June 10, 2013

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POLITICAL PULSE: Budget Deal Reached, Important Health Care Issues Remain

The action was very intense last week at the State House and this week is likely to be similar.  MMA was involved in three votes last week that were resolved by ONE VOTE.  Senate votes of 18 to 17 and a House vote of 72 to 73 took place on bills impacting the physician's role regarding Lyme disease and MaineCare expansion meaning that both matters are still pending this week with more close votes expected.  Read below to get an update on where these issues stand today.  Or participate in the weekly Legislative call on Tuesday night at 8:00pm.


After working through the night last Thursday and Friday nights, the Appropriations and Financial Affairs Committee reached a unanimous deal on the 2013-2015 state budget.  The deal is largely seen as a compromise by both parties, and the hope is with a unanimous deal out of the Committee it will receive enough votes on the floor of the House and Senate to override a potential gubernatorial veto.   Some of the major issues addressed by the budget proposal include reducing the cut to municipal revenue sharing and generating revenue through a temporary increase in the sales tax and meals and lodging tax.  Some of the key provisions followed by the MMA include: 

  • A last minute proposal to cut rates to all Medicaid providers, including physicians, by 1.4% was avoided 
  • The proposed cut to critical access hospitals from 109% to 101% was avoided 
  • The proposed 10% cut to outpatient hospital services was included - this will mean a cut of $32 million over 2 years 
  • No increase in the cigarette tax or tax on other tobacco products was included 
  • The proposed cuts to Drugs for the Elderly and the Medicare Savings Program were avoided 
While the Committee has reached a deal, it will not hit the House or Senate floor until this week.  Also unresolved in the budget is the paying the debt owed to Maine hospitals.   Hospitals and providers will be focusing advocacy around that issue this week. 


As reported in the Update last week, after a lengthy debate last Monday, the House voted 89-51 in favor of LD 1066 the stand-alone bill that would expand health coverage to 69,500 low income Mainers.  The majority vote included five Republicans:  Rep. Carol McElwee (R-Caribou), Rep. Jarrod Crockett (R-Bethel), Rep. Thomas Tyler (R-Windham), Rep. Windol Weaver (R-York), and Rep. Sharri MacDonald (R-Old Orchard Beach).  Later in the week, the bill headed to the Senate.  The original draft of the bill failed to garner any Republican support in the Senate.  Then Senator Katz (R-Augusta) offered an amendment that lead to three Republicans (Senators Flood, Saviello and Katz) as well as one Independent (Senator Woodbury) supporting the bill.  The amendments include: 

  • Expansion is contingent upon Maine receiving 100% match for all childless adults; 
  • Impose Co-payments for Expansion Population; 
  • Evaluation of Expansion and Report to Legislature; and 
  • Sunset Provision.  This amendment would sunset the expansion coverage on 12/31/2016.  

The bill still faces further votes in the House and Senate and it will be critical to receive additional Republican votes in both the House and Senate to ensure enough support to override a veto.  The time has come to communicate with your legislators about the importance of getting these priority items passed.  You can leave a message for your Senator at 287-1540 or toll free at 1-800-423-6900 and for your State Representative at 287-1400 or toll free at 1-800-423-2900.  It is particularly critical to reach out to Republican legislators. 

If you do not know who your Senator or Representative is, contact Maureen Elwell at MMA at 622-3374 ext. 219 or via e-mail to melwell@mainemed.com.  While calls are encouraged to all legislators, if you have questions about the key targets for calls on this bill or the items listed below, contact Jessa Barnard at jbarnard@mainemed.com

Passage of the MaineCare expansion will clear the way for payment of the substantial hospital debt, a critical issue for Maine's hospitals and physicians alike. 


LD 597, An Act To Inform Persons of the Options for the Treatment of Lyme Disease, hit the Senate floor two weeks ago week and was passed by one vote.  It passed out of Committee with a 12-1 vote and previously passed the House 122-18.  However, the bill is very problematic for several reasons.  It would require physicians to inform patients every time they order a laboratory test for the presence of Lyme disease that a negative result for a Lyme disease test does not necessarily mean that Lyme disease is not present.  Further, it requires the Maine CDC to link from their website to the websites of several advocacy organizations that promote long-term antibiotic use for treating "chronic Lyme disease."   Many Senators opposed the requirement that physicians use a scripted disclosure for every Lyme disease test.  The bill moved back to the House last week where an amendments to remove the scripting requirement passed by one vote, but still faces further procedural hurdles in that body as well as the Senate.  MMA members are encouraged to reach out to both their Representatives and Senators to urge them to oppose LD 597 and support Representative Carey's amendment. 


