June 17, 2013

 
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POLITICAL PULSE: Legislature Approaches Adjournment Deadline this Wednesday

The House and Senate worked long days most of last week and processed many bills including those dealing with the high profile issues of the State Fiscal Year 2014-2015 biennial budget (L.D. 1509), the ACA Medicaid expansion (L.D. 1066), and the repayment of the past due MaineCare hospital debt (L.D. 1555).  Governor LePage is expected to veto both the budget and the Medicaid expansion bills and proponents, including the MMA, are seeking sufficient votes to override each veto.  The legislature is scheduled to adjourn its First Regular Session this Wednesday, June 19th, but it is still unclear whether they will meet that deadline.  It is likely that the legislature will return later in the month to consider gubernatorial vetoes.  

STATE FISCAL YEAR 2014-2015 BIENNIAL BUDGET PASSES WITH 2/3 MAJORITY VOTES IN BOTH HOUSES

Late last week, the House and Senate enacted the unanimous Appropriations Committee report on L.D. 1509, the State Fiscal Year 2014-2015 biennial budget.  The votes on enactment were 102-43 in the House and 25-10 in the Senate.  The Governor has indicated an intention to veto the budget bill, but he also said that he would take the full 10 days to review and consider it.

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.
BILL ON NEW STATE LIQUOR DEAL, PAYMENT OF PAST DUE HOSPITAL DEBT PASSES WITHOUT A NAY VOTE; SIGNED BY GOVERNOR

After being a matter of partisan dispute for much of the session, last week the legislature was united in passing L.D. 1555 to enact legislation providing for a new state liquor contract and to pay the past due MaineCare bill to Maine's hospitals.  The bill passed by a vote of 149-0 in the House and went "under the hammer" with no recorded vote in the Senate.  The Governor signed the emergency measure into law on Friday, June 14th.  

BILL EXPANDING HEALTH INSURANCE COVERAGE FOR NEARLY 70,000 LOW INCOME MAINERS ENACTED IN BOTH CHAMBERS, BUT ON VOTES SHORT OF A VETO-PROOF MAJORITY 

Also last week, the House adopted the following amendments first offered by Senator Roger Katz (R-Kennebec) in the Senate: 

  • 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 votes on enactment were 97-51 in the House and 23-12 in the Senate.  You can view the House and Senate roll calls on enactment to determine how your legislators voted.

The bill still is short of the votes needed to withstand the Governor's anticipated veto and it will be critical to achieve additional Republican votes in both the House and Senate.  Now that the budget and hospital debt bills have passed, this is a priority.  Please contact your legislators to urge their support for this effort to cover more Mainers and to infuse more funding into Maine's health care sector.  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. 

LYME DISEASE BILL PASSES WITHOUT "SCRIPTING" OF INFORMED CONSENT BUT REQUIRING LAB RESULTS TO BE PROVIDED; MECDC WEB SITE TO INCLUDE VARIOUS LINKS

LD 597, An Act To Inform Persons of the Options for the Treatment of Lyme Disease was enacted in both chambers last week with a floor amendment that removes the "scripting" of informed consent on testing for Lyme disease but requires a health care provider to give the patient a copy of the results of a test for the disease.  It also broadens the types of links the Maine CDC must include on its web site regarding the disease beyond those advocated by the Lyme disease patient advocacy groups.

ABORTION BILLS DEFEATED

The following three abortion-related bills were debated and defeated last week.  MMA opposed all three bills as interfering in the doctor-patient relationship. 

  • LD 760 would have forceddoctors to tell women scripted information before obtaining an abortion - information intended to make the woman change her mind.
  • LD 1339 would have repealed 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.
  • LD 1193 sought 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.
The bills were defeated by strong majority votes in each chamber.  You may see a summary of the floor action on each bill by clicking on the L.D. number above. 

