November 5, 2012

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CMS Announces Final Rule Raising Primary Care Medicaid Payments

On Thursday, November 1st, CMS announced its final rule that will result in Medicaid payments to primary care physicians raising to Medicare rates in 2013 and 2014. Physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists are all eligible for the increased payments. The increase was included in a provision of the Affordable Care Act (ACA)

One controversial item resolved in the final rule was the exclusion of the specialty of obstetrics and gynecology from the increase.  ACOG had lobbied for inclusion of the specialty in the rule.  In the comments to the rule, CMS stated that the provisions of the ACA did not allow the inclusion of OB-GYN despite the role that many physicians in the specialty play in providing primary care to women.  

The American Academy of Family Physicians (AAFP) welcomed the higher payments for physicians, which will amount to $11 billion over the two year period.  But the AAFP warned that there could be major access problems once the temporary bonus program expires.  "Unless Congress acts to permanently extend and fund this provision, a sudden return to disparate and inadequate payment for primary care services needed by Medicaid patients after only two years will again threatened to restrict their access to such needed services," AAFP President Jeffrey Cain stated.

The final rule (CMS-2370-F) is scheduled to be published in the Federal Register tomorrow, November 6th. CMS estimates the federal cost of the rule to be approximately $5.8 billion in 2013 with state savings of $235 million.  In 2014, the federal cost is estimated to be approximately $6.1 billion with $310 in state savings.

Also on November 1st, CMS issued a final rule (CMS-1590-FC) on Medicare payment rates for 2013 that will raise payments for family physicians by approximately 7% and for other practitioners providing primary care services between 3% and 5%.  The 7% increase for family physicians is partly the result of a policy that will make a separate payment to a patient's community physician to coordinate care in the 30 days following a hospital or skilled nursing facility stay.  Unfortunately, this is set against a backdrop of the scheduled 26.5% cut on January 1, 2013 as a result of the SGR. The final rule also continues implementation of the physician value-based payment modifier by phasing in its application and expands access to services that can be provided by non-physician practitioners.

For more information about the Medicaid final rule visit: To view a copy of the final rule visit:

MaineCare Request to Feds on Hold

November 1st was the original date by which CMS was to respond to the State's request to amend its State Plan to allow cuts in MaineCare for approximately 36,000 low income parents, young adults age 19-20 and seniors.  Last week, CMS proposed written questions to the state which gives the federal government another 90 days to make a final decision.  In response to the delay, Governor Paul LePage released a statement saying he was concerned about the "political games" being played the the federal government.  Each day that the cuts are included in the budget but not effectuated increases the state budget gap in the existing fiscal year ending June 30, 2013. [return to top]

December First Friday Program & Webinar - Preparing Your Practice for Health Care Reform

MMA December First Fridays 

DECEMBER 7, 2012 • 9:00 AM - 12:00 PM

The Affordable Care Act (ACA) Post-Election:  What your practice needs to know in the aftermath of the election, including a segment on the role of the medical practice as a purchaser of health care for its employees.

8:30am Registration and breakfast for those in the office

9:00 Welcome and Introductions

9:10 The Affordable Care Act Post-Election.  What’s Hot, What’s Not, Benjamin Townsend, Esq.

10:15 BREAK

10:30 Small businesses as purchasers of health care under the ACA provisions, Ellen McPherson and Rick Morrone, Holden Agency. 

11:30  Discussion and Q & A

Click here to register online or click here to download a program and registration form. 


MMA Special Webinar: Implementing the Annual Wellness Visit in your Practice: Tips from the Field 

DECEMBER 11th, 12-1 pm 

Join the Maine Medical Association and Maine Primary Care Association for a webinar sharing tools and best practices for implementing the Medicare Annual Wellness Visit in your practice.  Dr. Roger Renfrew of Redington Medical Primary Care and Dr. Laura Jett with Norway Family Medicine will address why they find the visits useful, how they describe the visit to their patients, workflow issues and how they integrate the visit into their practice.  Certified Professional Coder Laurie Desjardins from Baker Newman Noyes will answer your billing and coding questions.   We will also share checklists, sample patient letters and other tools to use in your practice.  

