October 29, 2012

 
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Preparing Your Practice for Hurricane Sandy

All indications point to a difficult day or two here in Maine and indeed, throughout the entire northeast, as Hurricane Sandy arrives.  State and federal officials have provided guidance and MMA offers some practical advice for medical practices, courtesy of our friends and colleagues at the Connecticut State Medical Society.

  1. Post emergency contact information where your patients can find it.  This includes updating the home page of your practice website and perhaps simply putting a notice in your office window.  If there are local pharmacies you deal with routinely, you may wish to provide them with this contact information.
  2. Back up your office computer systems and make sure you can access critical records offsite.
  3. Contact the insurance plans you participate with to find out their contingencies for pre-authorization claims processing and prescription refills in the event of power and of service disruptions.  MaineCare has informed practices that in the event of loss of phone service in Augusta due to the upcoming storm, any calls made to the Molina Provider Services call center will be routed to the Idaho call center. These call center representatives will not be able to answer any questions related to claims or MIHMS, but will be able to record the necessary information and route it back to the Maine call center staff once Augusta has regained power. 
  4.  Plan ahead for alternative storage of vaccines and other perishable items in the event of a power outage.  A power outage has significant implications for vaccine storage.  For CDC guidance regarding vaccine storage issues during temporary power outages, see Impact of Power Outages on Vaccine Storage.  If you have any questions about emergency vaccine storage or handling, please contact the Maine Immunization Program Health Educators at: (207) 287-3746 or (800) 867-4775, Email:  ImmunizeME.DHHS@Maine.gov

For more information, visit: 

Federal Emergency Management:  www.fema.gov 

National Hurricane Center: www.nhc.noaa.gov

Above all, stay safe and don't take chances with your own safety and that of your patients and employees.

 

MMA Presents Annual Fraud & Abuse Seminar Friday, Nov. 2

MMA presents its Annual Fraud & Abuse Seminar this coming Friday, November 2, 2012. 

The morning will feature Laurie Desjardins, CPC, PCS of the Baker Newman & Noyes Learning Center and three of Maine's leading compliance attorneys.  John Gleason, Esq., chairs the Heathcare and Employment Practice areas for the firm of Curtis & Thaxter in Portland.  Susan Tedrick, Esq., is Chief Compliance Officer at Franklin Community Health Network and Gordon Smith, Esq., is the Executive Vice President of the Maine Medical Association.  

These healthcare attorneys and Ms. Desjardins will provide practical advice regarding compliance with state and federal regulations on coding, billing and related practices and will discuss the heightened auditing and compliance activities authorized in the Affordable Care Act (ACA).

The agenda for the three hour seminar, offered both live at the MMA offices in Manchester and over the internet through WebEx, is as follows:

9:00 am Welcome and introductions: Gordon Smith, Esq.

9:05 am Institutional Compliance vs. Small Practice Compliance, Health Care Reform, OIG Work Plans & Priorities, Monitoring and Reporting:  John Gleason, Esq, and Susan Tedrick, Esq.

10:05 am Break

10:10 am Enforcement Work Plan: Laurie Desjardins, CPC, PCS

11:10 am Q & A and Panel Discussion: All presenters

12 pm Adjourn

 Registration is available online at www.mainemed.com, by calling 622-3374 ext. 221 or by e-mailing Lisa Martin at lmartin@mainemed.com.  There is a charge of $65 per person and category 1 CME is available.

The last First Friday presentation of the year will be presented on Friday, December 7th.  The topic is the Affordable Care Act and specifically what a practice needs to know about the law and regulations regarding its responsibilities to provide health insurance to its employees. Representatives of the Holden Agency, a full-service insurance firm will present, along with other experts on the ACA.  The program will be presented from 9:00am to noon.

 A listing of all the First Friday programs in 2013 will be included with the Fall issue of Maine Medicine arriving on member's desks in November. [return to top]

MMA Seeking Grants Coordinator

The Maine Medical Association is pleased to announce a search for a grants coordinator.  Please see the full job description below.  If interested, submit your cover letter, resume/CV and at least three references to Jessa Barnard at jbarnard@mainemed.com by Friday, November 9th. 


Grants Coordinator

JOB DESCRIPTION 

SUMMARY of Position Description

The Maine Medical Association (MMA) Grants Coordinator will be responsible for leading the development and implementation of specific grant-funded MMA projects.  Currently, it will include coordinating grants in the areas of Health Care Reform Outreach and Education, Payment Reform and Administrative Advocacy. Duties include managing all aspects of the projects, including developing and managing project timelines, workplans, and budgets.  Typical project activities include identifying appropriate physician outreach audiences, creating and disseminating educational materials to physician practices, and planning educational meetings and webinars. Reports to MMA Associate General Counsel.

