October 15, 2012

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Highlights of October 10th MMA Board of Directors' Meeting

The newly re-organized twenty-five member MMA Board of Directors met this past Wednesday, October 10th and elected three at-large members of the Executive Committee, endorsed as policy four of the six Resolutions passed at the Annual Session, and voted to join the Maine Council on Aging.

Elected to serve one-year terms on the Executive Committee were Richard Flowerdew, M.D., Brian Pierce, M.D., and Charles Pattavina. M.D.  Dr. Flowerdew is an anesthesiologist practicing with Spectrum Medical Group.  Dr. Pierce is a family physician in independent practice in Rockport, and Dr. Pattavina directs the Emergency Medical Department at St. Joseph's hospital in Bangor.

Board members approved the following four Resolutions as MMA policy:

1.  Appropriate Use of Antibiotics;

2.  Support for our Public Health Infrastructure;

4.  Taxes on Beverages with Added Sweeteners; and

5.  Operation of Maine's Pre-litigation Screening Panels.

The Board deferred action on Resolution 6 entitled, Maintenance and Expansion of Health Care Coverage in Maine until the next Board meeting on December 5th.  The Board defeated a motion to endorse Resolution 4, Limits on the Possession of Dangerous Weapons, which under MMA policy will now be subject to a process by which the presenters of the Resolution, in this case the Public Health Committee, will be invited to attend the next board meeting for further presentation.

The Board also approved an invitation to join other organizations in establishing a new Maine Council on Aging (MCOA).  The MCOA intends to become a strong, collaborative, multidisciplinary group that represents the entire aging continuum of older adults in Maine which works to improve the lives of seniors in Maine, especially those who are vulnerable or disadvantaged.  The founding members of the Council included the AARP Maine Affiliate and the Maine Association of Area Agencies on Aging.

Board members were asked for input on the establishment of the new Committee on Annual Session which will plan next year's anniversary celebration and an audit committee.  Reports were also received on PAC contributions by the Maine Physician Action Fund and the anticipated legislative activity in the 126th Legislature convening in December.



Meet Your MMA Officers, Guy Raymond, M.D., President-elect

Guy Raymond, M.D. was elected President-elect of MMA on September 8th at the Annual Meeting of association members.  Guy is a long-time member of MMA and chaired the Medical Professional Health Program Advisory Committee from 2007 to 2011.  He is also a former President of the Aroostook County Medical Society and currently serves as President of the Medical Staff of Northern Maine Medical Center in Fort Kent.  He will become President of MMA on October 5, 2013 (the date of next year's annual meeting in Portland).

Guy is a native of the Fort Kent area and a graduate of Assumption College and the University of Vermont College of Medicine.  He completed a residency in Family Medicine at St. Margaret's Memorial Hospital in Pittsburgh, PA and is board certified in family medicine.

Following residency, Guy came home to Aroostook County and established a private practice in family medicine in Fort Kent, and for 13 years, also saw patients at an office in Madawaska.  In 1993, he accepted employment with Valley Medical Association and provided family medicine services in connection with VMA for several years before accepting a position as Medical Director of the NMMC emergency department.  He continues to practice full time in the emergency department at the Medical Center.  

Guy has been involved in many different health care organizations and activities during his medical career, including involvement with the Maine Health Alliance, the St. John Valley Hospice Program, and the Maine Health Policy Advisory Council.  In addition, he has been active in the community, serving on the Parish Council of St. Joseph's Parish in Wallagrass.  

Guy and his wife Nancy, a native of Vermont, are parents of four adult children and the proud parents of a new grandchild.  They reside in Wallagrass and enjoy many of the activities that the County has to offer, including golf, cross-country and alpine skiing, tennis, biking, and fishing.  Guy is also a very talented woodworker, having built many of the amenities in his home.

MMA appreciates the leadership of Dr. Raymond and we look forward to his continuing important role in the organization.



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Pain Management Policy Advisory Committee Meets

The MaineCare Pain Management Policy Advisory Committee, chaired by MaineCare Medical Director Kevin Flanigan, M.D., met last Tuesday morning to continue its work on the details of implementing the opiate limits which were part of the supplemental budget passed earlier this year.

