemented.   The department shall limit the total amount of opioids allowed for a member who fails to have an adequate response to the prescribed treatment, subject to exception based upon medical necessity. 

  • Second opinion: Prior to prescribing an opioid drug as part of a treatment plan for a member who suffers from one of the medical diagnoses known to typically have a poor response to opioid drugs, a prescriber shall obtain an evluation from a physician from outside the practice of the prescriber.

A couple IMPORTANT points:

1.  The limits will not apply to current users (MaineCare patients who have been on opiates consistently for six months prior to the effective date) until Jan., 1, 2013.  Prior to that time, it is hoped that MaineCare will develop rules that would exempt patients on small daily doses of the medication and exempt others by diagnosis or condition.  Without such exceptions, it is unclear how the 60,000 present users can be responsibly handled.  For those who are not exempt, the plan would be to allow them to continue on the medication through a prior authorization process if the review established medical necessity.

2.  The primary difference between these proposals and what was passed earlier is that there are no longer any hard caps on coverage.  Rather, at certain points in the process, authorization will have to be received if the patient is to have continuing coverage by MaineCare of the medication.  Bear in mind that there is no restriction on the physician from writing whatever prescription he or she believes is medically necessary.  Nor is there any prohibition against the patient paying for medication with cash.  Ultimately, these limits imposed are similar to any other health plan coverage decision, except that this plan happens to be paid for with tax dollars.

3.  PMP.  There is language being added to this proposal that will allow the Prescription Monitoring Program to provide to prescribers their own prescribing information, compared to a peer group.  If the prescriber is an outlier, he or she will be given an opportunity over time to bring their prescribing pattern into conformance with the peer group.  If that is not achieved, the Department could take actions against the prescriber such as limiting their ability to participate in the MaineCare program. 

For questions or concerns, please contact Gordon Smith, MMA Executive Vice President at or 622-3374 x 212. 

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Let MMA Train Your Staff on HIPAA, June 1, 2012

The Annual HIPAA Update is traditionally MMA's most popular First Fridays'  program and this year it will be presented on Friday, June 1st from 9:00 am to noon.  The faculty this year includes Stacey Mondschein Katz, J.D., of SMK Consulting Services, LLC, and MMA's three in-house attorneys, Andrew MacLean, Jessa Barnard and Gordon Smith.

The agenda for the morning follows:

8:30am   Breakfast and Networking

9:00am    Welcome, Introduction and Overview of State and Federal Privacy Law and HIPAA Regulations, Gordon Smith, JD

9:30am    HITECH Regulations, Mental Health Rules and Preparing for an HHS Audit, Stacey Mondschein Katz, JD

10:30am  Break

10:45am  Special Privacy Rules:  Minors and HIV, Jessa Barnard, JD and Andrew MacLean, JD

11:30am   Summation and Q & A,  All presenters, moderated by Mr. MacLean

MMA's sample Notice of Privacy Practices document, consent forms and release forms are currently being updated to comply with the HITECH regulations and will be made available to program participants.

This program is ideal for your annual HIPAA staff education or for training new staff.  There is a $65 fee and registration is available on the MMA website at  A HIPAA Training Certificate will be presented to each participant and CME has been applied for.

Members and practice managers are also reminded that MMA attorneys are available to come to the practice site to provide this program.  Normally, a $200 fee is charged for an on-site program which can be one hour or more if the practice is able to commit that much time to the education.

Any questions about the MMA's educational offerings can be directed to either Gordon Smith, EVP at or Gail Begin via e-mail to [return to top]

Coastal Women's Healthcare Honored for Leadership in EHR

Officials from the Centers for Medicare and Medicaid Services in Boston and HealthInfoNet honored Coastal Women's Healthcare in Scarborough last Thursday for its leadership in converting its paper charts to electronic health records and for linking to HealthInfoNet (HIN).  HealthInfoNet is Maine's statewide health information exchange.  Coastal Women's Healthcare is a private, independent gynecologic and obstetric practice with 10,000 patients in the greater Portland and southern Maine area.

