December 10, 2012

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

MMA Legislative Committee Meets Wednesday: Make Your Opinion Known

MMA's Legislative Committee will hold its organizational meeting for the First Regular Session of the 126th Maine Legislature this Wednesday evening, December 12th at the offices of the Association in Manchester. Representatives of specialty societies are encouraged to attend and share their legislative agendas for 2013.

Members of he 126th Maine Legislature were sworn in last week and will return to Augusta on January 8th for their First Regular Session, one that is expected to be long, busy, and contentious.  The Legislative Committee meeting Wednesday evening provides an opportunity for any MMA member and particularly state medical specialty societies to attend and share their suggestions and wishes with respect to the upcoming session.

The meeting is open to all members, but please register by communicating with Maureen Elwell at the office by sending an e-mail to or by calling the office at 622-3374, ext. 219.  Dinner will be available at 6:00 pm with the meeting beginning shortly thereafter.  It is expected to adjourn by 8:30pm.

The Committee is chaired by Amy Madden, M.D., a family physician practicing in Belgrade.

You can find an alphabetical listing of Senators and Representatives with their contact information on the web here.  The cloture deadline for legislators to file bill requests (unlimited in number during the first session) is Friday, January 18th.

Mercy Sale to Steward Nixed; Sale to EMHC Being Considered

In an announcement that was a surprise to most of Maine's healthcare community, Mercy Health Systems of Maine on Friday announced that its proposed sale to for-profit Steward Health Care LLC, based in Boston, had fallen through and that Mercy officials had instead signed a letter of intent to merge with Eastern Maine Healthcare Systems of Brewer. According to a communication sent to Mercy employees, the proposed merger would allow Mercy to continue its Catholic Identity and non-profit status.

Specifics of the proposal were not released although an EMHC representative said that it was hoped that a definitive agreement would be put together by the end of the year.  Approvals by the Vatican and the State are required, along with Catholic Health East in Pennsylvania of which Mercy is currently a member.

[return to top]

MaineCare Announces ACA Primary Care Payment Bump in January

At the Maine Medical Association Board of Directors meeting last Wednesday (Dec. 5), MaineCare Medical Director Dr. Kevin Flannigan announced that MaineCare will be prepared to pay primary care physicians at Medicare rates for primary care services delivered after January 1, 2013.  As reported in previous issues of the Weekly Update, this is a benefit provided because of the Affordable Care Act and is funded with federal dollars. Primary Care physicians practicing in the areas of family medicine (with or without OB), internal medicine and pediatrics are included.  Provider-based physicians will receive the increase, as well as physicians in private practice.  FQHC's will not be receiving the increase as they are already paid higher rates under the federal law.

Physicians will have to fill out a form attesting to their area of practice and to the fact that 60% of their charges are for office based services to be eligible for the extra payment.  MaineCare will be releasing the form shortly and the link will be provided in future editions of the Update.  While a majority of states will be making quarterly payments to their primary care physicians to reflect the increase, Dr. Flannigan stated that MaineCare is committed to incorporated the bump into its regular fee schedule and payments.   If physicians do not submit their attestation form before January 1, physicians will receive retroactive payments beginning after they submit the form.  

For more information about the payment increase, click here for an AMAnews article or here for a CMS fact sheet on the rule.   

The MMA Board also spent time reviewing a resolution on gun control passed at the 2012 annual session (sent back to the Public Health Committee for amendment), preparing for the 2013 legislative session and planning for the Board retreat to be held in Quebec City in January.  [return to top]

MaineCare Redesign Task Force Report Impacts Psychiatry, Radiology, Ob-Gyns, Others

The task force charged with idenfiying $5 million in savings from the MaineCare program has now circulated a draft report outlining short-, medium- and long-term solutions for savings.  The group was challenged to find the full $5 million already built in as savings to this fiscal year's budget and were able to identify only $1.3 million in savings from 2012-2013.  They did estimate $11.28 million of savings in 2013-14 and $22.59 million in 2014-15 from medium- and long-term initiatives.  

