July 1, 2013

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POLITICAL PULSE: Legislature Overrides Governor's Veto of Budget Avoiding Government Shut Down

Both the Maine House and Senate this past week found the votes necessary to override the Governor's veto of the Biennial Budget, averting a potential government shutdown and paving the way for a final adjournment of the session on July 9th when legislators return to Augusta to vote on more expected vetoes.  The MMA Legislative Committee has concluded its weekly conference calls for this session - thanks to all who participated!  We will report any final news from the July 9th session in the Weekly Update.  Look for an announcement of a meeting of the Legislative Committee in late November or early December before the start of the Second Regular Session of the 126th Maine Legislature in January 2014.

The override vote on the budget was closely watched though the bill ended up surviving the veto by a comfortable margin of 114-34 in the House and 26-9 in the Senate.  Some of the key provisions in the budget 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 
  • A study was included to examine hospital-based physician reimbursement rates.  DHHS is charged with studying the issue and reporting back to the legislature by December 2013. 

Bills that will involve the expenditure of state funds are taken from the Senate and placed on the “Special Appropriations Table” before final enactment.  These bills received further review by the Appropriations Committee and the Senate last week.   MMA's bill to restore MaineCare reimbursement for ambulatory surgical centers, LD 390, was reviewed by the Committee and carried over to next year.  This will allow the Appropriations Committee further time to study the cost currently associated with the bill ($93,000 per year of state funds) when it should actually be a cost saving measure to the State.   The Committee approved funding for the following health-care related bills which are now on the Governor's desk: 
  • LD 386, restoring the smoking cessation benefit for MaineCare recipients; 
  • LD 1181, strengthening the Kid Safe Products Act; 
  • LD 1232, removing the provision of current law that allows the Legislature to approve transfers of funds from the Fund for a Healthy Maine to the General Fund; 
  • LD 1274, increasing MaineCare reimbursement for ambulance services to 65% of the average allowable Medicare rate; and 
  • LD 1364, increasing the number of hospital and therapeutic leave days allowed for MaineCare recipients. 


LD 984, An Act To Amend the Health Plan Improvement Law Regarding Prescription Drug Step Therapy and Prior Authorization, was vetoed by the Governor on the 18th.  The bill was supported by the MMA and would have required that the clinical review criteria used by a health plan carrier in approving prescription drugs may not require dispensing of a medication for an off-label use and may not require failure on the same medication on more than one occasion for enrollees. The bill also required health insurance carriers to respond to nonemergency prescription drug prior authorization requests within 24 hours (consistent with current MaineCare policy).  The Governor was largely concerned with the requirement that carriers process PA requests within 24 hours.  Despite a last-minute attempt by MMA and other advocates to reach agreement with the Governor and Legislature, the veto was sustained and the bill will not proceed this year.  


As reported last week, the bill to expand health coverage to low income Mainers by 2014 fell short of the votes needed in the House to withstand the Governor's veto.  This means that nearly 25,000 parents and low income adults will lose MaineCare coverage as of January 1, 2014 and nearly 45,000 will not be eligible who would otherwise have full coverage funded with 100% federal dollars. The MMA continues to work with proponents to plan next steps and ensure as many people as possible in Maine can receive health coverage, though a bill will not move forward before January 2014.  

Three Hours of CME Available at 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 (Room 102) at the University of Maine in Machias with videoconferencing to the Washington County Community College in Calais.  A light dinner will be available in Calais as well. 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., State Senator David Burns (R, Whiting), John Lipovsky of the Prescription Monitoring Program, Clare Desrosier of the Diversion Alert 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]

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]

Anthem Defends Narrow Network of Providers During Hearing Before Bureau of Insurance

Anthem Blue Cross and Blue Shield of Maine defended its proposed narrow network of providers in a new health plan it intends to offer in the federally operated health insurance marketplace (previously called an exchange) opening on October 1, 2013.  The plan was the subject of a public hearing before the Maine Bureau of Insurance on Friday, June 28th.  MMA representatives attended the hearing but did not testify.

The proposed plan, which would be offered in the individual and small group market, includes 32 of Maine's 38 hospitals, but excludes the hospitals associated with Central Maine Health Care (in Lewiston, Bridgton, Rumford, and Brunswick), York Hospital, and Mercy Hospital.  Anthem and its partner in the plan, MaineHealth, defended the narrow network on Friday claiming that the hospitals in the network had agreed to price reductions in favor of the additional patients. Based upon these price reductions, it is assumed that the premiums for the plan will be lower than plans offered in the individual and small group market presently.

Anthem and Maine Community Health Options (a non-profit plan established with federal loans available through the Affordable Care Act) are expected to be the only two health plans offering policies in the marketplace when it begins on October 1, 2013.  Other plans could participate in 2015. While other plans will continue to offer health insurance policies in the state, including Harvard Pilgrim, Aetna, Cigna, and United, the subsidies being offered through the ACA are only available to individuals purchasing through the marketplace.

The Bureau of Insurance will accept public comments on the Anthem proposal until Friday, July 5th.

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MMA Loan and Trust Committee Awards Nearly $300,000 in Loans to Medical Students

MMA's Loan and Trust Committee met this past week to review loan applications from 52 medical students from Maine who sought to borrow funds from the Maine Medical Education Foundation (MMEF).  The Foundation is now in its 51st year and was originally founded with contributions by MMA members.  Over $4 million has been loaned since the program began.

