December 24, 2012

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Congress Leaves D.C. without Fixing or Delaying SGR cut

Having reached an impasse, Congress left Washington D.C. this past week without taking action to avoid either the so-called fiscal cliff or the 27% reduction in physician payments from Medicare resulting from the sustainable growth rate formula.  In Maine, the reduction would be approximately 32% when the 2% reduction resulting from the sequestration law is considered, costing each Maine physician participating in Medicare over $21,000 annually and amounting to well over $100 million in the aggregate.

Despite this grim news, all of us at the Maine Medical Association wish all of our readers all the best for the holidays and the new year.  We appreciate your support of MMA.

While Congress could return after Christmas if Congressional leaders and President come to an agreement, such an agreement which would avoid the so-called fiscal cliff is certainly not imminent.   While the prospect for fixing the SGR problem is largely tied to year-end federal budget negotiations that would prevent the across the board cuts brought on by sequestration, if no year-end deal is reached, Congress could pass a stand-alone physician pay fix if it chose to do so.

With no action in sight, CMS announced this past week that claims would be processed in 2013 under the lower rate (conversion factor would be approximately $25 instead of the current $34) for services provided in 2013. 

Republicans in the House have proposed a solution that would kick the can down the road for another year, but would pay for some of that delay by eliminating provider-based reimbursement in hospital outpatient departments and eliminate or postpone the primary care rate increase effective Jan. 1 because of provisions in the Affordable Care Act.   Both of these "pay-fors" are very unpopular with many Democrats and with hospitals and primary care physicians.  In previous issues of the Update we have noted the strong opposition of Maine's hospitals to elimination of provider-based reimbursement.  With respect to the primary care fee increase, MaineCare announced just last week that it would be bumping up MaineCare payments to primary care physicians to Medicare levels for 2013 and 2014, effective Jan. 1, 2013.  

MMA continues to be in touch with the members of our Congressional delegation urging them in the strongest possible terms to at least delay the nearly 30% reduction, due Jan. 1.  The following talking points from the AMA provide a sense of the impact of the impending SGR cut in Maine.

  • Maine seniors face significant challenges obtaining access to physicians.  These challenges will get much worse unless Congress acts very soon to permanently prevent steep cuts in Medicare payment rates.  At just 14 practicing physicians per 1000 Medicare beneficiaries, Maine is well below the national average.  Twenty-nine percent of Maine's Medicare beneficiaries are living below 150% of the federal poverty level.  Maine is also one of 29 states and the District of Columbia that have imposed cuts in services for low-income elderly, such as home care and rehabilitation.
  • Congress needs to avert the SGR cut and eliminate the formula that leads to this annual crisis.  SGR legislation would prevent a loss of $100 million annually for the care of elderly and disabled patients in Maine.  On average, a cut of this magnitude will reduce 2013 practice revenues by $21,000 per Maine physician, which will worsen access problems and make it extremely difficult to pay for office space and other expenses and avoid staff layoffs.  
  • 14,935 employees of medical practices, 262,290 Medicare patients and 42,524 Tricare patients in Maine will be helped by the legislation that averts these cuts.
  • Compared to the rest of the country, Maine, at 20%, has an above-average proportion of Medicare patients.
  • Almost 50% of Maine's practicing physicians are older than 50, an age at which surveys have shown many physicians consider reducing their patient care activities.
With Congress having failed to address the pending cut, physicians may wish to check out the AMA Medical Participation Options Kit.  For questions about Par, Non-Par, and opting out/private contracting, go to

MaineCare Opioid Limits Work Group Completes Work; Limits Take Effect Jan. 1

The MaineCare Opioid Limits Work Group, chaired by MaineCare Director Kevin Flanigan, M.D. has completed its work and has forwarded to MaineCare staff its recommendations for implementing the limits required by the Supplemental Budget on Jan. 1.  The limits impact both prescriptions for acute pain and chronic pain and will be effective retroactively.  The draft proposal, which is still being put into an emergency rule, is posted on the MMA website at (in Spotlight section).

The Work Group, consisting of physicians, mid-level providers, and advocates for MaineCare patients (MMA staff participated as well) met seven times over the summer and fall and received input from a wide variety of sources.  While the final supplemental budget took effect on August 30th, DHHS Commissioner Mary Mayhew agreed to delay the implementation of the limits until January 1, 2013, in order to provide the Work Group with time to receive input and provide recommendations for the emergency rule being drafted.  While the draft proposal is by no means perfect, it does take into consideration all the relevant interests and balances them in as fair and responsible manner as possible.