The task force will be taking public comment on the report tomorrow, December 11th at 1 pm in room 228 of the statehouse. Testimony will be limited to 3 minutes per person. 

MMA was pleased to see several of the initiatives, including long-term savings attributed to restoring the cut to the MaineCare tobacco cessation benefit and providing some dental coverage to those who seek dental services in the emergency room.  The group also rejected short-term savings from provider reimbursement cuts, acknowledging that provider cuts could make it harder to partner on longer-term initiatives such as care management.  

MMA is seeking feedback from speciality societies on additional initatives outlined in the report, including:

  • Prior authorization for "high cost" imaging and radiology 
  • Concurrent review for psychiatric services and prior authorization for all settings for psychiatric care provided to individuals under age 21
  • Monitoring the use of anti-psychotic medications 
  • Expansion of the value-based purchasing care management program to target MaineCare’s top 20% of utilizers
  • Ending reimbursement for elective inductions prior to 39 weeks with a prior authorization process for exception cases
  • An initiative to reduce medically unnecessary C-Sections

The full report can be found by clicking here

Please contact Andrew MacLean for more information or to share feedback on any of these initiatives:, 622-3374 x 214 [return to top]

Looming DSH Cuts Pose Threat to Hospitals In States Opting Out of Medicaid Expansion

The nation's safety-net hospitals—those that treat higher than average numbers of the poor and uninsured—are facing a double-barreled threat that could cost them billions of dollars and even put some out of business over the next several years, public health advocates told Bloomberg News in recent interviews.

The threat comes from a combination of scheduled cuts in federal subsidies for safety-net providers under the Affordable Care Act and uncertainty about how many states will participate in the ACA's Medicaid expansion.

In the face of this threat, safety-net hospital officials at the local level are bracing for some hard decisions they may need to make about what services to cut. At the national level, public health advocates are attempting to alert lawmakers to the problem, with the goal of getting the federal subsidies restored.

When the ACA was being negotiated, safety-net hospitals were willing to go along with the cuts in these subsidies—known as “disproportionate share hospital (DSH)” payments—on the assumption that a substantial portion of their costs of providing uncompensated care would be picked up through the ACA's planned expansion of Medicaid, according to Bruce Siegel, president and chief executive officer of the National Association of Public Hospitals and Health Systems (NAPH).

“That trade-off is now gone,” Siegel told BNA. The U.S. Supreme Court, as part of its landmark health care decision in June, held that states could not be required to join in the Medicaid expansion, effectively making it voluntary among the states, he noted.

As a result, in states that do not participate in the expansion, safety-net hospitals will not see any reduction in their uncompensated care costs, yet they still will be required to absorb the loss of federal DSH funding enacted under the ACA.

“If you take DSH funding away and don't expand Medicaid, it's a very dire situation,” Siegel said. “Hospitals will definitely be faced with closing services at a minimum and some will be faced with shutting down.”

Although there is no strict definition of safety-net hospital, they tend to be large urban or public hospitals and generally have a much higher share of uncompensated care costs than other hospitals. For example, uncompensated care averages 21 percent of total costs at NAPH-member hospitals compared with 5.5 percent at other hospitals, according to NAPH.

Enacted by Congress in 1981, federal DSH payments—which are administered by the states—are intended to go to hospitals serving a larger than average number of low-income and uninsured patients. The payments supplement regular hospital reimbursements under Medicaid and help to compensate the hospitals for care they provide that is not covered by insurance.

In fiscal year 2010, federal DSH payments totaled some $11.6 billion on top of federal Medicaid spending of $263.3 billion, according to the Kaiser Family Foundation. Payments to individual states ranged from $1.6 billion in New York to $9.8 million in North Dakota.

