What the Supreme Court Decision Will Mean for Maine's Physicians
While only three days have passed since the release of the United States Supreme Court decision upholding the Affordable Care Act in the face of a constitutional challenge by 26 states and other plaintiffs, speculation abounds regarding what the decision means for Maine.
One of the major areas of speculation involve the establishment and operation of the so-called health insurance exchanges which are to be operational in 2013 and ready to accept enrollments in 2014. The Maine Legislature adjourned this year without taking substantial action to create the infrastructure to create an exchange, setting up the very real possibility that the exchange in Maine will be operated by the federal government.
As reported in the New York Times on Friday, and as experienced by MMA lobbyists this winter and spring, a number of Republican-led states gambled on delay and as a consequence, face the prospect of the federal government taking over responsibility for the health insurance marketplace, where people will be able to choose among policies for their coverage. Under the law, which was virtually entirely upheld by the court in a 5 to 4 vote, individuals must be able to buy insurance coverage through the new state exchanges by January 1, 2014. But a more immediate deadline occurs on January 1, 2013, when states must demonstrate to HHS that the exchanges will be operational the next year. Otherwise, the federal government will take steps to establish a federal exchange.
The other speculation involves whether Maine will participate in the significant Medicaid expansion in 2014, which is paid for with 100% federal dollars in 2014 and 2015 with federal participation gradually decreasing to 90% in 2020. While a majority of the Court ruled that the Medicaid expansion was constitutional, it also ruled that the federal government could not penalize states for noncompliance by withholding their existing federal Medicaid dollars.
Without this penalty, many states, such as Maine, may simply refuse the money for the expansion. Governor Paul LePage released a very negative statement about the court decision on Thursday and DHHS Commissioner Mary Mayhew released a statement announcing that the LePage administration upon reviewing the language in the decision no longer believed it was necessary to seek federal approval to implement the action of the legislature earlier this year to remove up to 14,000 MaineCare enrollees from the program.
The federal government estimates that eventually an additional 32 million Americans will gain health insurance through public or private coverage by 2019, with 24 million obtaining coverage through the exchanges and about 16 million qualifying for Medicaid coverage through the Medicaid expansion. The majority of individuals buying through the exchanges will be eligible for subsidies available to persons earning up to 400% of the federal poverty level. If the exchanges are successful and Medicaid is expanded in Maine, hospitals, physicians and other health professionals will face a significant influx of new patients.
The nuances of the decision and the dissenting opinions are still being reviews. And, of course, the election in November will provide the opportunity for the voters to express their opinion at the ballot box.
MMA's full press statement on the decision is available here on the MMA webpage. MMA has added a track on ACA implementation at the July 25th Practice Education Seminar, see the article below. Registration is available for the Seminar on the MMA website.
Office of the Fire Marshal Seeking Data on Consumer Fireworks Related Injuries
The Office of the Fire Marshal would greatly appreciate the assistance of Maine’s medical community in tracking consumer fireworks related injuries. The purpose of reporting these injuries is to assist the Fire Marshal in developing any necessary statutory, rule, or policy changes essential to minimizing the frequency of fireworks injuries in Maine.
The Office of the Fire Marshal has developed a Consumer Fireworks Injury Report that attempts to collect data necessary for the Fire Marshal’s regulatory effort without being an undue burden on the medical community. The report form is available from the Office of the Fire Marshal website and also the MMA homepage, here. You also may call or email the MMA staff for a copy of the form.
Despite strong objections from the MMA, the Maine Society of Eye Physicians & Surgeons (MSEPS), the Maine Chapter of the American Academy of Pediatrics, the Maine Chapter of the American College of Emergency Physicians, and other public safety advocates, the 125th Maine Legislature enacted L.D. 83, An Act to Legalize the Sale, Possession and Use of Fireworks (P.L. 2011, Chapter 416) during its First Regular Session in 2011.
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Retail consumer fireworks locations are opening around the state and with the 4th of July holiday upon us, people will be using consumer fireworks and the medical community must anticipate and prepare for injuries from use of those products.
You can find more information about Consumer Fireworks in Maine on the Fire Marshal’s web site.
Report on Third Meeting of Prescription Drug Abuse Task Force
The 17- member Prescription Drug Abuse Task Force met on Tuesday, June 26th for the third time and reviewed an interim report prepared for the Governor who had appointed the Task Force along with Attorney General William Schneider. Each of the four subcommittees created by the group had prepared a summary of its activities and recommendations for the draft interim report which is expected to be sent to the Governor next week.
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The Task Force has met monthly while the subcommittees have been meeting more frequently to work on the major goals. The work of the Task Force is expected to continue over the next six months.
Among the several recommendations are the following (we are highlighting those of particular interest to physicians).