Three abortion-related bills are headed to the House and Senate floor.  MMA testified against all three bills as interfering in the doctor-patient relationship. 

  • LD760 would force doctors to tell women scripted information before obtaining an abortion - information intended to make the woman change her mind.
  • LD1339 would repeal Maine's successful adult involvement law and instead require physicians to obtain signed consent from a minor's legal parent before that minor can obtain an abortion.
  • LD1193 seeks to establish a fetus as a person separate from the woman who carries it for the purpose of suing doctors, abortion providers or anyone for wrongful death of a fetus.

MMA encourages interested members to contact their legislators to urge them to oppose all three of these bills. 


LD 754 was an anti-vaccine bill that would require physicians to disclose the ingredients in vaccines every time they provide a vaccine, as well as require clinicians to inform parents of their right to opt out of school vaccination requirements.  While a majority of the HHS Committee had voted that the bill ought not to pass, in a surprise vote, the House has voted 81-62 in favor of the bill.  After work by MMA, AAP, MaineHealth and others the Senate voted 25-9 against the bill.  The sponsor of the bill tried to force a conference committee to work out difference between the House and Senate, however, the Senate insisted on their original position to oppose the bill and the bill will die between the chambers.  

MMA Legislative Committee Conference Call, Tuesday, June 11th, 8 p.m.

**PLEASE TAKE NOTICE - THE CALL IN NUMBER HAS CHANGED (due to technical difficulties)**

The MMA Legislative Committee weekly phone calls will continue tomorrow, Tuesday, June 11th at 8 p.m..  They will be held every Tuesday at 8 pm through the session. 

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-668-4493  NOTE THAT THIS IS A NEW CALL IN NUMBER

Passcode:  23045263

No new bills of interest to MMA were printed last week, but we will update participants on the latest action at the State House.

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22nd Annual Practice Education Seminar being Held Wednesday, July 24 in Augusta

The Augusta Civic Center will again be the site of MMA's annual Practice Education Seminar.  Being offered for the 22nd year, this program is designed to offer physicians and practice managers the information and tools they need to be successful in their practice setting, whether the physician is in private practice or employed and regardless of specialty.  As the program runs from 8:30am to 4:30pm with three keynote talks and a dozen breakout sessions, there is sufficient time to cover many of the topics that are in front of practices currently, such as:

Preparing for ICD 10

Using social media to market your practice

Accountable Care Organizations

State Innovation Model grant (SIM)

Preventing Prescription Drug Abuse

Board of Licensure in Medicine update

E-Prescribing of Controlled Substances

Physician Payments Sunshine Act

Legislation Impacting on Medical Practice Enacted by the 126th Legislature

Affordable Care Act, including Exchanges, Essential Benefits and Mandated Coverage

The keynote presenter is Jack Lewin, M.D., Chairman of the National Coalition on Health Care.  Dr. Lewin is a former CEO of the American College of Cardiology and the California Medical Association.

Watch your mail for the brochure containing registration materials and a full agenda, or register on-line at www.mainemed.com.  Questions can be directed to Lisa Martin at MMA at 622-3374 ext. 221 or via e-mail to lmartin@mainemed.com.  Lisa will also handle any questions from potential exhibitors. [return to top]

MMA Releases New Model HIPAA Forms

At MMA's June 7 First Friday educational session, MMA staff released new model HIPAA forms, including an updated Notice of Privacy Practices and Business Associates Agreement.  These new forms are particularly important as they incorporate changes required by the new HITECH rules, which are enforceable as of Sept. 23, 2013.  All practices will need to update their Notice of Privacy Practices and make it available to patients as of that date.  MMA's forms will be available to practices at the MMA HIPAA website

The program also included important information that practices need to know about the new HITECH rules and special privacy rules in Maine regarding protecting substance abuse, mental health and HIV information.  Practices that were unable to attend can contact Maureen at the MMA at melwell@mainemed.com about purchasing the handouts or an archive of the session. [return to top]

Report on MMA Board of Directors Meeting, June 5, 2013

The MMA Board of Directors met for a regularly scheduled Board meeting last Wednesday.  The priority topics included a review of pending legislation, plans for the 160th Anniversary Gala and Annual Session, Oct. 4-6, 2013 in Portland and follow-up to the strategic prioritization exercise conducted during the winter Board retreat.  The Board also heard back from its invitation to the Maine Hospital Association regarding a potential exchange of observers at the respective board meetings.  The invitation was well received and these visits will begin with two observers attending two board meetings a year.