The group has already completed its work reviewing the new MaineCare limits on prescriptions of opiates for acute pain.  Briefly, this will be a 15-day limit with a maximum of two 15-day refills, both requiring face to face visits and prior authorization.  This policy has gone to a DHHS policy writer to be finalized and then opened for public comment.  Dr. Flanigan told the group he expects the policy to be ready for implementation by January 1, 2013.  The group has also provided feedback on use of the prescription monitoring program to give prescribers data on how their opioid prescribing compares to their peers.   MaineCare plans by end of November or early December to provide prescribers with letters explaining the types of reports that will be generated and steps MaineCare will take if prescribing appears to be problematic. 

After receiving these updates, the Committee began to review proposed changes to coverage for opioids for chronic pain.  The group agreed with the policy to only cover less than 300 mg morphine sulfate equivalents per day, and prescribers with patients receiving more than this would have to submit a prior authorization outlining a taper plan.  The group also recommended that patients could receive a 15 mg dose per day before any prior authorization requirement or other restrictions would apply.    

The meeting was attended by representatives of the Maine Medical Association, Maine Osteopathic Association, Maine Hospice Council, Maine Equal Justice Partners, and several clinicians, including Dr. Noah Nesin, Dr. Stephen Hull, and Noel Genova, PA-C.  

Once all policies are finalized, Dr. Flanigan will be hosting webinars, conference calls, and education sessions on the pain management policies, as well as the recent changes to MaineCare coverage for suboxone and methadone.    [return to top]

U.S. Senate Candidates Debate Health Care System, Public Health Issues

The American Lung Association and American Cancer Society Cancer Action Network last Friday hosted a debate among the candidates for U.S. Senate focusing on issues of public health and health care.   All candidates attended except the Republican running, Secretary of State Charlie Summers, who cancelled his appearance.  Cynthia Dill (D), Danny Dalton (I), Andrew Ian Dodge (Libertarian), Angus King (I), and Steve Woods (I) answered questions related to the Affordable Care Act, Medicare, cancer research, tobacco prevention, and the Clean Air Act.   

The candidates offered thoughtful responses and generally shared more opinions than not.  When asked about the Affordable Care Act, Dalton stated that he opposes an insurance mandate and Dodge does not support the ACA and believes it will lead to rationing care; Dill, King and Woods stated support for the law.  The candidates all agreed that it is critical to preserve Medicare and Social Security though several suggested reforms that might make the program more cost effective.  Both Dill and King stated strong opposition to a Paul Ryan-like voucher program while Dalton stated that he was open to some changes for younger people.  All agreed that the FDA process for approving drugs needs to be streamlined and improved to help get medications to the market sooner and with less cost.  When asked about the Clean Air Act, only Dodge expressed some doubts about the burden of EPA regulations while the remaining four candidates expressed strong support for federal regulation of air quality.  

The question about tobacco prevention brought out personal stories from a number of candidates, led off by Steve Woods, who years ago worked for Miller Brewing Company and was very uncomfortable with the bowls of free cigarettes offered in the lobby.  He supports strong regulation to prevent cigarette use and limit promotion and marketing.   Dodge was the one candidate who did not state strong support for FDA regulation of tobacco and stated that the government should not be involved in personal decisions to "self medicate."  

MMA members are encouraged to vote on November 6th.  Any registered voter can also vote by absentee ballot rather than in person. The deadline to request an absentee ballot is Thursday, November 1st.  For more information, view the Secretary of State's Absentee Voter Guide[return to top]

Medicare Open Enrollment Period Begins Today, October 15th

Medicare Open Enrollment Period is now October 15 – December 7, so it is that one time of the year that your patients can look at their Part D and Medicare Advantage plans and assess whether it is serving their current needs.  In the course of a year, many things can change: new diagnoses, changes in prescription drug needs, among others.  While this is a very busy time of the year, we wanted to highlight some tips to help you and your patients:

  • Host a Part D enrollment clinic at your practice or facility
  • Connect with your local Area Agency on Aging, and advertise local Part D enrollment clinics at your practice or facility 
  • Let your front desk staff and patient assistance staff know what resources are available to patients who have questions (both at your practices as well as in the community) *This is critical for new staff members*

 While you’re having the discussion around Part D, it’s a great time to remind your patients how the ACA has lowered the cost of both their prescription drugs and preventive care.  Improvements include:

  • Improved coverage for preventive screenings, including: mammograms, colorectal cancer screening, depression screening and more. 
  • Discounted name brand and generic drugs, in the donut hole
  • New services, such as the Annual Wellness Visit, that are meant to keep your patients well, longer and engage in long term preventive care planning. 

For more information on Open Enrollment, you can refer your patients to your local Area Agency on Aging: 1-877-353-3771 or visit www.medicare.gov  

For online resources around changes to Medicare, visit Legal Services for the Elderly: http://www.mainelse.org/

For FQHC-specific materials and short videos on Medicare preventive services available to your patients, visit the MPCA Members Forum: www.mepca.org.

The development of this article was supported by the work of The Maine Health Access Foundation  as well as ten other nonprofits across the state, who are collaborating to disseminate accurate, direct and effective information about how the Affordable Care Act affects people in Maine. [return to top]

Sign Up to be the "Doctor of the Day" for the Maine Legislature

During the 1996 legislative session, the Maine Legislature asked the Maine Medical Association and the Maine Osteopathic Association to furnish a physician for each day of the legislative session to assist in the event of a medical emergency.  Now the “Doctor of the Day” program is well established and respected, and legislators are enthusiastic about it.  This is a unique opportunity to observe the legislative process in action and to interact with the lawmakers.  We need your help to continue our presence and to ensure the continued success of this program.

The scheduling of volunteers for the 126th Legislative Session has already begun.  We would like to invite you to participate in the upcoming session that is scheduled to convene in January and is expected to run through June. 

Upon receipt of your registration, MMA staff will contact you to arrange and/or confirm the most convenient date for you to serve.  The House Clerk’s office staff then will mail you a packet with a legislative parking pass and confirmation letter informing you about your scheduled date.  On the day of your participation, a Maine Medical Association or Maine Osteopathic Association staff representative will meet you at the State House and will be available to guide you throughout the State House.  

This is an effective grassroots contact program for organized medicine in Maine and it has established substantial "good will" for organized medicine at the State House.  The “Doctor of the Day” program gives you the unique opportunity to observe the process in which your legislators make decisions affecting you as a physician and as a citizen of the State of Maine.  

If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA legislative staff at 207-622-3374, or docoftheday@mainemed.com. You can also register on line at the MMA's website. We hope to see you at the State House for what is expected to be a very interesting session for the medical community. [return to top]

MaineCare Redesign Task Force Briefed on Savings Options by National Consultants

The members of the MaineCare Redesign Task Force, chaired by DHHS Commissioner Mary Mayhew, continue their work to find $5.25 million in General Fund savings in FY 2012-2013 through a comprehensive review of the MaineCare program.  The group met last Tuesday afternoon, October 9th, and most of their meeting was devoted to a briefing on short-term, mid-term, and long-term savings options by consultants Seema Verma with SVC and Robert Damler with Milliman.  You can find all of the materials from the meeting, including the Medicaid Cost Containment Strategies Powerpoint on the web at:  http://www.maine.gov/dhhs/mainecare-task-force/october09-2012/index.shtml.

The Task Force is next scheduled to meet on Tuesday, October 23rd.  The group must provide an initial report to the legislature's Appropriations and HHS Committees by November 15th.

