December 3, 2012

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MMA Board of Directors Meets this Wednesday, December 5th

The MMA's 25-member Board of Directors will convene for its final meeting of 2012 and will pay particular attention to year-end membership and financial matters.  Members also will review Resolution #3, Limits on the Possession of Dangerous Weapons passed at the General Membership meeting in September, but rejected in a Board vote earlier this Fall.  The MMA Public Health Committee presented this Resolution and, in accordance with MMA policy, representatives of the Committee will have an opportunity to address the Board in support of this Resolution on Wednesday.  

This meeting of the Board of Directors will be the second since full implementation of a major revision of the MMA bylaws and establishment of a standing Nominating Committee charged with identifying and developing physician leaders and recruiting strong candidates from diverse personal and professional backgrounds for MMA leadership roles.  Relatively new Board members attending their second meeting and bringing new energy and perspective to the group are Paul Cain, M.D., Gregory D'Augustine, M.D. (returning after earlier service), Steve Feder, D.O., Laura Jett Anderson, M.D., G. Thomas Marshall, M.D., Mark McAllister, M.D. (returning after service as a resident), Kristin Mitchell, D.O. (returning after service as a resident), Janis Petzel, M.D., and Benjamin Young, M.D. (serving as a resident representative).

The meeting is scheduled from 4 to 6 p.m. at the MMA headquarters at the Frank O. Stred building in Manchester and any member is welcome to attend.

In addition to the priority topics mentioned above, the agenda for Wednesday's Board meeting includes:

  • Preparation for the First Regular Session of the 126th Maine Legislature;
  • Preparation for the January Board of Directors Retreat;
  • Recap of the AMA Interim meeting in November; and
  • Establishment of an Annual Session Committee to plan the 2013 Annual Session scheduled for October 4-6, 2013 at the Holiday Inn by the Bay in Portland and the 160th Anniversary Gala set for Saturday evening.

Following the Board meeting, members will have a dinner meeting with members of the Maine Osteopathic Association Board of Directors to exchange in formation and to look for opportunities for further collaboration between the organizations.

The next meeting of the MMA Board will be during the annual President's Retreat scheduled for January 18-20, 2013 in Quebec City.


Still Time to Register, What Employers & Small Businesses Need to Know About Health Reform, Dec 7.

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.

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Maine No Longer Most "Quit Friendly" State

The United States is at a tipping point when it comes to policies that help smokers quit, according to the American Lung Association's "Helping Smokers Quit: Tobacco Cessation Coverage 2012" report. Released today, the annual report provides a comprehensive review of each state's tobacco cessation coverage and an up-to-date look at federal coverage and requirements under the Affordable Care Act.

"Over the next year key decisions will be made by the federal government and the states about whether or not they will help save lives, prevent disease and reduce health costs," said Paul G. Billings, Senior Vice President, Advocacy and Education at the American Lung Association. "We know that the vast majority of smokers want to quit, but the complex web of state and federal coverage for effective quit smoking programs and treatments prevents too many from getting the help they need. States and the federal government can reduce the enormous health burden of tobacco use by providing access to these proven interventions."

The American Lung Association report shows that the federal government has missed several key opportunities to improve access to quit smoking medications and counseling. The record for the states is mixed, but far too many fail to ensure coverage.

Last year Maine was cited as the most "quit friendly" state in the nation.  Unfortunately, Maine has lost that distinction due to the cut this year of coverage by MaineCare of all tobacco cessation medications (except for pregnant women, which is federally required).  Maine is still listed as only one of two states that currently invests in quitlines at or above the recommended amount. 


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Long-Awaited Final ‘Sunshine’ Rule Lands at OMB for Regulatory Review

A much-anticipated rule under the health care reform law that would require reporting of device and drug company payments to doctors has been sent to the Office of Management and Budget for review, a key step on its path to final release.

The final rule on Transparency Reports and Reporting of Physician Ownership of Investment Interests (CMS-5060-F) from the Centers for Medicare & Medicaid Services was received Nov. 27, according to an OMB website.

CMS published in December 2011 a proposed rule (76 Fed. Reg. 78,742, Dec. 19, 2011), which is required by Section 6002 of the Affordable Care Act. That section is also known as the Physician Payments Sunshine Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid, or the Children's Health Insurance Program (CHIP) to report annually to the secretary of health and human services certain payments or transfers of value to physicians or teaching hospitals. The government would then publish the reported data on a public website.

Companies would have to begin disclosing all physician payment data 90 days after a final rule is published. In May, CMS said that it would not require any data collection until January 2013, and that a final rule would be issued later in 2012 (20 HCPR 787, 5/14/12).