Safe Disposal. This subcommittee focused its efforts on creating solutions in three areas:
- Solutions for disposal of collected unwanted medications which provide for environmentally safe, legal and affordable options to facilitate and enhance collection programs;
- Solutions that provide consistency among various regulatory jurisdictions to provide for safe, legal and consistent requirements to facilitate and enhance the collection of unused/unwanted medications;
- Solutions that provide for consistency among messages and outreach programs among diverse audiences to provide similar messages regardless of the audience.
The DEP has clarified the requirements of waste disposal options for collection programs to follow. Currently, there are 51 disposal drop boxes available statewide. And because of changes regulations at the DEP, more of the discarded drugs will be able to be incinerated in Maine at much lower cost than out of state.
Diversion Alert. This subcommittee worked exclusively on the diversion alert program, recognizing the necessity of establishing a statewide system for notifying providers about people who have been arrested and charged with criminal drug offenses in their area. The subcommittee recommended the pursuit of a two year pilot project that expands Diversion Alert to all sixteen counties. At the end of the project, an independent thorough evaluation will be undertaken to determine the continued efficacy of the program. A planning grant from the Maine Health Access Foundation will be pursued.
Education. The subcommittee was charged with creating and implementing an evidence-based community education campaign to aimed at preventing prescription drug abuse. The subcommittee made three primary recommendations, as follows:
- Use the web to promote greater public awareness of current efforts to address this issue, including the work of the Task Force and its subcommittees.
- Actively share with community-based prevention professionals the work of the Task Force and the broad range of resources available to them.
- Advocate for and obtain the additional resources needed to prepare and implement an evidence based community education campaign that fits Maine's current needs, resources, and community readiness to address he prescription misuse prevention problem.
Prescription Monitoring Program.
- Interstate Data Sharing. Current legislation enables this effort and a federal funding source exists to support testing, implementation and maintenance.
- Real Time Reporting. Current law enables OSA to change pharmacy reporting requirements, but it would require a change in Rules governing the Prescription Monitoring Program to ensure compliance. A federal funding source exists to support testing, implementation and maintenance.
- Ongoing Financial Support for PMP Promotion Efforts. Currently, the PMP is heavily reliant on federal funding sources for staffing, partial operations and enhancements and maintenance costs. The subcommittee strongly recommends consideration of other funding sources to ensure program sustainability, as well as funding to allow for sustained and appropriate staffing capacity to ensure full program capacity may be reached and successful outcomes are maintained.
- Changing the Level at which Law Enforcement may Request PMP Data. Allowing greater access to the data by law enforcement would require a change to the statute.
- Institutional Policies for PMP. Several major healthcare institutions have internally developed policies for the mandated registration and utilization of the PMP as a best practice and appropriate standard of care. The Task Force recommends that these policies and practices be encouraged and supported statewide.
- Utilization of the PMP by all professional health licensing boards and MaineCare. The subcommittee recommends the review of current utilization of PMP data by authorized investigators (specifically those from professional licensing boards and MaineCare) and collaborative effort between those offices and OSA to ensure that policies and procedures for investigators allow for PMP data to be utilized to its fullest extent.
- Prescriber Rankings. This recommendation was included in the State's supplemental budget, in order to provide MaineCare providers the opportunity for self-education and review. This enhancement to the PMP has an associated cost and no current funding.
- Adjusting Threshold Levels for Unsolicited Reports. The subcommittee recommends that the PMP Advisory Board review current levels, as well as evidence-based research, and best practices from other state PMP's and adjust the thresholds as necessary. The PMP Advisory Board has recommended the review of current thresholds and a reevaluation of current levels.
The Task Force meets again on Tuesday, August 21 at 3:00 pm in room 208 of the Cross Office Building in Augusta. Members of the Task Force requested presentations on controlled substances contracts with patients and a report on activities and observations of the licensing boards.
Steven Gressitt, M.D. is the sole physician on the Task Force. MMA EVP Gordon Smith represents MMA. Any questions may be directed to Gordon via e-mail to email@example.com.
Additional Presentations on ACA Added to Practice Education Seminar on July 25
In the aftermath of the Supreme Court decision, MMA has added an additional ACA track to the 21st Annual Practice Education Seminar being held at the Augusta Civic Center on Wednesday, July 25th from 8:30am to 4:30pm. During each of the three breakout sessions an ACA session will occur, beginning with an overview of the recent Supreme Court decision and what it means for Maine's physicians, hospitals and patients. The second presentation will focus on the Medicare annual wellness visit provided for in the law and the final break out will be a limited-enrollment focus group with practice staff and physicians on how ACA implementation should proceed in Maine.