Register today by sending your name, email and practice name to Ashley Bernier, or 207-622-3374. 

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CMS Extends Time for Filing for ePrescribing Hardship to Avoid 2013 Penalty

As a result of persistent AMA advocacy, CMS has decided to re-open the Communications Support Webpage to allow physicians who missed the June 30th deadline to file for a Medicare ePrescribing hardship in order to avoid a 1.5% penalty in 2013.  The AMA has been urging CMS to take such a step.  Please note that this is for the 2013 eRx payment adjustment only.  Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate timeframe later in calendar year 2013.

Physicians who would like to file a hardship but did not file one before June 30, 2012 will now be able to do so between November 1st and January 31, 2013.  The current hardship exemptions include: 

  • Has an inability to ePrescribe because of state, federal, or local law;
  • Had fewer than 100 prescriptions during the period from January 1, 2012 to June 30, 2012;
  • Practices in a rural area without sufficient high-speed internet access; or
  • Practices in an area without enough pharmacies available to do e-prescribing.

To avoid errors that could result in receiving the 2013 penalty, physicians must use their individual Type 1 National Provider Identifier in their exemption filing.  This is the number used in Box 24(J) of the CMS 1500 paper form or in the Rendering Provider Name or Billing Provider loop of electronic claims.  Physicians also must use the Taxpayer Identification Number (TIN) they use for billing when filing for the hardship.  For physicians who bill using their Employer Identification Number, this is the number that should be used when filing for a hardship exemption.  For those who bill using their Social Security number, the SSN should be used when filing.  

For additional information and resources, please visit  If you have questions regarding the ePrescribing Program or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via  They are available Monday through Friday from 7 a.m. to 7 p.m. CST.  Physicians who are Mac users may still experience trouble filing for a hardship, therefore, if this occurs, they should contact the Help Desk as well since CMS is working to resolve these issues.

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State Representative Linda Sanborn, M.D. Receives Legislator of the Year Award from Pediatricians

The Maine Chapter of the American Academy of Pediatrics on Saturday, November 3rd presented State Representative Linda Sanborn, M.D. (D, Gorham) with its Legislator of the Year Award. The award was presented at a luncheon held in connection with the Chapter's Fall meeting in Portland.

Representative Sanborn is completing her second term  in the legislature and is running for re-election for a third term.  She serves on the Joint Standing Committee on Health and Human Services and is currently the only physician in the legislature.  Representative Sanborn practiced family medicine in Gorham for over two decades prior to retiring in 2008 and running for the legislature.

In presenting the award,  Chapter President Steve Feder noted her leadership on several public health issues, including children's vaccinations and her fight to protect against tea-party assault the Fund for a Healthy Maine.

Dr. Sanborn resides with her husband Jeff and they have three adult sons.  She is an active Maine Medical Association member and recently completed the Hanley Center's Healthcare Leadership Development (HLD) course.

MMA congratulates Dr. Sanborn on this well deserved honor and award.

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MMA Announces 2013 First Fridays Seminars; Mark Your Calendar!

MMA 2013 First Fridays Education Sessions

8:30 AM – Registration and Breakfast; All sessions 9:00 – Noon with breakfast included

TWO WAYS TO ATTEND These programs are available 9:00 am - noon, both live in Manchester and over the web via Webex. Because of the substantial course materials, the per person $70 fee is the same whether attending in Manchester or participating through Webex.  Webex capacity is limited to 25 sites, so don’t delay!