Adopting digital records cost the practice approximately $500,000 which was partially offset by the $110,000 in federal incentive payments received this year through the achievement of  federal criteria for "meaningful use" of digital records.  Additional payments can be received during the next three years.  Over the next ten years, the federal government will pay out $27 billion to hospitals, physicians and other health professionals who adopt an electronic medical records system and who achieve meaningful use requirements.

During a media event held at the practice site in Scarborough, Barbara Slager, M.D. demonstrated the use of the EHR and HealthInfoNet and described what she believed were the benefits to patients.  Congratulations to Dr. Slager and all the physicians and health professionals at the practice as well as Practice Manager Beverly Neugebauer for achieving this recognition.  Traditionally, private practices have lagged behind health systems in adopting electronic health records.  In 2011, more than half of all office-based physicians were using digital records, but only about one-third had systems with basic features such as the ability to view lab results and manage prescription orders.

Greeway was the primary vendor for the EHR, assisted in implementation by Arcadia Solutions LLC of Burlington, MA.

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CMS Announces Proposed Rule for Enhancing Primary Care Reimbursement

On May 9, 2012, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that increases Medicaid payments for primary care services beginning Jan. 1, 2013, for calender years 2013 and 2014.  The proposal, a provision of the Affordable Care Act (ACA), provides more than $11 billion in funding to states to reimburse family medicine, general internal medicine and pediatric physicians at Medicare rates for Medicaid services. There would be no cost to the states initially as the increase would be paid for with federal dollars.

If the United States Supreme Court strikes down the entire ACA than this provision would not be funded and state medicaid fees would presumably remain unchanged.  If the Supreme Court throws out portions of the law, then the fate of this provision will depend upon what parts remain and who makes the decisions on where the law goes from there.

The enhancement of medicaid fees under the ACA was one of the more positive features of the ACA, in the opinion of the American Medical Association and the national specialty societies representing primary care physicians. [return to top]

Hanley Center Physician Executive Leadership Institute Opens Strong

Maine's new Physician Executive Leadership Institute held its first session last Thursday night with thirty-six participants in the Advanced Course.  Participants met Thursday evening, all day Friday, Friday evening and finished up at noon on Saturday.  This intensive 12 month program is designed to help physician leaders take on roles of greater influence and responsibility.  The Course will focus on six core competencies:

  • Systems Awareness
  • Strategic Focus
  • Self-Awareness
  • Key Management / Business Skills
  • Health Care Trends
  • Team Work & Collaboration         

The Course will be offered annually from 2012 through 2016.  Tuition for this first course was $7500.  The Daniel Hanley Center for Health Leadership is partnering with Brandeis University in presenting the Advanced Course.  Last week's session was led by Jon Chilingerian, PhD, a professor at Brandeis University who teaches graduate courses and executive education sessions in Organizational Theory and Behavior, Management of Health Care Organizations and Health Services Research.  He is Director of the Brandeis Health Leadership Program, sponsored by the American College of Surgeons.

For more information about the Advanced Course or to reserve a spot in next year's class, visit or contact Jim Harnar at


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Free In-Office Atypical Antipsychotic Education Available Through MMA's Academic Detailing Program

Request a free educational session on the topic of your choice: 

atrial fibrillation, chronic pain management & (coming soon) atypical antipsychotics

The Maine Independent Clinical Information Service (MICIS) is an innovative service that provides independent, evidence-based prescribing information directly to health care providers in the convenience of their own practice setting (also called "academic detailing").

CME is available at no cost.

For more information, or to schedule a visit with one of our clinician-academic detailers (Erika Pierce, PA-C, and Elisabeth Fowlie Mock, MD), call the Maine Medical Association today at 207-622-3374 x 211 or email Sessions can be tailored to meet your needs and range from one-on-one visits with a prescriber to an entire medical staff and typically last 45 minutes to an hour. 