However, the agency's schedule for issuing the rule prompted concerns from consumer groups, which Nov. 15 urged CMS to release regulations to implement the Sunshine Act “as quickly as possible.” The letter was signed by AARP, AFL-CIO, Community Catalyst, Consumers Union, the National Physicians Alliance, and the National Women's Health Network. The groups said that even if the rule had been issued Nov. 16, the law would not go into effect until Feb. 14, 2013, more than a full year behind schedule.

Industry groups also have pushed the government to issue the rule, and to give ample time to implement its requirements. In August, trade groups representing drug and medical device companies urged CMS to issue the final Sunshine Act rule and to allow companies 180 days to comply before it becomes effective. That letter was signed by the Advanced Medical Technology Association, the Biotechnology Industry Organization, the Medical Imaging & Technology Alliance, and the Pharmaceutical Research and Manufacturers of America.

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Mass. Begins Second Health Reform Phase By Implementing Cost Control Measures

A new Massachusetts commission Nov. 16 began the task of implementing the state's first-in-the-nation law mandating a slowdown in the increase of health care costs.

Members of the Health Policy Commission (HPC), chaired by Brandeis University professor and health policy expert Stuart Altman, were sworn in by Gov. Deval Patrick (D).

The 11-member panel will oversee a major overhaul in the state's health care sector—the second stage of a reform that began with passage of a bill in 2006 requiring that everyone in the state obtain health insurance.

The cost containment bill was passed by the Legislature in July and signed into law by Patrick on Aug. 4 (20 HCPR 1349, 8/13/12). It took effect on Nov. 5.

“This is the beginning of the future of health care reform in Massachusetts,” said Patrick, adding that he has “no illusions about how difficult or complicated this will be.”

The new statute establishes a health care cost growth benchmark equal to the potential economic growth rate of the state for each of the next five years. For 2013, the rate is set at 3.6 percent.

For the succeeding five years, the benchmark will be 0.5 percentage points less than the potential economic growth rate in order to rid the system of inefficiencies; after that it will revert to a rate equal to the growth rate. The HPC will be authorized to modify the rate.

Major strategies for achieving savings are payment reforms through bundled, episodic, or global payments, said David Seltz, an aide to Patrick, who presented an overview of the new law to the panel.

The cost increase targets are the “most complicated” part of the law, said Altman, adding that the HPC will seek to be flexible in enforcement, concentrating on “gross abuses.”

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Quality Counts Conference Call for Abstracts

The Quality Counts 2013 Conference Planning Committee invites you to submit a proposal to present an interactive breakout session during the QC 2013 conference which will be held at the Augusta Civic Center on Wednesday, April 3, 2013. 

A range of breakout sessions will provide learning opportunities for attendees under the framework of the Triple Aim which is guiding national health reform.  We encourage proposals that directly address one or more of the goals of the Triple Aim: improving population health, reducing healthcare costs and improving patient experience of care.

 Click here to download the submission form.   

DEADLINE FOR PROPOSALS:  Friday, December 14, 2012, 5:00 pm.

Review of submissions will begin immediately.  Applicants will be notified whether their proposal is selected or not by January 18, 2013.

Submit proposals to the attention of Dee Kerry deHaas by email: or by fax: 207.622.3332.   

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States, AMA Continue to Work on Primary Care Payment Increase

As previously reported in the Weekly Update, the Centers for Medicare and Medicaid Services released a final rule on November 1, 2012 implementing the Medicaid payment increase of specified primary care services furnished by certain primary care physicians in CY 2013 and 2014 to 100 percent Medicare rates.   

The increase in payment applies to primary care services provided by a primary care physician with a specialty designation of family medicine, general internal medicine or pediatric medicine and subspecialists within these specialties.  To qualify the designated primary care physician must be either:

  • Board certified in the following: American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA) or American Board of Physician Specialties (APBS), or
  • Have furnished evaluation and management services and vaccine administration services under eligible codes that equal at least 60 percent of the Medicaid codes he or she has billed during the most recently completed calendar year or, for newly eligible physicians, the prior month. 

Primary care services designated in the Healthcare Common Procedure Coding System (HCPCS) and eligible for the increased payment are as follows: 

  • E&M codes 99201-99499
  • CPT vaccine administration codes 90460, 90461 and 90471-90474 or their successor codes. 

The AMA has recently completed a review of the rule.  Of note: 

  • Medicare rates will be based on those in effect in CY 2013 and CY 2014 or, if greater, the payment rates that would be applicable in those calendar years using the CY 2009 Medicare physician fee schedule conversion factor.  
  • The increase applies to payments made under Medicaid-fee-for service, Medicaid managed care (MCOs), pre-paid inpatient health plans (PIHPs) and pre-paid ambulatory health plans (PAHPs).  
  • According to the final rule, states have until March 31, 2013 to submit a State Plan Amendment to the Federal Government to reflect the payment increase, but the rate increase must be effective January 1, 2013.
  • CMS will provide a State Plan Amendment template.  This has not yet been provided. 
  • Physicians will need to self attest that they are eligible for the increase and bill for the appropriate higher rate on the applicable Medicaid claims (otherwise CMS will pay the lower rate as billed).
The AMA is working with AAP, AAFP and ACP to schedule a conference call with staff from CMS and physician members to educate physicians about this payment increase.  This will hopefully occur in mid-December.  The MMA is in contact with staff at the MaineCare program and will continue to work to ensure the successful implementation of the payment increase in Maine.  [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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MaineCare Facing $100 Million Budget Shortfall

