June 18, 2012

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MMA to Host Physician Payment Reform Forum on Wednesday Evening, June 27

The Maine Medical Association will host a forum on physician payment reform June 27th featuring national expert Harold Miller.  The Forum is presented through the generous support of the Maine Health Management Coalition and is also co-sponsored by the Maine Osteopathic Association and Quality Counts.  The Forum will be held from 5:30 p.m. to 8:30 p.m. and dinner will be available.  

The Forum is intended to inform physicians of the expected role of physicians in payment reform and will cover subjects ranging from Accountable Care Organizations to bundled payments and answer questions such as : 

  •  What will payment reform mean to physicians?
  • What impact will an ACO have on your practice?
  • How can physicians lead payment and system change?

 Mr. Miller will share national lessons and local opportunities for physician engagement and leadership in payment reform projects taking place around the state.

 There is no charge to attend but registration is required.  Any physician interested in attending should communicate with Dianna Poulin at MMA by calling 207-622-3374, ext. 223 or via e-mail to dpoulin@mainemed.com. 

AMA Convene's Annual Meeting: Anticipation Mounts re Supreme Court Decision

Nearly a thousand physician delegates and alternate delegates convened the Annual Meeting of the House of Delegates of the American Medical Association in Chicago on Saturday, June 15th.  Among the delegates are Maine physicians Richard Evans, M.D and Maroulla Gleaton, M.D.  MMA President Nancy Cummings, M.D. is attending as an alternate delegate.  Daniel Spratt, M.D. and John McGill, M.D. are present as specialty society delegates.  Completing the Maine contingent is AMA former President Robert McAfee, M.D. and MMA EVP Gordon Smith.

Saturday's opening session featured presentations by out-going President Peter Carmel, M.D. and EVP James Madera, M.D.  Dr. Madera rolled out the new strategic plan of the organization and emphasized the new focus on a limited number of areas including Research & Education, Practice Support, Improving Health Outcomes, and Advocacy.  He noted that the organization could no longer try to be all things to all members.  He also announced the creation of a new position, a Vice President for Physician Satisfaction.  Dr. Madera noted that there would be more emphasis on outcomes and less on process.

A lot of conversation at the meeting has focused on the highly anticipated U.S. Supreme Court decision of the Affordable Care Act which could come as early as this week.  Other issues discussed through the presentation of Board of Trustee Reports, Council Reports, and Resolutions included the following:

  • Several issues surrounding EHR implementation, including a Board Report recommending tools to rate EHR's, vendor accountability and research on errors related to the EHR and CPOE.

  • Doctor on-line ratings and protecting physician reputations on-line.

  • Serving returning veterans and integrating their care into the community.

The meeting wraps up on Wednesday morning.  Watch for a more complete accounting of the reports and resolutions in next week's Update.




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Register Today for 21st Annual Practice Education Seminar, July 25 in Augusta

Registration is available on the MMA website at www.mainemed.com or by calling Lisa Martin at MMA at 622-3374 ext. 221 or via e-mail to lmartin@mainemed.com for the July25th Practice Education Seminar being held on Wednesday, July 25 at the Augusta Civic Center.

The keynote presenter is Susan Turney, M.D., President of the Medical Group Management Association (MGMA) in Englewood, Colorado.  Prior to accepting the MGMA position, Dr. Turney served as Executive Vice President of the Wisconsin Medical Society.  Dr. Turney will share with attendees the trends she sees across the country as practices wait to see what aspects of the Affordable Care Act remain as a result of the Supreme Court decision and the Presidential election.

Maine's former Insurance Superintendent Brian Atchinson, Esq. is the luncheon speaker.  Mr. Atchinson is now serving as President of the Physician Insurers Association of America and will update attendees on medical liability trends across the country.  He was instrumental in the enactment of Maine's prelitigation screening panel in the 1980s when he served as legal counsel to Susan Collins when she was Commissioner of Professional and Financial Regulation in the McKernan administration.

The afternoon keynote presentation will be given by Suzan Oran, a national speaker on the subject of engaging staff in the delivery of excellent patient care.

