July 16, 2012

 
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Three More Accountable Care Organizations in Maine Approved by HHS

Three Maine healthcare organizations will join Eastern Maine Healthcare Systems as Accountable Care Organizations under the Medicare shared savings program which is intended to provide a financial incentive to improve the health and lower the costs of Medicare patients.

The U.S. Department of Health and Human Services announced last week (July 10) that three more Maine healthcare organizations were approved to participate as ACOs in the Medicare shared savings program.  They stand to earn back a portion of any savings they realize from better management and coordination of patient care. The three organizations join Eastern Maine Healthcare Systems which was approved as a Pioneer ACO late last year.  

The three are:

  • MaineHealth, with nearly 1600 physicians
  • Central Maine ACO, with nearly 600 physicians
  • Maine Community Accountable Care Organization  LLC, with 126 physicians

They were among 89 selected nationally to participate in the program for three years beginning July 1, 2012.  

The largest of the projects, involving MaineHealth, will include approximately 35,000 Medicare patients.

Central Maine ACO is associated with Central Maine Healthcare and includes over 12,000 Medicare patients.  

The Maine Community Accountable Care Organization was developed through the efforts of nine federally qualified health centers and the Maine Primary Care Association.  Universal American is a partner in the initiative.

The ACO program was included in the Affordable Care Act, upheld as constitutional by the United States Supreme Court late last month.  Click here for the full announcement from HHS.

Not Too Late to Register for 21st Annual Practice Education Seminar, July 25

It is not too late to register for MMA's 21st Annual Practice Education Seminar.  In the aftermath of the Supreme Court decision, MMA has added an additional ACA track to the Seminar being held at the Augusta Civic Center on Wednesday, July 25th from 8:30 a.m. to 4:30 p.m. 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 lmartin@mainemed.com.  The full brochure (without the ACA track) 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 pre-litigation screening panels in the 1980s when he served as legal counsel to Susan Collins when she was Commissioner of Professional & 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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Watch Your Mail for Annual Session (Sept. 7-9) Registration Materials

Registration materials for the Association's 159th Annual Meeting will be mailed to all members this week, along with a letter from the Nominations Committee soliciting volunteers for Board vacancies and committee positions.  The meeting will be held in Bar Harbor again this year, at the Bar Harbor Hotel and Marina, September 7-9th.  The Friday afternoon educational program will be held at the Jackson Laboratory.  

The theme of this year's CME program is Caring for Our Elders and the keynote speaker is well-known author and geriatrician Dennis McCullough, M.D.  Dr. McCullough is the author of the best-selling book entitled, My Mother, Your Mother, Embracing Slow Medicine (2008). He is also the co-author of The Little Black Book of Pediatrics.  Dr. McCullough is associated with Dartmouth Medical School and resides in Norwich, Vermont.

On Saturday evening, MMA President Nancy M. Cummings, M.D. will  present the Presidential gavel and medallion to in-coming President Dieter Kreckel, M.D.  Dr. Kreckel is a family physician practicing in Rumford. He is a former President of the Maine Academy of Family Physicians.

While your materials are in the mail, interested members may also register now on the Association's website.

 
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Governors, Medicaid Directors Seek Guidance Following High Court's Ruling

The nation's governors and state Medicaid directors have asked the Department of Health and Human Services for guidance following the U.S. Supreme Court's June 28th decision to make a planned Medicaid expansion optional as part of its ruling on the health reform law.

In separate letters, the National Governors Association (NGA) and National Association of Medicaid Directors (NAMD) requested that HHS and the Centers for Medicare & Medicaid Services clarify a number of issues facing the states as they consider whether to participate in the major Medicaid expansion contained in the Patient Protection and Affordable Care Act.

Along with upholding the ACA's requirement that most Americans obtain health insurance, a majority of the court also upheld the ACA's expansion of Medicaid to people with income up to 133 percent of the federal poverty level.  However, the court said states must be able to opt out of the expansion without any threat of losing their current federal Medicaid funds.

“Our nation's governors are now grappling with new questions related to the Medicaid expansion, and clear guidance from HHS would help to inform decisions around what is best for each state,” NGA Executive Director Dan Crippen wrote in a July 2nd letter to HHS Secretary Kathleen Sebelius.