Speaking before the Maine Legislature's Appropriations and Financial Affairs Committee last Thursday (Nov. 29), Commissioner of Health and Human Services Mary Mayhew reported that the MaineCare program is currently facing a roughly $100 million budget shortfall.  She explained that the shortfall is due in part to increased spending over projections (mostly increases in hospital spending and changes in hospital payment methodology) though it is largely caused by unrealized savings that were built into the budget (including the cuts in eligibility that have not yet been approved by CMS) and decreased federal matching funds.   The shortfall will have to be addressed by the 126th Legislature when they reconvene in January. 

Ms. Mayhew also reported on the MaineCare Redesign Taskforce which was charged by the last legislature with identifying $5 million in savings in the MaineCare program, savings already built into the current fiscal year budget.  Ms. Mayhew stated that the Taskforce was able to succesfully identify and agree on $1.3 million in savings inititiaves.  They reviewed and discussed short-term, mid-term and long-term savings strategies and had more agreement around longer term approaches such as care coordination and changes to the prior authorization process.  The group was not willing to pursue short-term strategies that would undermine longer-term initiatives and partnerships, such as cutting provider reimbursement.  Ms. Mayhew stated that the Taskforce is finalizing a draft report which will be open for 2 hours of public comment on December 11th.  A final report will be submitted on December 15th.  

The Appropriations Committee also heard a general fiscal update and was told that the state is running approximately $35 million behind in revenue projections. Governor LePage has announced that he may issue a curtailment order for that amount, which would mean across-the-board spending cuts.  A curtailment order would likely go into effect in December and could impact MaineCare and DHHS. 

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OIG Opinion Outlines Permissible on-Call Physician Payments

On October 30th, the HHS Office of Inspector General (OIG) published an advisory opinion addressing whether the anti-kickback statute may be triggered when a hospital pays a per diem fee to physicians for providing on-call hospital emergency department coverage.  The OIG concluded that the arrangement in question presented a low risk of fraud and abuse and would not give rise to administrative sanctions because of a variety of factors outlined in the summary.  The OIG also outlined compensation structures to avoid when developing an on-call coverage arrangement.  While the OIG opinion is limited to the specific facts presented by the requesting hospital, OIG advisory opinions are relied upon by the health care community to gauge general parameters for appropriate arrangements, and this advisory opinion may be useful for physicians and hospitals seeking to structure a compensation arrangement for on-call care.

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Upcoming Events & Conferences


 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


Environmental Health Strategy Center 10th Anniversary Celebration 

Thursday December 6th 

5:30 pm - 7:30 pm

One Longfellow Square, 181 State Street, Portland

Enjoy hors d'oeuvres, live music, and a champagne toast to 10 years of preventing harm while we honor environmental health leaders

To learn more or purchase tickets, 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


AMA Webinar: Improving Practice Workflow

December 11, 2012, 7 pm 

This webinar will describe how high-performing medical practices delegate responsibilities among its medical staff an well as help physicians identify decisions and processes that can be delegated, develop practice protocols and execute workflow redesign strategies.  Free to AMA members. 

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


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.


MEDICAL DIRECTOR/PHYSICIAN - Health Access Network - Lincoln, Maine

Health Access Network (HAN), a Federally Qualified Health Center (FQHC) in Lincoln, Maine, is seeking a dynamic physician leader to serve in the role of Medical Director to provide overall direction and oversight of our clinical team, as well as provide part-time direct patient care. The Medical Director will join the health center’s leadership team in meeting the goals and objectives of the health center’s mission. Responsibilities include, but are not limited to administrative and clinical leadership of medical staff, quality improvement, credentialing & privileging, peer review, strategic planning, budgeting, provider recruitment and assist with the development of clinical policies and procedures. Position is two days a week administrative and three days providing direct patient care.

Qualifications: Board Certified in family medicine, Maine License, and have at least five years primary care and leadership experience. A practicing physician wishing to transition to a part time medical-administrative/management role is encouraged to apply. Community health center experience a plus. Familiarity with disease registries and electronic medical records is required. Must have exceptional verbal and written communication skills, and possess compassion, innovation, integrity, and excellence which are the health center’s values.

For more information or to forward your curriculum vitae' contact:  Sonia Maxwell, HR Director/Compliance Officer, P.O. Box 99, Lincoln, ME  04455, 207-794-6700,

12/31/12 [return to top]

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