The position requires a detail-oriented, self-motivated individual who is able to effectively support MMA’s grant funded projects and operations.  This is a one year position for 2013 with work beyond that period contingent on continued grant funding.  Number of hours and salary dependent on experience and education, with a minimum average of 20 hours per week.  

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

  1. Undergraduate Bachelors degree in health or related field; Masters or professional degree preferred.  Relevant work experience can substitute for education.
  2. Experience in project management, administrative practices, healthcare systems or meeting management normally acquired during 3 to 5 years of related work experience.  
  3. Excellent project management skills with demonstrated experience in managing wide range of clinical and/or administrative projects with excellent organizational skills.
  4. Excellent oral communication and presentation skills; demonstrated written communication skills. 
  5. Comfort communicating with physicians and practice staff.
  6. Excellent relationship management skills. 
  7. Experience with basic financial management skills, including budgeting and financial reporting.
  8. Ability to work both independently and to collaborate with teams of individuals in diverse settings, with solution-oriented approach.
  9. Knowledge of Maine healthcare environment and physician practices preferred.
  10. Knowledge of computer software, including Microsoft Office. 

ESSENTIAL FUNCTIONS AND PERFORMANCE EXPECTATIONS

  1. Project management 
  • Directs and manages identified MMA projects, programs, initiatives and resources that support achievement of established goals.
  • Develops project workplan and timeline, and monitors plan to assure timely completion of program tasks.
  • Coordinates ongoing assessment and evaluation of improvement efforts.
  • Manages project communications, including written and oral presentations, maintaining project information on MMA website, contributing to e-newsletters, and other communication vehicles as appropriate.
  • Manages project budget and budget reporting.
  • Supports grant reporting as indicated.

WORKING CONDITIONS

  • Ability to travel throughout the state.
  • Potential to work primarily from home with regular travel to MMA Headquarters in Manchester.

REPORTING RELATIONSHIPS

Reports to the Medical Association Associate General Counsel [return to top]

Opioid Management Policy Updates & Forums for Prescribers

MaineCare recently reminded prescribers of the new restrictions on MaineCare coverage for the use of opioids (e.g. oxycodone, hydrocodone, fenanyl) required by laws passed by the legislature. These new limits could include requiring a second medical opinion or requiring, when appropriate, that a MaineCare member try other treatments.  

At this time, the planned changes to MaineCare opioid pain management policy have not been implemented. The Department continues to work with stakeholders on developing necessary policy changes and finalizing the criteria that will be in place.  The Maine Medical Association and a number of practicing clinicians have been participating in these discussions, including a meeting held today at which the focus was on the alternative therapies that MaineCare enrollees would be expected to try prior to opioids being started, continued or re-instituted for the treatment of chronic pain.  These alternative therapies, which would be covered for payment, are expected to include Cognitive Behavioral Therapy,  Acceptance-Commitment Therapy, Osteopathic Manipulative Therapy, Chiropractic care and Physical Therapy.  Based on today's discussion at the Work Group meeting, patients will probably only have to fail at one of the alternatives in order to have grounds for their physician to prepare a request for a prior authorization.  But the number of alternatives tried, and whether the patient has been successful with the alternatives, will be in the hands of the physician.

New limits for MaineCare members that are using opioids for the treatment of acute pain will be effective January 1, 2013.  Policy changes further defining new limits for members using opioids for the treatment of chronic pain will be implemented beginning in early in 2013.  MaineCare policy will address opioid treatment of chronic pain as defined as the continuous use of opioids for pain for longer than eight (8) weeks. The Department will notify providers and members of policy changes regarding the use of opioids for chronic pain in advance of implementation.

MaineCare Medical Director Dr. Kevin Flanigan will be the guest speaker at Maine General's Grand Rounds on November 1st and 2nd speaking to the MaineCare changes to opiate coverage and the two year limit on medication assisted treatment effective January 1st.

Nov 1st in Waterville at the Thayer Campus in Dean 3 & 4 between 12:00-1:00pm

Nov 2nd in Augusta at MaineGeneral Medical Center on E Chestnut Street in CR 3, 4, 5 between 7:30-8:30am

Any questions regarding the grand rounds should be directed to Cora Damon at 872-1224 or Cora.Damon@mainegeneral.org.  Questions regarding MaineCare's policies can be directed to Gordon Smith, 622-3374 x 212 or gsmith@mainemed.com

Suboxone Limits Informational Forums – Coming Soon!

Effective January 1st, MaineCare will implement a 24 month lifetime limit for members prescribed suboxone for the treatment of opioid addiction.