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MaineCare Primary Care Provider Incentive Payments (PCPIP) Update

MaineCare has completed the PCPIP for eligible providers for the reporting period of 10/1/2010-9/30/2011.  Payments will be processed during the payment cycle week ending October 19th.   Electronic Fund Transfer (EFT) payments will be received during the week ending October 19th.  Paper checks will be mailed during the week ending October 26th.  Prior to payment, providers will receive a mailing that includes:

  • A Utilization Review report
  • PCPIP calculation details
  • Contact information for payment questions 

There may be some changes in payment amounts from prior PCPIP payments. These changes are for one of the following reasons:

  1. Office-based Primary Care Provider practices that are not an FQHC, RHC or affiliated with a hospital qualify for the PCPIP.   Some practice sites, also known as service locations, made changes that rendered them ineligible. Therefore, there were fewer service locations qualified to participate in the PCPIP program.
  2. With MIHMS implementation, many members were assigned to a rendering provider as their Primary Care Provider (PCP), rather than a service location.  In order to assign these members to a service location, PCPs were attributed to the service location where most of their MaineCare services were performed during the reporting period. For payment purposes, all members assigned to these PCPs were then attributed to that service location, as well.

For any questions regarding PCPIP, please contact PCP Network Services at 1-866-796-2463 extension 73320 or extension 76349. [return to top]

Maine Quality Forum Advisory Council Meets; Practices Sought for Patient Experience Survey

The Maine Quality Forum Advisory Council, chaired by Robert Keller, M.D., held a regular meeting last Friday, October 12th.  The agenda included:

  • a Dirigo Health Agency update by Director Karynlee Harrington;

  • an update on the L.D. 1818 work group and the Maine Health Data Organization;

  • consideration of staff/stakeholder recommendations for amendments to MHDO Rule Chapter 270, Uniform Reporting System for Quality Data Sets;

  • an update on the Patient Experience Survey project;

  • an update on the Patient Centered Medical Home project; and

  • a regular Patient Safety Report.

The Patient Experience Survey project is sponsored by the Dirigo Health Agency's Maine Quality Forum in collaboration with the Maine Health Management Coalition, Maine Quality Counts, and Aligning Forces for Quality.  The LePage Administration is working with the private sector to administer a uniform patient experience survey and to publicly report results.  The MQF selected the Clinician and Group Consumer Assessment of Healthcare Providers and System Survey (CG-CAHPS) because it is the gold standard and is used in all major national initiatives.  The target populations are adult patients of primary care and specialty care practices and the parents of children in pediatric practices.  The survey has a "look-back" of 12 months (versus "visit" survey which focuses only on the last visit).  

How can my practice site sign up to participate?

To participate in this initiative, practice sites (or medical groups or health systems on their behalf) must contract with one of the following Designated Vendors.  The following vendors have been selected by the DHA to administer a CG-CAHPS experience survey to patients served by primary care and specialty care practices in Maine.  Practice sites wanting to participate in this voluntary initiative and receive subsidies up to $8.60 per completed survey must contract with a designated vendor and agree to have survey results publicly reported. 

The four approved vendors are:

  • NRC Picker (contact Adam Waggoner, 402-475-2525);

  • Avatar International (contact Jennifer Beecher, 800-282-8274);

  • Metrix Matrix, Inc. (contact Brian Malaby, 888-865-0065, ext. 101); and

  • HealthStream (contact Kathy Gorman, 301-575-9310) - contract pending.

For more information about this initiative, please contact Alexander Dragatsi with the Maine Quality Forum at 287-9965 or alexander.dragatsi@maine.gov.

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Planned MIHMS Disaster Recovery Testing Rescheduled to November 10 12

Maine DHHS recently announced Disaster Recovery Testing on MIHMS, scheduled for October 11-13.

MaineCare will NOT perform the Disaster Recovery Test at the time previously scheduled. The Health PAS online portal will be available for normal activity during that time.

MaineCare has rescheduled the Disaster Recovery Test on MIHMS to 3:00 AM on Saturday, November 10, 2012 through 3:00 AM on Monday, November 12, 2012. The MIHMS Health PAS Online Portal will be unavailable during this time. [return to top]

CMS Distributes 2011 PQRS & Electronic Prescribing Incentives & Reports

The Centers for Medicare & Medicaid Services (CMS) announced that it has begun distribution of its 2011 Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-Rx) incentive payments and feedback reports.  Incentive payments for both programs amount to 1% of total estimated 2011 Medicare Part B Physician Fee Schedule allowed charges for covered professional services furnished during the reporting period.  Incentive payment distribution began in late September and will continue into early November.  For more information on how to access 2011 PQRS and e-Rx feedback reports, please visit the CMS QualityNet portal at:  https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.