To encourage states to participate in the Medicaid expansion, which is scheduled to begin in 2014, the ACA provides that the federal government will pick up 100 percent of the states' expansion costs—with an enhanced match rate known as the federal medical assistance percentage (FMAP)—during the first three years, phasing down to 90 percent by 2020.

Among the questions NGA addressed to Sebelius were the following:

  • Will states that expand Medicaid coverage up to a level below 133 percent of the federal poverty limit (FPL), for example up to 100 percent FPL, still receive the enhanced FMAP available for “newly covered” populations?
  • Will states be allowed to phase in Medicaid coverage up to 133 percent of FPL in years after 2014 and still receive the enhanced FMAP?
  • If a state opts not to pursue Medicaid expansion as written in the ACA, what other Medicaid provisions of the law would apply to their state's program?
  • What options and federal assistance are available for states that decide not to pursue Medicaid expansion as written in the ACA?

The NGA letter emphasized that Medicaid expansion “will be an important point of discussion” at the group's annual meeting, held July 13-15 in Williamsburg, Va.

Medicaid issues have been making headlines in Maine recently, with Governor LePage not yet making a decision on whether to accept the increased funding to expand MaineCare but interpreting the Supreme Court decision to allow the State to move forward with cuts to MaineCare eligibility passed by the legislature this spring in the meantime.  Democrats, including U.S. representative Chellie Pingree, have weighed in with their view that the State is still not authorized to make these cuts. 


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CMS Releases Proposed Medicare Physician Fee Schedule for 2013

As expected, the Centers for Medicaid & Medicare Services (CMS) on Friday, July 6th released the Proposed Medicare Physician Fee Schedule for next year.  Also as expected, the proposed reduction in physician fees because of the sustainable growth rate formula is 27 percent. 

The proposal would increase payments to family physicians by approximately 7 percent and other practitioners providing primary care services between 3 and 5 percent, according to CMS.  The 7 percent increase would be before the statutorily mandated 27 percent cut. CMS also said it is proposing for the first time to pay for the care required to help a patient transition back to the community following a discharge from a hospital or skilled nursing facility by creating a new procedure code to recognize the additional resources required.  The proposed rule also addresses the next phase in a plan to enhance the Physician Compare website that would give beneficiaries more information for purposes of choosing a physician.

The AMA, national medical specialty organizations, and state medical societies, including MMA, will all be busy the remainder of this year advocating to members of Congress that access to care for Medicare patients would be severely impaired by fee reductions of the magnitude currently in the schedule.  In previous years, facing similar draconian cuts, Congress has stepped in at the last minute and restored the cut (most recently in December 2011).  But, it is becoming more and more difficult to do so given the current D.C. climate and the focus on the increasing federal deficit.  

A link to the full regulation can be found here

 
 
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MDs Suggest Features for New Pay System But Acknowledge Changes Will Take Time

Five physicians representing major medical groups told the Senate Finance Committee July 11th that a new Medicare payment system should include such features as value-based compensation, bundled payments, medical homes, and the availability of current data.

The physicians acknowledged, however, that instituting such changes will take time.

The roundtable discussion was the third the committee has assembled in its quest for a replacement to the sustainable growth rate payment formula.  Previous panels represented private payers and former Centers for Medicare & Medicaid Services administrators

Panelist Ardis D. Hoven, president-elect of the American Medical Association, said that “restructuring our Medicare payment and delivery system is an enormous undertaking that requires initial immediate steps that can advance us further down the road, combined with a long-term strategy that takes us to the finish line.” Congress should require CMS to establish models that coordinate Medicare and private payers' efforts and those that focus on limited bundles for physicians' services or episodes of care, she said.

 Other speakers included Barbara McAneny, who represented the American Society for Clinical Oncology; Glen Stream, president, American Academy of Family Physicians; W. Douglas Weaver, past president, American College of Cardiology;  and Frank Opelka, a fellow with the American College of Surgeons. 

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OMB Extends Review of Omnibus HIPAA Rule, Delaying Issuance of Final Regulation

The White House Office of Management and Budget (OMB) has extended its review of the final rule that will update Health Insurance Portability and Accountability Act regulations.

The agency's review of the final rule was expected by late June, but OMB has updated its website that gives the status for rules under review, noting the extension. OMB does not publish a date for when reviews are expected to be completed.