Nine breakout sessions are also scheduled on the following topics:

  • Employer Expectations of Maine Physicians

  • Maine's New CO-OP Health Plan

  • MaineCare Update

  • Update on State HIT and Health Information Exchange

  • Responding to Complaints to State Licensing Boards

  • Tools for Medical Professionals in Assessing Senior Drivers

  • Update on Actions of the 125th Legislature

  • Prescription Drug Abuse and the Prescription Monitoring Program

  • What's New in Academic Detailing

The program runs from 8:30 a.m. to 4:30 p.m. and we hope to see you there!

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Maine Primary Care Association Announces New CEO

The Maine Primary Care Association (MPCA) has chosen Vanessa Santarelli as its new Chief Executive Officer.

Santarelli will officially begin her work at the Association on July 31st and will bring with her considerable acumen in working with elected officials and business leaders, developing collaborative relationships, and coalitions - that even in this challenging economic environment have resulted in bi-partisan support for the role of Community Health Centers. 

She originally hails from Maine, earning her Bachelor's degree in political science from the University of Southern Maine.  She has worked with and for State government in Maine, and has spent the past four years in a key leadership position within the Bi-State Primary Care Association that serves New Hampshire and Vermont.

Earlier this year, Santarelli was awarded the George Washington University School of Public Health's 2012 Geiger Gibson Emerging Leader award at the National Association of Community Health Centers' Annual Policies and Issues Conference in Washington, D.C.  This award is designed to highlight and share the accomplishments of young members of the health center and primary care association family.

Until Santarelli assumes her duties, Darcy Shargo, MPCA's chief operating officer, will lead the Association.

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MaineCare to Delay June 27th Claims Cycle Payments

Last week, the Department of Health & Human Services announced that it has continued to experience cycle payments that are higher than normal, creating a shortfall in excess of the budget that was recently passed by the Legislature.  DHHS states that it has been monitoring the weekly cycle payments to identify options to minimize the shortfall; however, because anticipated claims payments are expected to exceed available funding they will cap a portion or all of the last payment cycle of the fiscal year.  

DHHS states that they are trying to minimize the impact on providers and will  therefore run a special cycle the first Monday of the new fiscal year, which equates to a three to five business day delay for those payments that did not process.

In the announcement, DHHS states that they understand the impact this may have on providers and regrets the need to implement this process.   Should you have any questions or concerns, please call DHHS Provider Services at 1-866-690-5585.


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Power Point Presentation on Activities of 125th Legislature of Interest to Physicians Now Available

Members or medical practices interested in a report on the actions of the 125th Legislature may contact Andy MacLean, Jessa Barnard, or Gordon Smith at MMA to receive a copy of the Powerpoint recently prepared.  Or, you may schedule a presentation by one of MMA's lobbyists at your practice (MMA charges $200 for out-of-office presentations).

During the course of the two sessions in 2011 and 2012, MMA followed more than 300 pieces of legislation impacting on public health, physician practice, Mainecare, or health system delivery reform.

The MMA staff also is working on a final legislative summary that will be available later this summer.  We will notify you through the Update when the document is available.


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Job Opening - Family Practitioner

Family Practitioner Position in Jonesport

Busy rural practice located in Jonesport seeking a Family Practitioner to join our successful, well-established practice.  Coverage would include a four day work week, nursing home coverage, and shared call for the practice.  We are currently not looking at any hospital coverage.  We offer a competitive salary and benefits with the possibility of loan repayment through the National Health Service Corps.  This is an excellent opportunity to practice in a gorgeous ocean community.  For more information, please contact Laurie Charbonneau, Administrator at lauriec@ammc.us207-497-5614.


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Upcoming Events & Conferences

Adverse Childhood Experiences (ACEs)

Thursday, June 21st - 9:30 a.m. - 12:00 p.m. at MaineGeneral's Thayer Unit/Dean Auditorium in Waterville.  

Wednesday, June 20th -  6-8:00 p.m. at Maine Medical Association in Manchester.  

