November 26, 2012

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Providing Health Insurance to Your Employees Under the ACA: Learn What You Need to Know at MMA on Dec. 7

Small employer opportunities and obligations under the Affordable Care Act (ACA) are complex.  Learn what you need to know at MMA's final 2012 First Friday educational program on Friday, Dec. 7 from 9:00am to noon.  The program is offered both live and on-line via webex.

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 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; Gordon Smith, Esq., 

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. Or call Lisa Martin at 622-3374 ext. 221 to reserve a spot. There is a $65 registration fee, whether attending at MMA offices in Manchester or via webex.


AMA, MMA and Many Others Focus on SGR Fix or Delay in the Lame Duck Session

Congress returns this week for its traditional "Lame Duck" session with an aggressive work agenda in order to avoid the fiscal cliff that is now a common term in the nation's vocabulary.  First on the agenda of medicine is taking action to avoid the scheduled 27% reduction in physician fees paid by Medicare (the "SGR" cut).  In addition, Congress will be urged to take action to avoid the additional 2% reduction to all providers, including hospitals, which will take place if the sequestration provisions enacted earlier this year are not repealed or amended in some way.

The road to SGR relief was made more difficult last week by action of the Congressional Budget Office in revising the estimate of the amount of funds needed for a one-year fix to delay SGR cuts until Jan. 1, 2014. Previously, the announced amount was $18 billion.  But the CBO increased the estimate to $25 billion, meaning that the Congress will need to find savings in other areas amounting to $25 billion in order to delay the SGR cut by just one year.  A permanent repeal, which may be possible in the budget negotiations during 2013, would cost over $350 billion.

In a conference call with AMA Vice President Richard Deem this past week, state medical societies were reminded of the principles signed off on earlier regarding the SGR issue and were urged to communicate with their congressional delegations regarding the absolute need to delay the SGR cut prior to Jan. 1, 2013 and to permanently repeal the flawed formula during 2013 when there is likely to be major budget negotiations

Among points to be made to our federal representatives are the need for investments in infrastructure needed to accomplish payment reform and to protect investments in public health, graduate medical education and quality improvement.  At a time when physicians are being asked to do more, radical reductions in reimbursement are unconscionable and will result in access issues for America's seniors.

The AARP is one of the organizations allied with medicine on the issue.  In its communication to members, the organization has continued to express concerns about access and has advocated for the longest possible period of SGR relief for physicians.

The American Hospital Association has also advocated for delay in the SGR cut, but has argued that the "pay-fors" needed to cover the cost of the delay should not come from reducing or repealing provider-based reimbursement.  As so many hospitals in Maine have transitioned to provider-based reimbursement from Medicare, its elimination would cause particular hardship in our state.  Some hospital's entire operating margin is based on the current formula. 

MMA will be communicating with the Maine Congressional Delegation regarding the need for the actions noted above, but all members should communicate with the their federal representatives about the issue.  To contact your representatives, click here.  For more information about the AMA's campaign, click here

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Obama Administration Proposes Rules for Several Key ACA Provisions

The federal department of Health and Human Services last Tuesday (Nov. 20) proposed hundreds of pages of new rules implementing several key provisions of the Affordable Care Act (ACA), including details on Essential Health Benefits, Health Insurance Market Reforms and Employer Wellness Programs.  More details on the federally operated health insurance exchanges are expected to be released later.  While MMA attorneys are still reviewing the more than 300 pages of proposed regulations, a cursory view and the summaries provided by the AMA and several news organizations suggest the following:

  1. States are provided with flexibility with respect to the determination of the Essential Health Benefits provision.
  2. Employer Wellness Provisions are provided with more robust flexibility to provide incentives to employees.
  3. All of the regulations are subject to a public comment period, with the Essential Health Benefits provision having a deadline of Dec. 20.  MMA will provide comments on the proposal by that time.  

The Essential Health Benefits provision is of great interest as it provides for a state definition of what must be included as a floor for benefits in a health insurance plan covering any individual or small group, regardless of whether the plan is sold on the exchange.  Maine's benchmark is, by default, the largest selling small group plan or Anthem's Blue Choice plan.  The plan has fairly generous provisions in the ten basic areas that the ACA requires to be covered.