Registration is available on the MMA website or by calling Lisa Martin at MMA at 622-3374 ext. 221 or via e-mail to firstname.lastname@example.org. The full brochure is available here.
The keynote presenter for the event 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 now that the Supreme Court has issues its ruling. She is also expected to comment upon the recently established CO-OP in Maine, Payment Reform and Health Information Exchange.
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:
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- 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!
ePrescribing Hardship Exemption Deadline Extended Through Today, July 2
CMS has published a notice extending the June 30th deadline for filing an ePrescribing hardship exemption to July 2nd. CMS appears to be doing this because there are some computer system updates underway for the Communication Support Page. The AMA has communicated its strong concerns with the challenge this presents for physicians and has requested a longer extension of the deadline.
The AMA has also learned that some physicians with Apple computers are having challenges submitting their hardship exemptions. The AMA has urged CMS to address this issue and is also utilizing this information to press CMS to further extend the deadline.
The AMA strongly recommends that any physician who remains unable to submit a hardship exemption request by the end of the day (11:59pm ET) on July 2nd through the Communications Support do the following:
- Document any calls and emails you have with the Communications Support webpage team and retain these for your records.
- Send an email to the CMS ePrescribing email box to indicate that you were unable to file online, state the reason why, and indicate which hardship you are applying for at eRx_hardship@cms.hhs.gov.
CMS also advises eligible professionals who experience difficulties accessing the Communication Support Page outside of the maintenance hours stated above to please contact the QualityNet Help Desk.
QualityNet Help Desk – Monday– Friday, 7:00 AM – 7:00 PM CST
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MMA Hosts Forum on Physician Role in Payment Reform
Last Wednesday, the Maine Medical
Association hosted a successful forum on physician payment reform featuring
national expert Harold Miller. Mr. Miller is CEO of the Center for
Healthcare Quality and Payment Reform and is a frequent speaker around the country on how physicians can engage in the issues of reducing health care costs and payment reform.
Approximately fifteen physicians attended the event, representing a mix of specialties, primary care and in-patient and out-patient settings.
Mr. Miller opened the evening with a slide presentation on how
to find "win-win-wins" in saving health care dollars and improving care. According to Mr. Miller, one of the fundamental
impediments to improving value in health care is that efforts to improve
quality and reduce cost in health care are often perceived as being at odds
with each other. Yet in health care, there are easily
identified examples where improvements in quality and cost are possible. For
example, reducing healthcare-acquired
infections and hospital readmissions. The key is to find areas
where money can be saved and then determine how to align payment and distribute
the savings so all parties benefit. For
example, with health care acquired infections, hospitals will actually lose revenue if
fewer people experience infections and therefore do not require follow up care. A payment reform solution is for hospitals to be paid more for good outcomes (out of a portion of the saving that would otherwise
only go to the payer) but not at all for follow up needed to treat hospital acquired infections.
The second half of
the evening was spent with the physicians attending brainstorming areas where savings can be
found and how to accomplish reforming the payment incentives to make these
changes happen. Examples included reducing unnecessary imaging, reducing ambulance use to reach the emergency room, and reducing unnecessary colonoscopies for young people.
The event was presented through the
generous support of the Maine Health Management Coalition and was also
co-sponsored by the Maine Osteopathic Association and Quality Counts
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You can find more information on Mr. Miller and his research on payment reform at his organization's website, http://www.chqpr.org.
Reminder that Annual MMA Benefit Golf Tournament is Monday, July 30
There are still slots available in the Annual MMA Charitable Golf Tournament being held at the Augusta Country Club on Monday, July 30 following postponement of an earlier June date because of inclement weather. The event begins with lunch served on the deck at 11:00am followed by a shotgun start at noon. Refreshments and awards follow after the golf.
The net proceeds of the tournament this year will benefit the Medical Student Scholarship Fund within the Maine Medical Education Trust. The scholarships will be given to Maine students attending medical school once a principle amount has been raised.
Contact Lisa Martin at MMA at 622-3374 ext. 221 or via e-mail to email@example.com. Individual golfers can be accommodated at $125 per golfer with teams at $500. Hole sponsorships are also available for $500.
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Treat yourself and join us at the beautiful Augusta Country Club on July 30!