The Bingham Program and the American Academy of Pediatrics, Maine Chapter are pleased to announce the opportunity to participate in one of two seminars with Dr. Vincent Felitti to learn more about  and how Maine is using this information at a variety of local pilot sites throughout the state.

For more information or to register, please go to https://www.surveymonkey.com/s/FelittiRegistration


Save the Date: 

CMS Region 1 National Medicare Training Program 2012

August 7-9, 2012

Sheraton Framingham Hotel and Conference Center, Framingham, MA

Information about key aspects of Medicare, Medicaid, Children's Health Insurance Program (CHIP), and pertinent legislation

More information to be distributed via CMS later in May


Maine Immunization Program Regional Trainings 

July 27, 2012 – Houlton Regional Hospital – Houlton

August 3, 2012 – Hilton Garden Inn – Bangor

August 9, 2012 – Fireside Inn – Portland

Augusta 10, 2012 – Maine Principals Association – Augusta

Open to all health professionals responsible for managing and supporting childhood vaccine programs including physicians, nurse practitioners, physician assistants, and practice managers.

For more information or to register, click here


2012 New England Clinical Symposium & Workforce Summit 

August 23, 2012 

Holiday Inn By the Bay, Portland

Maine Primary Care Association and the Maine Office of Rural Health and Primary Care will host their first Summit  featuring two prominent keynote addresses, an 'Ask the Expert' Roundtable/World Café, a clinical track on caring for aging New England and a workforce development track. 

For more information or to register, click here


17th Annual Northern New England Conference on Child Maltreatment 

September 13 & 14, 2012

University of New England Campus Center, Biddeford, ME 

The goal of this conference is to provide multi-disciplinary training to increase professional skills and knowledge of professionals who are involved in child abuse prevention, recognition, evaluation, reporting, investigation, treatment and all forms of child maltreatment. 

For more information, email spec@spurwink.org or call 207-321-6080 x 3311. 


First Annual Let's Go 5210 Childhood Obesity Conference 

September 27 & 28, 2012

Maine Health Conference Center, 110 Free Street, Portland 

For anyone who works 1:1 with patients and families.  Learn how to build capacity in your practice, in your community and for your patients. 

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Maine Vaccine Board Provider Loss Mitigation Fund Claims Due June 30

If you are a Maine Provider who administered vaccines to minors between January 1, 2012 and April 30, 2012, and reimbursement was denied by an insurer, then you may be eligible for reimbursement by the Maine Vaccine Board under its Provider Transitional Loss Mitigation Program.

The Maine Vaccine Board (MVB) recognizes that as the new universal vaccine program for children began on January 1, 2012 providers may have unused vaccine which they previously purchased for use in children under the age of 19.  The MVB is concerned about transitional costs borne by providers as this new program is implemented.  Many insurers will continue to reimburse providers for use of purchased vaccine, but some may not.  To lessen the potential financial burden on providers, the MVB has established a process to reimburse providers at least a portion of the cost of purchased vaccine if reimbursement is denied by an insurance carrier. This applies only to vaccines administered to children from January 1, 2012 and through April 30, 2012.

For more information or to submit claims to the Loss Mitigation Program, please visit the MVB website at http://www.mevaccine.org/mevaccine.nsf/pages/provider-ptlmp.html.  Claims must be post marked no later than June 30, 2012.  [return to top]

Prepare for Version 5010 - Enforcement Deadline Coming June 30

Version 5010 refers to the standards that HIPAA-covered entities (health plans, health care clearinghouses, and certain health care providers) must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses.

All covered entities should have been fully compliant with Version 5010 by January 1, 2012; however, an enforcement delay is in effect until June 30, 2012.

Regional CMS staff are hosting an informative webinar for healthcare providers, clearinghouses and vendors on Version 5010 on June 20th from 10:00 am - 11:00 am.  Topics include:  Current Conversion Statistics, Final Preparations for 5010/D.0 Cutover, Operational Concerns and Future of EDI Communications.  CMS will be distributing call registration information as the date approaches. 