In other business, President-elect Guy Raymond, M.D. announced that the Jan. 2014 President's Retreat will be held at the Samoset Resort in Rockport.

A full set of minutes of the meeting will be available on the MMA website at www.mainemed.com once the minutes are approved by the Board.


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Important Announcement from MaineCare on ACA's Enhanced Reimbursement for Primary Care - New Attestation form Required

Included below are important updates related to the 2013/2014 Primary Care payment increase, which was effective January 1, 2013.

The Centers for Medicare and Medicaid Services (CMS) has informed the Office of MaineCare Services (OMS) that the enhanced rates OMS had set are too high, and OMS will need to decrease the rates.

Effective Wednesday, May 29, 2013, claims will pay at these lower, corrected rates. Claims paid from January 1, 2013 through Tuesday, May 28, 2013 will be reprocessed. This reprocessing will begin the first week in June.

Next, CMS has also asked OMS to update the self-attestation form. Providers who have already attested must re-attest using the new form, which is available online at www.maine.gov/dhhs/oms/pdfs_doc/news/2013-14_PCP_Increase.doc, along with instructions.  Please complete and submit the revised form by June 30, 2013.

Please note that, although our previous attestation process permitted PAs and APRNs practicing under the supervision of a qualifying physician to attest on their own behalf, CMS has said that the supervising physician must do the attestation on behalf of any PAs and APRNs that they supervise and are responsible for.

Lastly, CMS has informed OMS that hospitals – specifically provider specialty 062 (Hospital Based Professionals) – are NOT eligible for the increase (due to the fact that MaineCare cost-settles hospital-based physicians), so there is no need for hospital-based providers to attest.  The Department will send a separate communication to hospitals informing them of the timing to reprocess claims that were inappropriately paid at the enhanced rate.

Thank you for your patience and OMS apologizes for any inconvenience this has caused. If you have any questions, please contact Provider Services at: 1-866-690-5585. [return to top]

Next Prescription Drug Abuse Education Program Being Offered July 8 in Machias

The Maine Medical Association will offer a three hour CME program on the subject of preventing prescription drug abuse in Machias on Monday evening, July 8, from 5:00 to 8:00pm.  Dinner will be available.  The program will be held in the Science Building at the University of Maine in Machias with videoconferencing to the Washington County Community College in Calais. The program is being presented at the request of the Washington County coalition working on preventing prescription drug abuse in the county.  The program is funded by the Maine Office of Substance Abuse and Mental Health Services and the Board of Licensure in Medicine.  Faculty announced to date include Tamass Peredy, M.D., John Lipovsky of the Prescription Monitoring Program and Gordon Smith, Esq., from MMA.  Other faculty will be announced in a few days.

There is a $20 charge, payable to the Maine Medical Association.  Watch your e-mail for opportunities to register or you may register through Ashley Bernier at MMA by calling 622-3374 ext. 213 or via e-mail to abernier@mainemed.com.

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Job Openings

Physician Needed – Portland, Maine

Do you want to work in a fun office?  Do you want to help people positively change their lives?  Would you like to treat only grateful patients?  Tired of the hassles of running a practice? Dealing with insurance?  Non-compliant patients?

We are an active, growing practice of Obesity Medicine in Portland. Since 2009, we have had tremendous success in helping people regain control over their health, getting off of anti-hypertensives and reigning in their metabolic problems.  We practice according to the guidelines of the American Society of Bariatric Medicine, using scientifically validated principles.  Our team is seeking a physician with a positive personality and attitude to ideally work full time (though part time is an option), starting immediately.  We work cooperatively with the patients' primary cares.  We will train you in Obesity Medicine practice.  We have a star team to support you.  If this sounds like you, please email us at jobs.drverne@gmail.com.  Include your contact information, and we will call you.