OMB received the final rule from the Department of Health & Human Services Office for Civil Rights on March 24th, and the review had been expected to take about 90 days, according to OCR officials. OMB review marks the final stage of the rulemaking process.

The rule covers four previously released proposed and interim final rules:

  • a final breach notification rule,

  • a final HIPAA enforcement rule,

  • a final rule implementing changes to HIPAA's privacy and security standards, and

  • a final rule modifying HIPAA's privacy rule in accordance with the Genetic Information Nondiscrimination Act.

When the final rule is released, the Maine Medical Association will be publishing an updated sample Business Associates Agreement and Notice of Privacy Practices. 


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MaineCare Gathers Input on Opioid Benefit Redesign

Kevin Flanigan, MD, Medical Director of MaineCare Services, convened an advisory committee today to provide input on how to implement the changes to MaineCare opioid coverage and other pain management issues contained in the supplemental budget that passed by the legislature in May.  As a reminder, a summary of the provisions in the budget can be found on the MMA website, here, and include limits on prescriptions of opioid medication for acute pain, requirements for patients to participate in alternative interventions before receiving prescriptions for chronic pain, prior authorizations before patients with certain diagnoses can receive opioid medications, and generating reports for prescribers showing how their prescribing patterns compare to their peers. 

The advisory committee meeting was well attended, including a number of physicians and MMA staff.  The committee largely discussed its process for reviewing draft recommendations and began to discuss in more detail the issue of generating reports with prescribing data.  The group will meet regularly to discuss each of the elements in the budget proposal and Dr. Flanigan plans to present a draft policy to MaineCare administration this fall.  The policy will have to go through formal rulemaking and Dr. Flanigan did not give a final effective date for the changes.  The advisory committee has scheduled its next meetings for August (dates have been changed so watch the Update for specifics).

The policies and rules will not be finalized prior to the effective date of the legislative proposals so watch these updates to learn about how the MaineCare staff will handle these issues in the transition. 

 
 
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MMA Seeking Volunteers for Board and Committee Positions, Physicians Action Fund

Any membership association is only as strong as the engagement of its voluntary leadership.  The new MMA Nominations Committee, established in the new bylaws adopted last September and chaired by former President Stephanie Lash, M.D., is seeking volunteers for seven Board of Director positions and several committee positions, including positions on the Legislative Committee, the Public Health Committee, and the Membership & Member Benefits Committee.  If you are interested in being considered for one of these positions, or would like more information, please contact Diane McMahon at 622-3374 x 214,  dmcmahon@mainemed.com or EVP Gordon Smith at 622-3374 x 212, gsmith@mainemed.com.

The MMA is also seeking members who are interested in serving on the Board of the Maine Physicians Action Fund. MPAF is a nonpartisan political action committee established by the Maine Medical Association. MPAF works to support and elect pro-medicine candidates in Augusta and across Maine. MPAF also works on the Federal level with AMPAC, the AMA's political action committee, to support medicine-friendly candidates across the country who are seeking election to the U.S. Congress.  MPAF's work is particularly critical in an election year such as this.  Any interested member should contact Gordon Smith, Andy MacLean at 622-3374 x 214, amaclean@mainemed.com or Maureen Elwell at 622-3374 x 219, melwell@mainemed.com.   

 
 
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Job Openings

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.

07/23/12

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.

07/30/12

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 kmillsap@cmglp.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

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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

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3rd Annual Maine Telehealth Conference 

August 14, 2012

Colby College, Waterville

The conference will feature talks on new and emerging clinical telemedicicne programs, Legal and Regulatory issues related to Tele-healthcare programs, IT and Management, Telehealth options for primary care, Updates on Reimbursement for Telehealth Services. 

For more information, or to register, click here

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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. 

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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

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3rd Annual Patient Safety Academy

September 7, 2012

USM Portland Campus, Abromson Center 

Join colleagues and other health care professionals this September in an engaging and thought-provoking day of presentations, workshops, and skill-building activities designed to advance patient safety throughout the state and region.

For more information or to register, click here

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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. 

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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.

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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.  

For more information and registration information, click here

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Maine CDC Infectious Disease Conference 

November 13, 12012

Augusta Civic Center, Augusta, Maine

Presenting a review of emerging issues in the field of infectious diseases, particularly as they impact the Maine medical community. 

For more information or to register, click here[return to top]

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