MaineCare also reminds practices that If your organization submits electronically in batches to MaineCare, you must complete certification testing by June 30, 2012. To certify, log in to the MIHMS Health PAS Online Portal. If you are unable to submit HIPAA Version 5010 transactions after June 30, 2012, you will be required to submit via Direct Data Entry (DDE) or through paper claims. On July 1, 2012, any HIPAA Version 4010 transactions submitted electronically in batches to MaineCare will be rejected.  Testing resources are available. Visit the HIPAA Version 5010 webpage for background information, testing instructions, and Frequently Asked Questions about testing HIPAA Version 5010 transactions with MaineCare. [return to top]

June 30 Deadline to ePrescribe and Avoid 2013 Penalty

In January 2009 the Centers for Medicare & Medicaid Services (CMS) began offering eligible providers incentive payments for their use of an electronic prescribing (ePrescribing) system to prescribe for Medicare patients.

Eligible professionals need to report 25 separate electronic prescribing events during the reporting period (2012 calendar year) to receive an incentive and 10 times before June 30, 2012 to avoid a 2013 penalty.  

Individual eligible professionals may be subject to a 1.5 reduction in Medicare payments in 2013 unless they are successful ePrescribers before June 30, 2012 (report 10 unique ePrescribing events for CPT codes reported on Medicare Part B claims with the G8553 code).  A number of exceptions do apply.   To learn more about the exceptions and how to request and exemption from CMS, click here to view the AMA website on the ePrescribing program. 


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Quality Counts Announces Maine PCMH Pilot Expansion

To:  Maine Primary Care Practices

 We are writing to notify the Maine primary care community of a potential opportunity to increase the planned expansion of the multi-payer Maine PCMH Pilot to include up to 50 qualified adult primary care practices. 

Maine's participation in the CMS MAPCP demo currently brings in approximately $2.5M per year in new Medicare payments to the 22 adult Pilot practices ($1.7M) and the 8 Community Care Teams (CCTs) ($720K).  Bringing in the planned 20 new practices is expected to bring in approximately $2.5M of additional Medicare payments to practices and CCTs (i.e. nearly doubling that revenue).  Bringing in an additional 30 new practices could be expected to bring in an additional $3.4M in new Medicare payments to these new practices and CCTs.   

In order to proceed, CMS requires that the other payers agree to participate, and that Pilot Conveners offer the same level of practice transformation support for all practices in the Pilot. While we fully recognize the importance of this opportunity, resources do not currently exist to provide this practice transformation support for an additional 50 practices, and we do not have sufficient time to secure additional grant resources  in the  required timeframe.  Given that, we are proposing that new practices selected for the Pilot contribute a modest per member per month (pmpm) payment to support these required practice improvement activities.

 While final approval of this additional expansion of the Pilot is contingent upon these additional steps and subject to CMS approval, we feel that it is highly possible that we will be allowed to proceed.  Given that, we are re-opening the online application process for the Maine PCMH Pilot and the MaineCare Health Homes initiative for a 2 week period, from Friday, April 20 through 5PM on Friday, May 3.  Please follow this link to the QC website where we have posted comprehensive information, along with an updated timeline and eligibility criteria.        

We appreciate your interest in and support for the Maine PCMH Pilot.    

Maine PCMH Pilot Conveners,

Karlynee Harrington, DHA's Maine Quality Forum
Lisa M. Letourneau MD, MPH, Maine Quality Counts
Elizabeth Mitchell, Maine Health Management Coalition 


For questions on the Maine PCMH Pilot, contact Nancy Grenier at tel. 240-8767 or ngrenier@mainequalitycounts.org

For questions on the Maine PCMH Pilot Community Care Teams (CCTs), contact Helena Peterson at tel. 266-7211, or hpeterson@mainequalitycounts.org

For general questions or clinical concerns, contact Dr. Lisa Letourneau at tel. 415.4043 orlletourneau@mainequalitycounts.org 

For questions about the MaineCare Health Homes program, contact Michelle Probert at tel. 287.2641, ormichelle.probert@maine.gov.

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