Watch the Weekly Update for updates on these topics as the state prepares for a federally operated exchange in 2014, with people able to enroll by Oct. 1, 2013.  Persons with incomes between 133% and 400% of the federal poverty level will be entitled to subsidies to assist with the payment of the premium.  Persons between 100 an 133% would be covered by MaineCare depending upon whether the state chooses the option of Medicaid expansion under the law.  Governor LePage has not yet announced his decision on that question, although the new Democratic majority in the legislature may also have influence on the decision.

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Maine Health Management Coalition Hosts Dr. Christine Cassel in Portland Next Week

Opportunities to improve health and lower healthcare costs do exist. Quality, safety, overutilization, and coordination issues have contributed to the US having the highest per capita healthcare costs in the world, but there are providers, employers, insurers, and others in the healthcare system that are working hard to steer us down a path to high quality, affordable care.

At this year’s Maine Health Management Coalition symposium, titled Leading Maine to Better Health, attendees will hear from four business and healthcare leaders that have shown an exceptional ability to affect change and bring others along with them.  Attendees will hear about cutting edge quality improvement and cost reduction initiatives from the people that champion them, and they will leave with practical tips and inspirational fuel to carry them out.

The symposium will be held at the Abromson Center in Portland on December 6th from 8:45-2:30 pm. 

Speakers include: 

  • Dr. Christine Cassel, CEO of the American Board of Internal Medicine
  • Paul O'Neill, former US Secretary of Treasury
  • Gerald Shea, CEO of the National Quality Forum
  • Jerry Noyce, CEO of the Health Enhancement Research Organization  

For more information, an agenda, or to register, please visit

This program has been approved for 4 Continuing Medical Education credits, 4 HRCI credits, and 4 broker credits.


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MaineCare Re-opens Application for Health Homes Initiative - Deadline Dec. 14

The Office of MaineCare Services is pleased to announce that it is extending the deadline for NCQA PCMH recognition and re-opening the application process for primary care practices interested in participating in the MaineCare Health Homes Initiative.  This is being done in an effort to include as many eligible primary care practices as possible in this important initiative.  

The deadline for achieving NCQA PCMH recognition for practices in the Health Homes Initiative is being extended to June 30, 2013.  The application process for MaineCare Health Homes is being reopened until Friday, December 14, 2012.  (Please note that this does NOT affect deadlines for NQCA PCMH recognition for practices newly entering the multi-payer Maine PCMH Pilot). 

Practices that have previously completed an online application for participation in the multi-payer Pilot and Health Homes initiative do not need to complete a new application,  but should note the extension of the NCQA PCMH deadline to June 30, 2013.  Practices interested in applying to participate in the MaineCare Health Homes initiative that did not previously complete an application will need to complete the online application by Friday, December 14, 2013 using the online application at

More information on the MaineCare Health Homes initiative will be offered during a webinar on Tuesday, December 4th at 12 pm as part of the Quality Counts Provider Lunch & Learn Webinar series (please see for more information).

Questions about the MaineCare Health Homes initiative should contact Kitty Purington at, or tel. 624.6921 or Lisa Letourneau at or tel. 415.4043, or see more information on at[return to top]

MMA Special Webinar: Implementing the Annual Wellness Visit in Your Practice, Dec. 11

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.   There is no cost to participate. 

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AMA Offers Practice Automation Tools

MMA members are welcome to take advantage of a host of AMA resources on the full suite of electronic health care transactions that can save physicians tens of thousands of dollars a year in administrative costs and improve patient satisfaction.

Register now for the webinar, “Helping your patients understand financial responsibility at the time of service, part two: What to do when you encounter bumps in the road,” on Thursday, Nov. 29 at 1:30 p.m. Eastern time. Access a related AMA toolkit for tips on how to get payment from patients before they walk out the door. One of its resources, “Cash practice alternatives: Considerations for physicians,” helps you assess which business model best suits your practice’s particular situation. You can access all the AMA practice automation tools at

The vast majority of physicians are already subject to the HIPAA privacy and security mandates by virtue of the fact that they bill Medicare electronically. Take advantage of the rest of the electronic transactions to fully automate your practice. Automation saves money and ensures transparency - both critical to success in the current health care environment.  

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Window Closing Soon for New Dirigo Enrollment

The health insurance that has helped Mainers with limited incomes get coverage over the last few years will take its last new applications on December 10, 2012 for coverage to start on January 1, 2013 (but read about exceptions below). If your patients need insurance but have a limited budget there are only two weeks left to get applications through the Dirigo door. Note that DirigoChoice policies do not exclude pre-existing conditions, and they are open to anyone, even if they don't need a subsidy.