MMA Legislative Committee Conference Call, Tuesday, June 18th, 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 18th 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]

AMA Annual Meeting Convenes in Chicago

The Annual Meeting of the American Medical Association convened on Saturday, June 15, 2013 in Chicago with Maine delegates Richard Evans, M.D. and Maroulla Gleaton, M.D. in attendance, along with alternate delegates appointed for this meeting, MMA President Dieter Kreckel, M.D. and Jo Linder, M.D.  Also in attendance from Maine were former MMA President Robert McAfee, M.D., MMA EVP Gordon Smith, Esq., and specialty society delegate Jack McGill, M.D. 
 
At the opening session of the House of Delegates on Saturday, outgoing President Jeremy Lazarus, M.D. noted some of the successes of the year and reported that the AMA had a nearly 3% increase in dues paying memberships this past year and appears headed to have another increase this year for the third year in a row.  Reserves are also strong, built upon the strong sources of non-dues income that the Association enjoys.
 
Tomorrow, Ardis Dee Hoven, an infectious disease specialist from Lexington, Kentucky will be installed as the 168th President of the AMA.  Dr. Hoven will be the third female physician to be President.
 

On Saturday evening, President Lazarus announced the medical schools selected to share $10 million in grants as part of the AMA's "Accelerated Change in Medical Education."
 
The meeting concludes on Wednesday morning.
 
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NH Senate Votes Down Medicaid Expansion

On June 6th, the Republican-controlled New Hampshire Senate voted against the ACA Medicaid expansion contrary to the wishes of the House and the Governor's Office, both controlled by Democrats.  Instead of the expansion, the Senate voted in favor of an 8-member study commission to look at the impact of expanding Medicaid.  This provision was included in one of two budget bills (H.B. 2) that passed 13-11.  Reflecting one of the principal Republican arguments against the ACA Medicaid expansion heard here in Maine, NH Senate President Peter Bragdon (R) said, "New Hampshire should take the time to understand this complex and costly offer.  The federal government is making many promises when it comes to helping states fund Medicaid expansion, but we have been disappointed before with these types of promises and need to be cautious."  In response to the Senate vote, Governor Maggie Hassan (D) said, "[t]he rejection of $2.5 billion in federal funds for Medicaid expansion undermines efforts to strengthen our economy and improve the health and financial well being of New Hampshire's working families."  

According to Avalere Health's tracking of state action on Medicaid expansion, as of May 30th, 22 states and the District of Columbia will expand Medicaid under the ACA, 3 states are leaning toward expansion, 6 states are leaning against expansion, and 19 states do not plan to expand. [return to top]

Overview of Maine Quality Forum Advisory Council Meeting

The Dirigo Health Agency's Maine Quality Forum Advisory Council, chaired by Robert Keller, M.D., held a regular meeting on Friday, June 14th.  DHA Executive Director Karynlee Harrington provided an update on agency activities in anticipation of the agency's closing at the end of the year.  Unfortunately, Harvard Pilgrim Healthcare, the current underwriter for the DirigoChoice product, will not offer a product through the ACA exchange at least in the first year, so Dirigo members who wish to continue coverage will have to change plans.  Anthem Blue Cross Blue Shield and Maine Community Health Options both expect to offer plans through the exchange.

Ms. Harrington also summarized efforts to continue the work of the Maine Quality Forum following the closing of the Dirigo Health Agency.  The so-called L.D. 1818 Work Group earlier this year recommended to the Insurance & Financial Services (IFS) Committee that the MQF be continued and that it be housed at the Maine Health Data Organization (MHDO).  The IFS Committee unanimously recommended that the Appropriations Committee adopt this strategy as part of its biennial budget report, but the Appropriations Committee did not include it as part of the final budget plan.  So, the MMA and other stakeholders interested in continuing the work of the MQF will try to persuade the legislature to enact a bill during the Second Regular Session (beginning in January 2014) to accomplish this.  Regrettably, the Appropriations Committee did divert $800,000 from DHA's reserves to the General Fund ($300,000 in FY 14 and $500,000 in FY 15) to close the biennial budget.