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DHHS Announces Final Rules Amending Medicare Conditions of Participation Regarding Medical Staff

The federal Department of Health and Human Services announced late last week that it would publish the final rules changing Medicare Conditions of Participation regarding medical staff issues this Wednesday, May 16th.  While they will be published in final form in the Federal Register, a prepublication copy is available here

The final rules contain changes in the provisions relating to medical staff and hospital governance, medical staff membership and privileges for non-physician practitioners and related issues.  The American Medical Association and many other medical associations had filed written comments on the draft rules expressing concern about a number of the provisions.  At first glance, medical staff attorneys around the country are reporting that the final regulations are somewhat improved from the proposed rules.  Further analysis will be presented in upcoming issues of the Weekly Update. [return to top]

Tell Congress: Pass the Safe Chemicals Act

Thanks to support from Maine doctors and the Maine Medical Association, Maine has made incredible progress to phase out toxic chemicals that build up in the food web and our bodies.  Last year, the Maine legislature voted almost unanimously to phase out BPA from baby bottles, sippy cups, and other reusable food and beverage containers.  This was the first phase out of a toxic chemical under Maine’s Kid Safe Products Act. 

While Maine is a national leader in chemical policy reform, Congress needs to catch up.  This month, Congress has an opportunity to take action on the Safe Chemicals Act.

The current federal law, the Toxic Substances Control Act (TSCA), is outdated and ineffective at protecting public health and giving businesses and consumers accurate information about chemicals used in everyday products.  Only about 200 of over 84,000 chemicals now in commerce have been fully tested for health hazards, and only five have ever been restricted, despite widespread scientific evidence of harm from many chemicals. 

The Safe Chemicals Act takes a measured, science-based approach to fixing this broken system.  The MMA passed a resolution in 2010 supporting these reforms to TSCA.   

A group of Maine moms and activists will join others from across the United States for a National Day of Action on May 22nd to urge Congress to pass the Safe Chemicals Act this year.   Please take one minute to sign our petition, so our Maine activists can deliver 2,500 signatures to Congress on May 22nd. 

For more information about the Safe Chemicals Act, click here
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IOM Report Identifies Key Obesity-Prevention Strategies to Scale Back 'Weight of the Nation'

America's progress in arresting its obesity epidemic has been too slow, and the condition continues to erode productivity and cause millions to suffer from potentially debilitating and deadly chronic illnesses, says a new report from the Institute of Medicine.  Solving this complex, stubborn problem requires a comprehensive set of solutions that work together to spur across-the-board societal change, said the committee that wrote the report.  It identifies strategies with the greatest potential to accelerate success by making healthy foods and beverages and opportunities for physical activity easy, routine, and appealing aspects of daily life.

The report, which was released last week at the Centers for Disease Control and Prevention's "Weight of the Nation" conference, focuses on five critical goals for preventing obesity: integrating physical activity into people's daily lives, making healthy food and beverage options available everywhere, transforming marketing and messages about nutrition and activity, making schools a gateway to healthy weights, and galvanizing employers and health care professionals to support healthy lifestyles. The committee assessed more than 800 obesity prevention recommendations to identify those that could work together most effectively, reinforce one another's impact, and accelerate obesity prevention.

To read the report or for more information, click here.  Coordinated with the release of the report, The Weight of the Nation, a new four-part film series presented by HBO and IOM, takes an unflinching look at the severity of the obesity crisis and its tolls on individuals and families as well as its crippling effects on the nation's health care system. The series will debut on HBO tonight and tomorrow and will be free to stream after the 15th.  For more information, click here

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MMA Senior Section Meeting May 23rd Looks at the Future of State Medical Societies

MMA's Senior Section has met quarterly for the last several years and has examined issues ranging from medical marijuana to physician impairment.  Next week's meeting, on Wednesday (11:30am-1:30pm), May 23, will feature a presentation on the changing role of state medical associations by Scott Colby, Executive Vice President of the New Hampshire Medical Society and myself.  Mr. Colby is in his second year in the position, having followed Palmer Jones who served in the role for over two decades.  Any MMA member, whether retired or not, is invited to attend the session, but please RSVP to Lisa Martin at so that we can be sure to have enough lunch for everyone.