Call the Dirigo Health Agency at 1-877-892-8391 or 287-9900 for any assistance needed.  Patients or practices can also call the Consumers for Affordable Health Care HelpLine at 1-800-965-7476 with general questions about this coverage or other coverage opportunities.

EXCEPTIONS: The following people will still be able to enroll in Dirigo coverage after December 10th:

  • Current individuals and small businesses already enrolled in DirigoChoice will be able to renew their coverage and add dependents or employees to that coverage through 2013.
  • People who have been uninsured for 6 months or more AND who have one of 48 pre-existing conditions are eligible to enroll in Dirigo through the Pre-Existing Condition Insurance Plan through 2013.
  • People who are receiving Trade Adjustment Assistance or payments from the Pension Benefits Guaranty Corporation will still be eligible for Dirigo's Health Coverage Tax Credit program through 2013. 
  • Employees of businesses already enrolled in the Part-Time Worker Coverage Voucher Program will be able to renew their coverage and add dependents through 2013. Employers will also be able to enroll new employees in the program.
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MaineHealth Releases Colorectal Cancer Screening Resources for Providers

The MaineHealth Cancer Resource Center recently added a colorectal cancer (CRC) screening resource webpage for primary care providers (PCPs).

 The page includes:

  • brief, best practice points
  • links to clinical CRC screening guidelines
  • screening resources for PCPs and
  • information about a free screening program for Maine residents.

To visit: [return to top]

Primary Care Case Management Panel Reports Now Available Online

MaineCare Primary Care Case Management (PCCM) Providers can now access their PCCM Member Panel Reports online, and MaineCare encourages you to review them for accuracy. 

What are Panel Reports?

This report identifies the PCCM members assigned to each provider as of the 15th of each month. It will be viewable on the portal on or about the 17th of each month. 

Where is it located?

Login to your Trading Partner account at: My Health PAS-Online.  You can then access your reports by clicking on File Exchange>Reports>PCP Roster Reports.

If you do not have a Trading Partner account, your Panel Report will be mailed to the appropriate Pay-To address on file. If you need help setting up a Trading Partner account, contact the EDI Help Desk at (866) 690- 5585, option 3.

How do I review it?

Please be sure to check that the:

  • PCP Provider/Member assignment is correct
  • PCP Provider is still associated with the Pay-To on the report

Why is it important to review my report?

This information may impact your claims once the referral warning period ends in early 2013.  The assigned or covering PCP must be the referring provider on the claim. Additionally, if information is not correct on the report, your Management Fees may be affected.

When will the referral WARN period end?

The referral warning period ends on 12/31/2012 for dates of service 1/1/13 and after.  This means that for dates of service prior to 12/31/2012 the WARN message will still appear.  For dates of service 1/1/13 and after, claims will deny if a referral is not present for services that require one.

Will there be training for Providers/Specialists available on how to submit PCCM Referrals?

Yes. Trainings are scheduled in December for PCCM Providers and Specialists.  Please reserve your traini­ng spot by going to:

 If you have any questions regarding these reports or need to make updates, please contact MaineCare Provider Services at 1-866-690-5585. 

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NH Supreme Court Upholds Constitutionality of Medical Malpractice Screening Panels

In an opinion issued on October 30, 2012, the Supreme Court of New Hampshire has largely upheld that state's medical  malpractice screening panel statute, which is based on Maine's, under the state constitution.  The MMA, the Vermont Medical Society, the New Hampshire Medical Society, and the American Medical Association participated as amici curiae in the case, Petition of Southern New Hampshire Medical Center, et al.  The Court determined that the screening panel did not violate the Separation of Powers Clause of the state constitution and that it did not interfere with the plaintiff's state constitutional right to a jury trial.  In protecting the system from the primary constitutional challenges, the Court cited the leading Maine case on the constitutionality of the screening panel system, Irish v. Gimbel.  On the other hand, the decision seems to give the parties more flexibility than the Irish case in commenting on the panel process, including its limitations, at trial.  

 New Hampshire's screening panel system has been in place since 2007.