Click here to register online or download a program and registration form here

FEBRUARY 1 Preventing Prescription Drug Abuse While Treating Chronic Pain

MARCH 1 Protecting Professional Reputation in an Age of Social Media

APRIL 5 Annual Coding Seminar

presented by the Learning Center at Baker Newman & Noyes

MAY 3 Update on the Affordable Care Act

JUNE 7 Annual HIPAA Update

SEPTEMBER 6 Risk Management Seminar

- presented by Medical Mutual Insurance Company of Maine

NOVEMBER 1 Annual Compliance Seminar: Preventing Allegations of Fraud & Abuse

DECEMBER 6 Accountability, Transparency & Public Reporting: The Importance of Your Data

For questions or more information, please contact Lisa Martin at or 207-622-3374 x 221. 

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Maine Identifies First Case of West Nile Virus In Human

The Maine Center for Disease Control and Prevention announced last week that it has identified the state's first-ever case of West Nile virus (WNV) in a Maine resident from Cumberland County. 

The patient, who has now recovered, presented with symptoms including fever, encephalitis, meningitis, weakness and double vision. The symptoms began on October 1. Since the patient had not traveled during the exposure period, this is considered a locally acquired case. 

NV is a virus that is transmitted through the bite of an infected mosquito. It can cause serious illness in humans, large animals and some species of birds. Nationally and regionally, 2012 has been an extremely active year for WNV. Prior to this human case, seven mosquito pools in Maine tested positive for WNV in August and September. Five of the positive mosquito pools came from Cumberland County and the other two were in York County. 

While winter is approaching in Maine, the temperatures are still high enough to support mosquito activity. "As long as the temperatures remain above freezing there is potential for West Nile virus transmission," said Dr. Stephen Sears, State Epidemiologist. Mosquitoes will remain active until the first hard frost of the season. While some parts of Maine have already experienced their first hard frost, others have yet to reach freezing temperatures, making it important to remember to protect against mosquito exposures. [return to top]

Health Care Grant Doubles Predicted Number of Workers Assisted

A Maine Health Care Sector Grant is on track to train more than 800 people for jobs as nurses, clinical nurse instructors, certified nursing assistants, and allied health professionals by the end of the grant period in February 2013. This figure doubles the number of trainees projected in the original proposal. 

Unemployed workers make up more than 25 percent of the total enrollment in the training program. 

The State Workforce Investment Board (formerly the Maine Jobs Council) and the Maine Department of Labor have used this grant from the U.S. Department of Labor to maintain and strengthen partnerships among Maine's employer, education and workforce sectors to advance the development of a skilled health care workforce. 

The other health professions targeted by the grant include phlebotomist, medical lab technician, medical coding, radiology technician, respiratory technician, surgical technician, physical therapy assistant, occupational therapy assistant and pharmacy technician.

A series of meetings will provide an update on health workforce initiatives, review health workforce needs, identify training barriers and determine next action steps. Members of the healthcare industry, policymakers, educators, economic developers and labor and employment specialists are invited to participate. Registration information is available at 

The meeting schedule is:

  • Nov. 8, 2012, 9:30 a.m.-12:30 p.m., Northern Maine Community College, Presque Isle
  • Nov. 27, 2012, 12:30-4:30 p.m., University of Southern Maine, Portland
  • Nov. 29, 2012, 12:30-4:30 p.m., Rockland Public Library, Rockland

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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:


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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 by Friday, November 9th. 

Grants Coordinator


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.  


  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. 


  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.


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


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

Job Openings

CLINIC MANAGER - Orthopaedic

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 or contact Janine Valliere at 207-783-1328 or



Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Nurse Practioner for our  Dexter location.  Ideal candidate will have two or more years experience with exceptional clinical, interpersonal and EMR skills.    Maine License and DEA registration required.  Excellent compensation, benefits and working environment.  

Send resume and cover letter to:  Melanie  Knowles, Human Resources, Sebasticook Family Doctors, 18 Moosehead Trail, Suite 5, Newport, ME 04953,  

12/3/12 [return to top]

Upcoming Events & Conferences

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


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]

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