Maine Quality Counts' Lisa Tuttle provided an update on Maine's Patient-Centered Medical Home Pilot.  Ms. Harrington and Maureen Booth from USM's Muskie School also updated members on various MQF projects, including:

  • Status of Chapter 270 Quality Measure Recommendations;
  • Independent Validation of CLABSI Data (JBI);
  • Patient Experience Matters Initiative; and
  • Culture Survey of Maine Medical Practices.

The next regular meeting of the MQF Advisory Council is Friday, September 13th from 9 a.m. to noon. [return to top]

Upcoming Webinars on Payment Reform, June 20 & July 18

Quality Counts Triple Aim Series: Overcoming the Barriers to Better Healthcare Payment Systems

June 20th, 12-1 pm 

Harold Miller, a nationally-recognized expert on healthcare payment and delivery systems, will describe how the biggest barriers to payment reform can be overcome, and how, with the right kind of payment reform, achieving the Triple Aim can also be a win-win-win for patients, payers, and providers.  Click here to register or learn more. 

AMA Innovators Committee Hosting Webinar on Designing New Payment Models
 
The AMA Innovators Committee will hold a webinar on July 18, at 7 p.m. EDT, titled, “Building new payment models and getting paid.”The sixth in a series of seven webinars on delivery and payment reform, this 60-minute webinar has been approved for continuing medical education credit in the form of AMA PRA Category 1 CreditTM. In addition to describing how practices can measure their performance in preparation for value-based payments, this webinar will help physicians:
 
  • Describe the difference between episode-based bundles and global bundles.
  • Identify the technology and analytic tools necessary to build and maintain these payment models.
  • Recognize the challenges associated with each model and identify solutions.
Click here to register for the July 18 webinar.
 
Listen to recordings of past Innovators webinars (also for CME) and learn about future webinars at www. ama-assn.org/go/paymentpathways. These webinars are free for AMA members. 
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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. [return to top]

CMS Hosting Call on Avoiding Medicare PQRS and e-Rx Penalties, June 18

A 90-minute CMS conference call at 1:30pm EDT on June 18 will help physicians understand how to avoid payment penalties in the Medicare quality and ePrescribing (e-Rx) programs. Sign up for the call today. Registration will close at noon EDT on June 18 or when space is full.

Physicians must meet requirements for the Physician Quality Reporting System (PQRS) in 2013 to avoid a 1.5 percent reduction in Medicare payments in 2015. A number of reporting options are possible for physicians as individuals or as group practices, including paper claims, registries and electronic health records. There are two simplified reporting options available for physicians who wish to avoid the 2015 penalty: reporting only a single measure or measure group and reporting via administrative claims. Reporting through these options, however, will not qualify physicians for an incentive payment. Visit the AMA’s PQRS Web page to learn more.

In addition, just a few weeks remain to avoid a 2 percent penalty in 2014 for physicians who do not meet the Medicare e-Rx program’s requirements this year. While CMS will automatically evaluate whether physicians qualify for a limited set of exemption categories tied to the Medicare electronic health record meaningful use program, physicians may also request a hardship exemption through the agency’s quality reporting communication support Web page by June 30.

Visit the AMA ePrescribing Web page to learn more about the e-Rx program, including a list of the exemption categories. Also consult CMS’s Web page on payment adjustment information to learn more about the 2014 payment penalty. 

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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.

7/1/13 

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.

7/1/13 

Emergency Department PA

Full time position.  Emergency Department practitioner.  Primary duties are direct patient care in the emergency room setting; diagnosis and treatment; meeting with physician supervisor in a timely manner.  Graduate of approved Physician Assistant's program.  Certification in BLS, ACLS, PALS, and ATLS or equivalent.   Current Maine licensure.  Medical Practice maturity as evidenced by at least two years of mid-level practitioner experience within an emergency department setting or by completion of an ER specific residency training program.  DEA Certificate.

For more information or to apply please visit us at www.mdihospital.org or contact Charlotte Skiff at 207-288-5081, ext. 1165 or Charlotte.Skiff@mdihospital.org.

7/8/13

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

7/8/13

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.

8/19/13           

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Upcoming Events

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

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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