 The draft proposal, which is expected to be drafted into an emergency rule before January 1, is divided into sections dealing with acute pain, (pain expected to be resolved within 60 days) and non-acute or chronic pain.   Exceptions to the limits are made for the following categories:

 1.  A MaineCare member who is receiving opioid medications for symptoms related to HIV, AIDS and cancer and other qualifying diseases and conditions, as set forth on the Department's Preferred Drug List.

 2.  A MaineCare member who is receiving opioid medications during inpatient treatment in a hospital, in a nursing facility or during hospice care.

3.  A MaineCare member who is receiving 30 milligrams or less of morphine sulfate equivalents on a daily basis.

 4.  A MaineCare member for whom MaineCare reimbursement for opioid medications for the treatment of addiction is restricted by limits applicable to methadone and buprenorphine and naloxone combination medications.

 While prescribers impacted by the limits are encouraged to review the details of the proposal on the MMA website (in Spotlight section) at, the essence of the proposal is a limit of 15 days of medication for acute pain, with the ability to receive up to three 14 day renewals through prior authorization so long as there is a face to face visit with the patient.  A renewal beyond 57 days would require a treatment plan consisting of incorporation of non pharmacologic treatments and functional assessment of the member by the physician or other prescriber.  In essence, treatment beyond 57 days will move the patient to the non-acute, or chronic pain limits.

 For treatment for chronic pain, opioids will be covered by MaineCare only after one or more non-pharmacologic treatment alternatives are attempted.  The proposed rule includes as such alternatives physical therapy, occupational therapy, chiropractic therapy, osteopathic manipulative treatment, cognitive behavioral therapy, and acceptance commitment therapy. Note that the Department may waive the requirement of a non pharmacologic intervention treatment through prior authorization when participation is not feasible and opioid treatment is medically necessary.

 Post-surgical pain is treated as acute pain, but a more liberal provision applies as after the first fifteen day script, the surgeon may renew the script for a total of 60 days, in one or multiple prescriptions through prior authorization.  But there is a requirement that the patient be seen by a provider (not necessarily the surgeon).

 Efforts are being made to notify patients and prescribers before the limits take effect.  Dr. Flanigan is doing a webinar this week (see article in this issue of the Update) to discuss the proposal.  MMA staff is also available to present CME programs on this topic to medical staffs and other interested groups.  If your practice or staff is interested in a presentation, contact Gordon Smith, Esq., at or by calling 622-3374, ext. 212.

 Finally, physicians are reminded that these limits imposed by the Legislature are limits on the ability of MaineCare to pay for the medication.  The physician is free to write for whatever medication he or she believes is appropriate for the patient and the patient may pay cash for the medication if it is not covered by MaineCare.  But in doing so, he prescriber may wish to consider whether these limits will eventually be considered the appropriate standard of care for treatment of pain.


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Legislative Leaders Announce Committee Assignments

Last week, Democratic leaders of the 126th Maine Legislature announced the composition of the 17 joint standing committees of the 126th Maine Legislature.  You can find the complete list on the legislature's web site here:  The MMA's advocacy is focused on the following 4 committees that have some role in the development of health care policy in Maine:

  • Health & Human Services
  • Insurance & Financial Services
  • Judiciary
  • Labor, Commerce, Research & Economic Development
Committee assignments for the 4 physician members of the new legislature are:
  • Representative Linda Sanborn, M.D. (D-Gorham):  Appropriations & Financial Affairs
  • Senator Geoffrey Gratwick, M.D. (D-Penobscot):  Insurance & Financial Services, Chair; Environment & Natural Resources
  • Representative Jane Pringle, M.D. (D-Windham):  Insurance & Financial Services
  • Representative Ann Dorney, M.D. (D-Norridgewock):  Health & Human Services
The new legislature will begin work on Tuesday, January 8th.

The MMA Legislative Committee weekly phone calls will begin Tuesday, January 8th.  They will be held every Tuesday at 8 pm through the session. 

Conference call number:  1-877-669-3239

Attendee Pass code:  23045263

Any interested member and specialty societies are invited to join.  