Practice Opportunity for Psychiatrist – Augusta, Maine

Liberty Healthcare anticipates an opening for a full-time attending Psychiatrist at the Riverview Psychiatric Center in Augusta, Maine. This position offers a small case load, competitive compensation package, regular 40-hour workweeks, minimal on-call, 7+ weeks off annually, liability insurance, onsite CME, relocation assistance and a collegial work environment. Psychiatrists who have an interest in providing inpatient services to adults who have serious and persistent mental illness and/or forensic patients are encouraged to apply.  Details available online at www.libertyhealthcare.com/upload/303.pdf.  Contact Ian Castronuovo at (610) 389-7430 or ianc@libertyhealth.com.


Seeking two (2) full time psychiatrists, psychiatric nurse practitioners and/or physician assistants 

Assistance Plus is seeking two (2) full time psychiatrists, psychiatric nurse practitioners and/or physician assistants for the Medication Management Program in Benton and Wilton. The professional team is overseen by Robert Gordon, medical director. Our primary focus is to assist those with behavioral health disorders.

Applicant must be a graduate of an accredited degree program and licensed to practice in the State-of-Maine. A minimum of three years experience required.

We offer a generous benefit package of full coverage for health, dental, and 401K along with a sign on bonus of $5,000.  This position is Monday through Friday and no on call coverage is required.

Please submit resume and cover letter to Jillian Jolicoeur 453-4708 ext 408 or email jjolicoeur@assistanceplus.com


Family Practice Physicians

Katahdin Valley Health Center is recruiting dedicated Family Practice Physicians that are committed to providing quality health care services to the people in Central/Northern Maine.  Join our practice in one of the newly expanded facilities.  We are seeking physicians for our Millinocket and Houlton locations.  KVHC is a fully electronic medical record site and offers a competitive salary ($170,000 to $190,000 annual) and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off, $2500 annually toward CME as well as a completely outpatient site.  The call schedule is 1 in 8 with additional coverage from the Open Access Clinic.  Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.

Physicians that join KVHC will be providing quality care in a dynamic, cutting edge environment, within a patient focused team of 10 Providers and 90 Staff Members.  As one of New England’s highest performing Federally Qualified Health Centers (FQHC), KVHC has a mission to provide community accessible, quality healthcare with compassion and dignity. 

To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at mlefay@kvhc.org or visit our website at www.kvhc.org.  KVHC is an equal opportunity employer.


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Upcoming Events

Maine Concussion Management Initiative Concussion Training

Friday, June 14

7:30 a.m. - noon

Colby College

Covers two levels of training: An Introduction to Concussions and Concussion Management or Interpreting Neurocognitive Testing

For more information or to register, click here


Maine Center for Cancer Medicine Presents Educational Lecture Series:  Screening & Treatment

4th Wednesday of Each Month (with exceptions), 6 pm – 7 pm

100 Campus Drive, Conference Room, Scarborough, Maine

Note: To attend the live presentation or join a lecture via Webex, contact Betsy Chase

at 207-396-7634 or chasee@mccm.org

FREE CME Credit Available

June 26, 2013:  Lung, Screening & Treatment Update  Dr. Thomas

July 24, 2013:  Breast, Screening Update  Dr. Weisberg

August 28, 2013:  Breast, Treatment Update  Dr. Weisberg

September 18, 2013:  GI, Screening Update   Dr. Benton

October 23, 2013:  GI, Treatment Update   Dr. Dugan

November 13, 2013:  Melanoma Review and Update for the PCP   Dr. Aronson

December 18, 2013:  Palliative Care Review  Dr. Keating

January 22, 2014:  Brain, Screening and Treatment Dr. Evans

February 26, 2014:  Clinical Research Overview  Dr. Thomas

March 26, 2014:  Hematologic, Treatment Update  Dr. Ryan


What Health Care Providers Can Do to Address the Needs of Returning Veterans and Their Families 

July 16th, 2013

8:00 am—12:00 pm

Hannaford Lecture Hall, College of Pharmacy. University of New England

Register Online

This training, part of a national educational campaign aimed at civilian healthcare professionals, will enable these community providers to use their current clinical skills to provide culturally appropriate treatment to service members and their families.


Save the Date: 

Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here. 

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