MaineCare is hosting public forums for suboxone providers to discuss this change. The first forum will be held on Monday, November 5th from 5:30- 7:00 PM, in Bangor, at the Ramada Inn in the Kennebec Room. Email MIHMSNews.DHHS@maine.gov with questions. Another forum will be held in Portland on Monday, November 19th from 5:30- 7:00 PM. The location for the Portland forum will be announced soon.

The Bangor forum will also be broadcast via webinar. You can listen to the meeting presentation and participate by typing into the questions and answers section of the webinar. You can join the Bangor Suboxone Limits Information Forum by webinar by going to: https://stateofmaine.adobeconnect.com/_a827390218/mainecaresuboxonelimitsinformationforum/.  Select “Enter as a Guest” and enter your first and last name to sign in. After you enter the meeting room, the “Join the Audio Conference” screen will pop up. Enter your telephone number including the area code, in the “Dial-Out” box and select “Join.” The Adobe computers will call your telephone number. When you answer the call, press 1 to connect to the conference.

If you choose to call-in option, without participating in the webinar, call 1-877-455-0244 and enter code 1127267168. [return to top]

MaineCare Mandatory Generic Substitution Requirements

In response to several requests, MaineCare has provided the following reminder about the July 1, 2012 implementation of mandatory generic substitution requirements for prescription drugs, as required by law passed by the legislature. 

The MaineCare Benefits Manual, Section 80 reads: 

The Department shall require substitution for a brand-name drug of a generic and therapeutically equivalent drug as required by Maine Revised Statues, Title 32, Section 13781, absent Prior Authorization from the Department. Prior Authorization requires that the prescriber has indicated that the brand-name drug must be dispensed and that the brand name drug is medically necessary.

MaineCare members may be able to still have brand name drugs covered if there is no therapeutically equivalent generic available or they have a Prior Authorization for a brand name prescription.

These changes are part of the Department of Health and Human Services’ Supplemental Budgets and Administrative Savings Initiatives that were signed by Governor LePage. See Public Law 2011, c. 477 and c. 657.

You can find copies of the emergency, proposed and adopted rules at: http://www.maine.gov/dhhs/oms/rules/index.shtml. Select the link for emergency, proposed or adopted rules.  [return to top]

GOP Block Grant Plan for Medicaid Likely to Strain Safety Net, Study Finds

Converting federal Medicaid payments into state block grants and repealing the health care reform law, as called for in the House Republican budget plan, would drop 37.5 million people from Medicaid enrollment and cut payments to hospitals by nearly $364 billion over 10 years, according to a study released October 23rd by the Kaiser Commission on Medicaid and the Uninsured.

The study, prepared by the Urban Institute, said the GOP budget plan, which is similar to a Medicaid block grant plan endorsed by GOP presidential candidate Mitt Romney, “represents a fundamental change in the structure and financing of the Medicaid program” and “would almost certainly worsen the problem of the uninsured and strain the nation's safety net.”

Under the House-passed budget plan for fiscal year 2013, federal Medicaid spending would be cut by $1.7 trillion over the 2013-2022 period. Of that total, $932 billion would come from repeal of the Affordable Care Act (assuming all states took part in ACA's Medicaid expansion, which the U.S. Supreme Court made optional), according to the analysis. Another $810 billion in spending would be cut as a result of the block grant conversion.

Together, the cuts would represent a total reduction in federal Medicaid spending of 38 percent over 10 years, the analysis said.

Under the block grant proposal, beginning in 2013 federal Medicaid spending would be capped each year and payments would be distributed to each state based on a formula. Under the GOP plan, Medicaid spending would be increased annually only to keep up with population growth and inflation. Because both these rates are lower than the expected growth rate in Medicaid spending, the federal government could achieve significant savings while giving states additional flexibility to design their programs, the report noted.

Cuts in Enrollments Likely

The implications for Medicaid enrollment under the GOP budget plan, however, would be severe, according to the study. One reason is because states have few ways they can achieve more savings by improving program efficiency. Medicaid spending per capita already is lower than private per capita health spending, the study noted. Moreover, Medicaid payment rates to providers are already so low that many physicians do not participate in the program.

As a result, the most likely area states can look to for Medicaid savings is eligibility, the study said. If states maintained their current rates of Medicaid spending per year under the block grant plan, about 37.5 million adults and children currently eligible for Medicaid would lose their coverage, the study concluded.

This number includes 17 million people who would not receive coverage because of the ACA repeal (again, assuming all states participated in the Medicaid expansion) and an additional 20.5 million low-income Americans who would lose coverage as a result of the block grant conversion, which would shift more health costs to the states under the spending formula.

  [return to top]

National Medical Staff Services Week Coming Nov 4-10

In 1992, President George Bush issued a proclamation designating the first week of November as “National Medical Staff Services Awareness Week,” to acknowledge and thank medical services professionals (MSPs) for playing “an important role in our nation’s healthcare system.”