AMA Helps Physician Practices Navigate Private Payer Audits
Physician practices may be subject to as many as 20 different types of federal, state and private payer audits including many that may involve payers retrospectively demanding partial or whole recoupment of previously paid claims. To help physician practices navigate payer audits, the AMA has created an audit webinar series. The first in this series, “Private payer audits: What you need to know,” attracted a live audience of over 150 physician practices and reviewed: the various types of private payer audits; how physicians can minimize their risk of being audited; what physicians should do if they are audited; and, what actions physicians can take if the audit results in recovery payments. The presenter, Dennis Mihale MD, MBA, is a Partner and Chief Medical Officer with Sunera, a health care auditing firm that focuses on medical records, technology audit, and HIPAA compliance. The webinar has also been archived for physicians and their practice staff. [return to top]
Study Predicts Health Care Will Produce 5.6 Million New Jobs by 2020
A new study by the Georgetown University Center on Education and the Workforce concludes that the nation's demand for health care services will grow at twice the rate of the national economy and will be 20% of GDP and will create 5.6 million new jobs in the next 8 years. The study describes the following 4 classes of health care workers:
- allied health care professionals
- paraprofessional health care support
According to the study, 3.4 million of those new jobs will be for allied health care professionals, defined as individuals with formal education and clinical training, including "a variety of technologists, technicians and related professionals who support care delivery in health care facilities, practitioner offices, and community settings." Growth in this category is attributed in part to the complexity of health information technology and its ever-increasing role in our health care system.
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Thirteen percent of all jobs in America will be in the health care industry by 2020 according to the report and 82% of these jobs will require postsecondary education and training.
Dr. Berwick Identifies 6 Key Problems in Health Care Today in Speech to Health Lawyers
Former CMS Administrator and Harvard professor Donald M. Berwick, M.D. addressed health lawyers last week at the American Health Lawyers Association annual meeting in Chicago. He said the the PPACA is the country's best chance to achieve health care reform in the next decade and that policymakers need to concentrate on eliminating waste and inefficiency in the health care system. His recent research suggests that $11 trillion of waste could be eliminated by focusing on six issues that account for most of the waste and inefficiency problems:
- Overtreatment. We pay far too much for procedures, medications, and therapies that are unnecessary, redundant, or of no benefit to patients.
- Failure to coordinate care. We pay additional money too often because insufficient monitoring of patients' progress during treatment and lack of coordination among members of the treatment team.
- Failure in execution. We pay additional money too often because of sloppy execution.
- Pricing failures. Market forces do not have the same impact on pricing in health care, but strategies that encourage practitioners and patients to behave differently could produce substantial savings.
- Excessive administrative costs.
- Fraud and abuse.
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Dr. Berwick estimates that between 21% and 47% of total health spending could be eliminated by focusing on these six problems.
Job Openings - Psychiatrist in Rockport, Family Practitioner in Jonesport and Medical Director in Rockland
Psychiatrist Position in Rockport
Midcoast Medicine seeks psychiatrist for thriving half time practice in Rockport. 2-3 days per week established panel for many years inside family medicine group setting. Please call Chris McIntosh (207) 230-0698 for more information.
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 firstname.lastname@example.org, 207-497-5614.
Medical Director for Treatment Center in Rockland, Maine
Colonial Management Group, LP (CMG) operates a number of nationally recognized and accredited methadone treatment centers dedicated to helping these individuals and their families regain control of their lives. We take great pride in treating our patients with dignity and respect in each phase of their treatment experience.
Colonial Management Group, LP, is currently searching for a licensed physician to be the Medical Director for our treatment center in Rockland, Maine.
This position is a part time position for physicians, offering convenient work hours. Experience in substance abuse field is not required per specific state standards. ASAM (American Society of Addiction Medicine) certification preferred but not required. Qualified candidates must have current license to practice medicine in the state, board eligible or board certified. A valid DEA license is also required. Candidate must be able to prescribe schedule 2 and 3 drugs. Candidates must be able to pass a credit check, background check and drug screening.
Candidate will provide direct care, medical evaluation and consultation for patients on a daily basis. Candidate will need to cover approximately 9-12 hours per week between the hours of 5:30am-2:00pm. Hours can be built flexibly around physician’s current schedule. For more information, contact Karen Millsap at email@example.com or 407-351-7080 ext: 136.
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Upcoming Events & Conferences
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
Registration information available by clicking here.
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.
Rewiring the Brain
August, 20, 2012
Samoset Resort, Rockport
This seminar will examine the use of brain-based interventions to enhance outcomes with a variety of client populations. Keynote presenter John Arden, PhD.
More information will be posted here as the date approaches.
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. Target audience includes the clinicians and administrators of New England's critical access hospitals, community health centers, rural clinics and tribal health centers.
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 firstname.lastname@example.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.
For more information, click here.
11th Annual Downeast Ophthalmology Symposium
September 28-30, 2012
Harborside Hotel & Marina, Bar Harbor, Maine
The Maine Society of Eye Physicians and Surgeons will host the 11th Annual Downeast Ophthalmology Symposium in beautiful Bar Harbor, Maine once again this year. Offering 15.25 AMA PRA Category 1 Credits to ophthalmologists across the country.
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