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Job Openings


Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Nurse Practitioner 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,  


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


PSYCHIATRIC NURSE PRACTITIONER Position Available in Dexter, Maine

Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Psychiatric Nurse Practitioner for our Dexter location. Position includes assessment, medical management, therapy and group work. Ideal candidate will have 3 or more years experience in a busy community health outpatient setting delivering high quality care. 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 or at


PSYCHIATRIST – Tri-County Mental Health Services – Lewiston, Maine

Our Assertive Community Treatment (ACT) Team has an exceptional opportunity available for a full-time Psychiatrist. Under the direction of the Director of Psychiatry, the Psychiatrist is responsible for outpatient psychiatric management of individuals with severe and persistent mental illness with an emphasis on medication management.  Additional duties include assessments, development of the plan of treatment, recommendation of consultations and referrals, participation in discharge planning, and on-call coverage.

Position Requirements:  Must possess active State of Maine Medical Doctor license, Board Certification (ABPN or AOBNP) in Psychiatry, and DEA Certificate.  Computer proficiency and valid driver's license are also required.  Equal Opportunity/Affirmative Action Employer.

For consideration, forward resume with cover letter to:

As one of Maine’s largest and most comprehensive agencies providing services addressing mental health, substance abuse and intellectual disabilities, this year Tri-County Mental Health Services celebrates 60 years of giving home to Maine people.

Visit us at:


PRIMARY CARE POSITIONS Available at Mayo Regional Hospital

Mayo Practice Associates, a department of Mayo Regional Hospital in Dover-Foxcroft, Maine, has several openings for primary care physicians. Positions are available at our rural health centers in Dover-Foxcroft, Guilford and Milo for either internal medicine or family medicine-trained physicians. Mayo offers a competitive base salary and benefits plan, productivity incentives, medical educational loan reimbursement and a relocation allowance. Mayo Regional consistently ranks among Maine's top critical access hospitals for overall quality of care.

Applicants should send resume and cover letter to: Ben Dever, Mayo Practice Associates, 897 West Main St., Dover-Foxcroft, ME 04426, or


PHYSICIAN MEDICAL DIRECTOR for Hospice of Southern Maine

Hospice of Southern Maine seeks a full time Physician Medical Director responsible to assist the CEO in the administration of HSMs clinical services program, and for liaison activities with the local medical community. Provides oversight of the medical services of the program to ensure an adequate and qualified medical staff for clinical service and coverage needs. Reviews patient eligibility for hospice services; certifies patients meet medical criteria for admission and recertification based on available prognostic indicators. Performs home visits and visits for inpatient hospice services related to patient assessment and care as needed and appropriate.  

Job Requirements:
Completion of medical education and relevant residency training required. Fellowship in Palliative Medicine preferred. Work experience in internal medicine, geriatrics, palliative medicine or other relevant field of medicine required. Work experience in a certified hospice program and administrative experience preferred. Physician licensure by the State of Maine as a doctor of medicine or osteopathy required; board certification in hospice and palliative medicine preferred. Valid drivers license with an automobile that is insured in accordance with state and/or agency requirements and is in good working order required.

For additional information or to apply contact HR at

Hospice of Southern Maine is an equal opportunity employer, and does not discriminate against applicants or employees on the basis of race, color, sex, sexual orientation, religion, national origin, age, veteran status, disability or any other characteristic protected by applicable law. All employment decisions shall be consistent with the principles of equal employment opportunity. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act, the Vietnam Veterans Readjustment Act, the Maine Human Rights Act, and Title I of the Americans with Disabilities Act, applicants that require accommodation in the job application process may contact the Human Resources Office at 207-289-3640 or by e-mail at for assistance.

12/24/12 [return to top]

Upcoming Events & Conferences

AthenaHealth Webinar: Optimizing Group Practice Growth, 7 Strategies for Success

Wednesday, November 28, 12:15 p.m.

If you’ve been feeling the pressure to expand your group practice, you’re certainly not alone. In the current financial landscape, growth provides much-needed economies of scale and can yield greater leverage with payers; but without the proper tools, preparation and partners, on-boarding new physicians can be a huge and risky problem. Register today and have the right information to grow your practice

To register, click here


 The Waiting Room

Portland Museum of Art, Portland

Friday, November 30, 6:30 p.m. *  Saturday, December 1, 2 p.m. * Sunday, December 2, 2 p.m.

The Waiting Room is a character-driven documentary film that uses extraordinary access to go behind the doors of an American public hospital struggling to care for a community of largely uninsured patients. The film--using a blend of cinema verité and characters' voiceover--offers a raw, intimate, and even uplifting look at how patients, staff, and caregivers each cope with disease, bureaucracy, and hard choices.

Tickets are $7 and sold on the day of the show at the Admissions Desk

For more information, 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