Under the ACA, DSH payments will be reduced by $500 million in 2014 when the Medicaid expansion will begin in states that decide to participate. This reduction will be followed by additional cuts, increasing each year until 2019 when the total amount of DSH funding cuts over the 2014-2019 period will total $17.5 billion.

That means the total amount of DSH Medicaid funding available in FY 2019 will be about 50 percent less than it would have been without the cuts, according to the Congressional Budget Office.

Hospitals also can receive DSH funding under the Medicare program. That funding will be cut by some $22.1 billion from 2015 to 2019 under the ACA. But because the Medicare DSH cuts will be spread across many more hospitals, they will not have as direct an impact on safety-net hospitals.

For safety-net hospitals, the combination of fewer states participating in the Medicaid expansion along with the scheduled Medicaid DSH cuts will saddle them with an additional $53.3 billion in uncompensated care costs by 2019, according to NAPH, which represents 200 hospitals and health systems across the country. 

Confronted with twin threats to their funding, safety-net hospitals and their advocates are beginning to formulate an action plan. For now, much of the activity is at the local level, according to Siegel. He noted that his group is assisting NAPH member hospitals to make the case for their states to participate in the Medicaid expansion. “At the end of the day, this is an issue to bring to the state capitol,” he said.

[return to top]

Free First Friday Education Program on Prescription Drug Abuse, Feb. 1

The MMA's First Fridays Educational Series for 2013 begins on Friday, Feb. 1 from 9:00am to noon and includes an unusual feature.  THERE IS NO COST to attend, either in person at the MMA offices in Manchester or via webex from a laptop or desktop.  Because of grant funding by the state Office of Substance Abuse and Adult Mental Health Services, we are able to present the program without charge.

Faculty for the program includes Tamas Peredy, M.D. of the Northern New England Poison Control Center, John Lipovsky, the new coordinator of the Prescription Monitoring Program, Noel Genova, PA-C of the Chronic Pain Consultation Program and Gordon Smith, Esq. of MMA.  MaineCare Medical Director Kevin Flanigan will also be available to describe the MaineCare limits on opiate medication, effective Jan. 1, 2013.

Registration is available on the MMA website at  Although the registration form notes that a fee is charged, just complete your registration form without including that portion.  A new form with a full agenda and goals and objectives will be available shortly and will be distributed electronically to all of the e-mail addresses we have available for members and their staffs.

Only twenty five remote sites are available so sign up as soon as possible if you know that your facility or practice would like to attend.

A complete list of all the 2013 First Friday programs is also on the website and was included with your Fall issue of Maine Medicine. [return to top]

Acadia Hospital Requests Your Opinion Regarding Establishing a Program for Eating Disorders

 Acadia Hospital, a mental health and substance abuse treatment facility in Bangor, has asked for MMA's assistance in disseminating an on-line survey tool assessing the viability of establishing a program to treat eating disorders.  Below is a link to the survey which they are requesting psychiatrists, primary care physicians, hospitalists and Ob-Gyns to complete.  Please complete the survey only if you have not done so previously.

This survey will close on December 28.  Your participation is much appreciated.


[return to top]

Last Chance to Register: 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 Jessa Barnard, or 207-622-3374.   There is no cost to participate.  [return to top]

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.    [return to top]

Upcoming Events & Conferences

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

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,


DFD Russell Medical Centers seeking NURSE PRACTITIONER

The DFD Russell Medical Centers (DFDRMC) operates three community health centers in central Maine.  We are looking for a full-time NP for immediate placement.  A current unencumbered Maine license and proficiency with electronic medical records are required.

Excellent benefits, including medical, dental and life insurance, 403(b) retirement plan, flexible spending accounts, a generous paid time off plan and incentive plan.  Salary is commensurate with experience.
We are an equal opportunity employer committed to diversity in the workplace. 

To submit your resume, please email or fax Laurie Kane-Lewis, CEO or fax 207-524-2549.     

1/7/13 [return to top]

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