State medical societies across the country are struggling to keep up with the pace of change in health care, while many are still stuck in a governing structure adopted in the middle of the 19th century.  The Maine Medical Association has undergone significant change in the past decade, beginning with the de-unification of the county medical societies and the elimination of a traditional House of Delegates in 2003.  The changes continued with a new set of bylaws adopted in 2011 which eliminated any geographic limitations to election of members of the Board of Directors.  The membership model of only individual physicians joining the Association  is also being examined for its appropriateness in a time when many physicians are choosing to practice in health care systems.  Given the trends, MMA has also been reviewing and changing the services it offers to members. The New Hampshire Medical Society has also been examining its present structure and services.  Please join the MMA on the 23rd as we share with you this essential part of our work on behalf of the physicians of Maine and New Hampshire. [return to top]

Upcoming Events & Conferences

2012 New England Medical Group Management Association Regional Conference 

Practice Management - A Changing Landscape 

May 15-17, 2012

Samoset Resort, Rockland, ME 

In the face of the changing healthcare landscape, you need to understand the challenges and opportunities your practice is facing. The 2012 New England MGMA Regional Conference features a wide range of speakers who will provide you with the insight and tools you need to help your practice thrive.

For more information or registration, visit:

Members of the Maine Chapter MGMA now receive a $50 registration reimbursement. 


Integrating Mental Health with Medical Practice 

Friday, June 1, 2012

9:00 am - 4:30 pm 

Viles Arboretum, 153 Hospital Street, Augusta, ME 

 This day-long conference includes presentations, panel discussions and work groups to help attendees understand key questions underlying integration of care. 

For more information, or to register, click here.


22nd Annual Maine GERIATRICS Conference

June 7-8, 2012 

Harborside Hotel & Marina, Bar Harbor, ME

Registration Open.  CME Available. 

 For more information or to register visit


Save the Date: 

Medical Mutual Practice Manager Seminar: 

Caring for our Seniors - Complex medical & liability issues

June 13, 2012

DoubleTree by Hilton Hotel, South Portland, ME 

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Job Openings - Primary Care Physician, Hospitalist NP/PA

Lifestyle Position/Primary Care Physician - Augusta, Maine

Board Certified Internal Medicine or Family Practice Physician sought for full-time staff Primary Care Physician position based at the Riverview Psychiatric Center in Augusta, Maine.   Responsibilities primarily involve providing basic primary care services to a caseload of approximately 45 patients. Enjoy working regular 40-hour workweeks in a collegial environment. No third party insurance billing, no evenings, no weekends, and no-on call responsibilities.  Offering $170k per year, pay by direct deposit on the 15th of each month, 37 paid days off annually, and paid liability insurance. For additional details contact Ian Castronuovo at (610) 389-7430


Hospitalist Nurse Practitioner/Physician's Assistant Position Openings

Sebasticook Valley Health (SVH) a system of healthcare services including a Joint Commission Accredited 25 bed Critical Access Hospital located in Pittsfield, Maine is looking for two full-time nurse practitioners or physician assistants for our expanding hospitalist program. 

The qualified candidate will feel comfortable responding to ED admissions, managing inpatient medical care including proper documentation, meeting with Care Coordinators and Utilization Review staff on a daily basis and performing procedures, as well as assisting the Emergency Department as appropriate.  The current schedule is 3 to 4 days per week, including weekend rotations, 4PM to 10PM with on-call.

The Hospital serves a population of 30,000 and offers primary care, specialty services and emergency services in addition to inpatient care. SVH is one five rural community hospitals which along with Eastern Maine Medical Center, a level 2 trauma center, comprise Eastern Maine Healthcare System. 

The town of Pittsfield is a safe and pretty community with a good school system. The Maine Central Institute, a prestigious college preparatory school is a prominent part of the landscape. Pittsfield is conveniently located for easy access to the mountains, nearby lakes, rivers and the coast of Maine.

Please contact Terri Vieira, Chief Operating Officer at 1-207-487-4032 or email Terri at


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Receive Two Hours of Category One CME for Completing Pain Management Home Study Course

The Home Study Course on the Management of Pain has recently been updated and is available on the MMA website.  Many thanks to primary author Noel Genova, PA-C and a physician advisory committee that reviewed and edited several drafts of this important material.  It can be taken, at no cost, for two hours of CME if the pre-test and post-test questions are taken and the evaluation form completed.  Thank you also to the Maine Board of Licensure in Medicine which has funded this work and the consultations that Noel has performed out in the practices.

The link to the course follows: [return to top]

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