What role do these professionals play? They are the people behind the scenes who make certain the credentials of all practitioners who are caring for patients are correct and have been verified. MSPs are experts in provider credentialing and privileging, medical staff organization, accreditation and regulatory compliance, and provider relations in the diverse healthcare industry. They credential and monitor ongoing competence of the physicians and other practitioners who provide patient care services in hospitals, managed care organizations, and other healthcare settings.

The American Medical Association-Organized Medical Staff Section also recognizes the medical services profession in a resolution that formally acknowledges “the importance and value of medical services professionals to the healthcare organization and its physician members, and recognizes their contribution and dedication in preserving quality patient care.”

MSPs are a vital part of the community’s healthcare team. They are dedicated to making certain that all patients receive care from practitioners who are properly educated, licensed, and trained in their specialty.

For more information about MSPs and the National Association Medical Staff Services (NAMSS), visit www.namss.org or the Maine Association Medical Staff Services (MeAMSS) at www.meamss.org. [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]

DHHS OIG Cites Quality of Care & Contractor Oversight Among Priorities for 2013

During a webinar last week, Deputy Inspector General for evaluation and inspections Stuart Wright said that reviewing patient quality of care and the performance of Medicare contractors will be among the top priorities for the federal DHHS Office of the Inspector General (OIG) in 2013.  In particular, the office will take a close look at the care Medicare beneficiaries receive after hospitalization in various post-acute settings, such as skilled nursing facilities.  A previous OIG review determined that 13% of Medicare beneficiaries received care that resulted in permanent harm after being admitted to a hospital.  Wright stated that the office also will review the effectiveness of Medicare contractors, particularly Recovery Audit Contractors (RAC).

You can find the webinar, OIG Outlook 2013, on the web at:  https://oig.hhs.gov/newsroom/outlook/index.asp.

Also, please note the relevant article above on the MMA's First Fridays Compliance program scheduled for this Friday, November 2nd.

[return to top]

Upcoming Events & Conferences

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

***

A Moderated Public Discussion: What If Everyone Had Health Care in Maine?

Sponsored by Maine AllCare

November 15, 2012 6:30 PM

Think Tank, 533 Congress St., Portland

This forum will cover the problems, the progress, and ideas on how to make health care really work for everyone.

For more information, contact Beth Franklin at 650-3177 or info@maineallcare.org

***

Maine General Medical Center Fall Coding & Compliance Conference 

Achieving New Heights in Health Care Reform 

November 16, 2012

Waterville Elks Banquet & Conference Center, Waterville 

6.5 AAPC CEUs Covering: The Road to ICD 10, Vascular & Thoracic Procedural and Terminology Overview, Introduction to APC and more 

For more information or to register, contact Cindy Sturtevant, 872-4058

*** 

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. 

***

 Graceful Synergy: Defining the Partnership between Public Health and Accountable Care

December 6, 2012, 5 pm 

Grace Restaurant, Portland

Support the Maine Public Health Association while hearing from Lisa Harvey McPherson, RN, MBA, MPPM, Vice President of Continuum of Care and Chief Advocacy Officer of Eastern Maine Health Systems and Barbara Crowley, MD, Executive Vice President and MaineGeneral Health pediatrician, who will deliver a presentation examining the relationship between public health and accountable care.     

 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: 2013 Quality Counts Conference 

April 3, 2012

Augusta Civic Center, Augusta 

QC 2013 will feature Dr. Donald Berwick, former CMS Administrator, as keynote speaker highlighting the theme of reaching the Triple Aim of improvement.  Registration materials and detailed agenda will be available January 2013.

***

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]

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

CLINIC MANAGER - Orthopaedics

Central Maine Orthopaedics (CMO) is a successful orthopaedic practice in Central Maine and we are currently recruiting for a full-time Clinic Manager for our Ambulatory Clinic. The foremost duty of this position is to ensure that the day-to-day operations and management of the clinic run smoothly and efficiently.  This position requires a professional with strong leadership characteristics with an associated broad skill set who will serve as role model, mentor, and coach/facilitator. This is a CMO senior manager role responsible for both organizational and operational outcomes.  This position ensures CMO's continuing compliance with our organizational standards and policies in the areas of human resources, fiscal management, purchasing, medical records, facilities management, and clinical operations.  This position is responsible for delivery on the organization's strategic plans, benchmarks, and critical success factors  and therefore must demonstrate accountability and responsibility for own work and expected outcomes for those supervised.  Central Maine Orthopaedics is an Equal Opportunity Employer.

For additional information regarding this position, please view the full posting on our web site at www.cmogroup.org or contact Janine Valliere at 207-783-1328 or JValliere@cmogroup.org

11/26/12 [return to top]

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