The MMA Legislative Committee held its organizational meeting for the 126th Maine Legislature December 12th. The meeting was well attended by MMA members, representatives of specialty societies and other allied organizations.  We hope to continue strong attendance on our weekly conference calls to discuss MMA's legislative priorities and our positions on pending bills.  The last day to introduce bills for the upcoming session is January 18th so time on the call will also be spent discussing bills MMA plans to introduce this session.  

For more information contact Andrew MacLean at or 207-622-3374 x 214.    [return to top]

Flu Vaccine Remains Available As Disease Continues To Rise

The Maine Center for Disease Control and Prevention reports that influenza activity in Maine has steadily increased in November and December.  Influenza A/H3 and influenza B have been confirmed in Maine indicating both strains are circulating.  Maine CDC has followed up on 13 outbreaks of influenza as of Tuesday December 18th. Influenza hospitalizations are also being reported, indicating the severity of illness this influenza season.  One pediatric death attributed to influenza was reported to Maine CDC in mid-December. Pediatric death due to flu is required to be reported to public health officials and is rare, according to the CDC. Influenza vaccination is still strongly encouraged and is widely available, especially to  protect those persons at risk of more severe disease.  The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated.

For questions regarding the vaccine please contact the Maine Immunization Program at 207-287-3746 or 1-800-867-4775 or by e-mail at

For questions regarding the disease, or to report cases or an outbreak contact the Infectious Disease Epidemiology Program at 1-800-821-5821 or by e-mail at

For more information, also see the MeCDC Health Advisory here[return to top]

Maine Quality Forum Advisory Committee Reviews Options for Public Reporting of Patient Experience of Care Surveys

The Maine Quality Council Advisory Committee, chaired by Robert Keller, M.D., met on Friday, Dec. 14 to conduct its regular business but set aside the majority of the meeting to review options for the public reporting of Patient Experience Survey Data which is expected in 2013.  A total of 284 medical practices (175 primary care, 95 specialty and 15 mixed) have agreed to participate in the collection of the data with 90% of the cost being covered by the state. These practices represent over 1300 individual providers.  A condition of participating was agreement to have the survey results publicly reported on the MQF website.

To assure consistency in approach, the Dirigo Health Agency contracted with four vendors to administer the survey,  The surveys are being completed during this period of time.

The initiative is being conducted in collaboration with the Maine Health Management Coalition and Maine Quality Counts.  The ultimate purpose is to collect survey date using a standardized instrument (CAHPS) and approach so that valid publicly reported comparisons can be made about primary and specialty healthcare in Maine at the practice site level.  The survey results will not drill down to the level of the individual provider within a practice. Many large employers or the Maine Health Management Coalition may use the survey data to rank and tier provider networks.

No conclusions were reached on the choices presented by consultants to the project, Dale Shaller and Lise Rybowski, but the Advisory Council will continue to discuss the options while the data is being collected.

No practices in Maine have ever used the CAHPS version for the patient centered medical home which focuses on how well the practice provides patient-centered care, coordinates with other providers and supports patient engagement. [return to top]

MaineCare Announces ACA Primary Care Payment Bump in January

At the Maine Medical Association Board of Directors meeting 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.   [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]

Maine CDC Recognizes Efforts To Ward Off Infectious Disease

The Maine Center for Disease Control and Prevention recently recognized two organizations and two individuals by presenting them with the Pump Handle Award for their contributions to help reduce the impact of infectious diseases in Maine.

Redington-Fairview General Hospital in Skowhegan was honored for its efforts to prevent an outbreak of pertussis by holding public clinics to provide vaccinations, while Maine's Summer Camps were also recognized for its efforts to contain illnesses and minimize the spreading of infectious diseases.

Dr. George Stockwell, who practices in Windham, earned the distinction for his leadership in collecting data and reporting in to Maine CDC to help statewide tracking of influenza; and Paul Gauvreau, Esq., of the Office of the Attorney General, was recognized for the legal advice he has provided based and his insight on disease reporting and outbreak management.

The Pump-Handle Award has been given for more than a decade in Maine. The award's name is a tribute to Dr. John Snow, who is considered by many to be the father of epidemiological science. Snow identified that a public water pump was the source of a cholera outbreak in London in 1854. Snow convinced authorities to remove the handle of the pump, preventing any more of the infected water from being collected. The spring that fed the pump was later found to be contaminated with sewage. 