CMS will convene a National Provider Call on October 23rd from 1:30 to 3:00 p.m., EDT, to help address questions regarding the 2011 PQRS and e-Rx incentive payments and feedback reports.  You can find information about the call at:  http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2012-10-23-PQRS-eRx.html.

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Job Openings

MD/DO Position Available in Dexter, Maine

Sebasticook Family Doctors is accepting applications for a MD/DO at our busy Dexter location.  Ideal candidate will have two or more years experience in a busy community health outpatient setting delivering high quality care.  Exceptional clinical, interpersonal and EMR skills are required.   SFD offers  excellent compensation, benefits and working environment.   Join our growing team!  

Interested applicants should send resume and cover letter to:  Melanie Knowles, Human Resources, Sebasticook Family Doctors, 18 Moosehead Trail, Suite 5, Newport, ME 04953 or at mknowles@sfdchc.org

10/29/12 [return to top]

Upcoming Events & Conferences

Webinar: Colorectal Cancer Screening in Primary Care

October 16, 2012, 12-1 pm 

The Maine Primary Care Association and the American Cancer Society are pleased to host national expert, Durado Brooks, to discuss the latest research on colorectal cancer, screening recommendations and actions you can take in your primary care practice to prevent the disease or find it early. 

To join the online meeting on 10/16, click here.  

Call-in Number: 1-866-469-3239 

Access code:804 979 716 


Maine Public Health Association 2012 Annual Conference 

Community Connections: Building Creative Partnerships for the Health of All Mainers

October 17, 2012

Civic Center, Augusta 

Join us at Maine's premier Professional Public Health event, the 28th MPHA Annual Meeting. We will be partnering with many organizations across the State to bring the highest quality of education, innovation and inspiration to those that work in and around the field of public health.

For for information or to register, click here


Risk Management Considerations When Using Social Media and Technology in Psychiatry

Maine Association of Psychiatric Physicians General Membership Meeting 

November 2, 2012

Waterville Hampton Inn, Waterville, ME 

Guest speaker: Moria Wertheimer, BSN JD, Assistant Vice President, Healthcare Risk Management, Allied World Assurance Company

For more information or to register, contact Dianna Poulin, dpoulin@mainemed.com or 622-3374 x 223. 


Maine Cardiovascular Summit 

Best Practice: Cardiovascular Care in the Field, in the Clinical Practice, and in the Community

November 8, 2012

Samoset Resort, Rockport 

National  and local cardiovascular health experts will come together to discuss best practice in cardiovascular care. 

For more information, or to register, click here


Maine CDC Infectious Disease Conference 

November 13, 12012

Augusta Civic Center, Augusta

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


Free Aging Advocacy Conference 

November 14, 2012

Augusta Civic Center, Augusta

Maine’s Aging Network is hosting a FREE Aging Advocacy Summit to prepare volunteers, staff and advocates to effectively participate in Maine’s health care redesign efforts at the local, state and national level.

For more information or to register, click here


Women's Health 2012: Strengthening Partnerships to Improve Health Equity 

November 16, 2012

Senator Inn, Augusta

The Maine Women’s Health Campaign invites you to attend a day-long conference dedicated to women’s health. We will hear from distinguished national and state health policy leaders and experts on women’s health, health equity, health policy, and public health, including Paula A. Johnson, MD, a women’s health specialist and pioneer in the treatment and prevention of cardiovascular disease.

For more information or to register, click here. 


Maine HIV, STD & Viral Hepatitis Program HIV & Primary Care Conference 

December 7, 2012

Maine Principals' Association, Augusta 

For more information or to register, click here


Save the Date: First Annual Conference of the Medical Professional Health Program 

Health, Wellbeing and Awareness 

April 5, 2013

Holiday Inn By the Bay, Portland

This will be the first Medical Professionals Health Program Health Conference focusing on addiction, recovery and wellness. The conference is open to all licensed professionals.  [return to top]

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