"Maine CDC has long-held relationships with people across the state whose work helps prevent the spread of infectious disease,'' said Dr. Stephen Sears, State Epidemiologist. "This award is just one small way to recognize and thank them for a job well done."

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Medical Practices Invited to Attend Bar Association Trainings - Employment Law, Health Reform

The Maine Bar Association encourages physician practice staff to attend the following Continuing Education events: 

12th Annual Employment Law Update - MSBA Live Program and Live Webcast

Date:   February 28, 2013

Format:  Live Program and Live Webcast

Live Program Location: Hilton Garden Inn, Freeport

CLE Credits: 6.5 including 1.0 ethics/professionalism education

Online Registration for the live program: Please click here.

Online Registration for the live webcast:  Please click here.


 Health Care Reform in 2012: Where are we now and where do we go from here?  - MSBA Webcast Video Replays

The Supreme Court decision in late June settled the constitutionality of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act (ACA). Although there remains much uncertainty as to the permanency and future of the ACA, its provisions now in effect or that will be in effect in 2013 have a direct effect on group health insurance renewals for 2013. The program will provide a review of the ACA provisions coming into effect in 2012 and 2013 that will have a direct impact on those renewals and the employers providing group health insurance coverage to their employees. This is information about which lawyers and their clients need to be aware as they deal with their 2013 renewals. The panel includes presenters whose expertise and experience enable them to address the various issues facing employers, the brokers, and the carriers as the implementation of the ACA continues.  Faculty will respond to questions immediately following each topic.

CLE Credits: 3.0

Registration: To register online for the January 22, 2013 webcast, please click here. To register online for the February 19, 2013 webcast, please click here.

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January 31st Deadline Set for 2013 Medicare ePrescribing Hardship

If physicians believe they meet one of the Medicare ePrescribing hardship exemptions but did not file by the June 30, 2012 deadline, they will have another opportunity to spply.  Pursuant to AMA advocacy, CMS has reopened the Communications Support webpage to give physicians more time to file for a hardship, allowing more physicians to avoid the ePrescribing penalty.  Available hardship exemptions include physicians:

  1. unable to ePrescribe because of state, federal, or local law/regulation;
  1. with fewer than 100 prescriptions between January 1st and June 30, 2012;
  1. in rural areas without sufficient high-speed internet access; or
  1. in areas without enough pharmacies available for ePrescribing.
Many of the ePrescribing penalties received in 2012 by physicians who filed for a hardship exemption were due to filing errors.  Therefore, it is important to know that hardships should be filed using the physician's individual Type I NPI.  That is, the rendering Provider NPI used for box 24(J) of CMS 1500 form, or the NPI used in the Rendering Provider Name loop or the Billing Provider Name loop, if the billing provider and rendering provider are the same on the 837 (electronic claim) and the Tax ID number (TIN) they use to bill.  Physicians who bill using their Employer Identifier number (EIN) they should use their EIN for filing a hardship and those who bill using their Social Security Number (SSN) should use their SSN for filing hardship.

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; if this occurs they should contact the Help Desk as well since CMS is still working to resolve these issues.

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Job Openings

Physician Assistant or Family Nurse Practitioner

Full-time physician assistant or family nurse practitioner wanted for multi-service, progressive, rural community health center in a medically underserved area. Services include family practice, mental health counseling, pediatric psychiatry, integrated behavioral health and radiology. EMR. Practice is outpatient only. Located in Porter, ME, between Portland and the White Mountains.  Please submit your resume to or mail to: 

Human Resources Coordinator

Sacopee Valley Health Center

PO Box 777

Parsonsfield, ME 04047

Sacopee Valley Health Center is an
Equal Opportunity Organization.




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.     


HOSPITALIST - Belfast, Maine

Multi-specialty community hospital on the coast of Maine seeks full-time BC/BE Hospitalist to join an established group and provide full medical oversight of hospital inpatient and critical care activities. Belfast offers beautiful views of Penobscot Bay and is ideal for outdoor enthusiasts. Exceptional family environment with excellent schools.

Send CV to Dan Bennett, Director of Operations, Waldo County General Hospital, P.O. Box 287, Belfast, Maine 04915. Tel. (207) 930-6741, Fax (207) 338-6207, e-mail:

 2/11/13 [return to top]

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