All applicants were awarded a loan and applicants from Aroostook County will also receive an additional grant, courtesy of funds contributed by the Aroostook County Medical Society.  There were three students from The County who qualified.

Of the 52 loans granted, 43 were to applicants in allopathic schools (over thirty were associated with the Tufts Medical School-Maine Track) and 9 were to applicants in osteopathic schools.

Interest on the loans is not assessed during the medical school years and then is assessed at 1% , 3% and 5% respectively during the years of residency.  The loans are expected to be paid back within ten years of completion of a residency or fellowship.  [return to top]

CMS Redesigns Physician Compare Website

The Centers for Medicare and Medicaid Services (CMS) launched a redesigned Physician Compare website last Thursday (June 27).  The original Physician Compare website was established in January 2011 as required by provisions in the Affordable Care Act.  The site featured information on Medicare participating physicians and other eligible professionals who participated in the Physician Quality Reporting System (PQRS).

In 2012, CMS initiated a full redesign of the site based on feedback from site users, the AMA and other physician organizations.  The goal of the redesign was to improve the accuracy and currency of the information available on the website as well as improve the usability and functionality for all users.  Two primary enhancements of the redesign include an overhaul of the underlying database and the addition of a new intelligent search functionality.  

You may visit the site here. [return to top]

Federal Government Rolls Out New Website, Call Center to Prepare for Insurance Marketplace; Trainings In Maine Scheduled July 16 & 25

The Federal Government this past week rolled out its anticipated website that will be used to enroll individuals and small businesses in the health insurance marketplace beginning Oct. 1, 2013.  At www.healthcare.gov individuals and small businesses (50 or fewer employees) can get acquainted with what the site will look like when enrollments begin.  Health insurance will be subsidized for individuals and families with incomes below 400% of the federal poverty level if they purchase through the marketplace.

The website does not yet have specific rates but by Oct. 1 this information will be available.  At the point, the site describes how the exchange will operate and individuals can learn what they can do to begin to get ready for open enrollment this fall.  The website will add functionality over the summer so that, by October, consumers will be able to create accounts, complete an online application, and shop for qualified health plans.  Coverage under the plans will begin January 1. 

HHS also launched a new 24-hours-a-day consumer call center.  Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning Oct. 1, 2013, will assist consumers with application completion and plan selection.  In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service.  Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.

Maine practices interested in learning more can attend one of several trainings being offered around the state on the marketplace.  The next two HHS training are being offered in Brewer and Lewiston: 

Date:  Tuesday, July 16

Time:  1pm - 4pm

Location: Brewer Medical Center, 735 Wilson St., Brewer, ME 

Register at http://cmshimtrainingme2.eventbrite.com 


Date:  Thursday, July 25

Time:  1pm – 3:30pm

Location: Community Concepts, 240 Bates Street, Lewiston, ME 04240

Register at http://cmshimtrainingme3.eventbrite.com

Ray Hurd, Regional Administrator, of the Centers for Medicare & Medicaid Services (CMS) invites community agencies, health care organizations and other stakeholders to participate in a training forum about the Health Insurance Marketplace in Maine.  This training event is part of our ongoing commitment to encourage public participation by engaging in conversations about the Marketplace in Maine.

If these dates do not work for you, please contact Jessa Barnard at the MMA, jbarnard@mainemed.com, if you are interested in scheduling a training at your practice location.   [return to top]

ONC Report to Congress Says Physician EHR Use Doubled from 2009 to 2012

On June 27th, the Office of the National Coordinator for Health Information Technology (ONC) issued its second annual report to Congress entitled, Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Information.  The report states that in 2012, 40% of office-based physicians had adopted a basic EHR system, compared with 21% in 2009.  The ONC defined a "basic EHR system" as one that could record some patient information electronically, including patient history and demographics, patient medication and allergies, and laboratory and imaging results.

The report credits the federal EHR incentive programs for encouraging progress.  As of April 2013, more than 291,000 health care professionals (representing more than half the eligible professionals) and more than 3800 hospitals (representing approximately 80% of eligible hospitals) have received payments through the EHR incentive programs.

The report also indicates a significant increase in physicians' use of e-prescribing with new prescriptions and reorders sent electronically increasing from 4% in 2008 to 47% in 2012.

Despite the progress, the report cites the following top 5 barriers remaining to EHR adoption by physicians:

  • the cost of the EHR system;

  • loss of productivity;

  • time and effort spent selecting the right EHR;

  • the need to provide appropriate employee training: and

  • the annual maintenance cost of an EHR system.

You can find the full ONC report here.

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CMS Delays Until October 1st Compliance with Face-to-Face Rule for Certain DME

The 2013 Medicare physician fee schedule included a requirement that a physician, nurse practitioner, physician assistant, or clinical nurse specialist document a face-to-face visit with the Medicare beneficiary within 6 months of an order written for certain DME equipment on or after July 1st.  On June 27th, CME announced that it was delaying the compliance date until October 1st because officials believe more time is necessary to educate the provider community about the new requirement.  You can find more information about the requirement here. [return to top]

Congress is Headed Home for the Fourth of July

The July Congressional recess (July 1st through the 5th) is a great time to visit with or contact your member of Congress about issues important to you and your patients.  To help you along, the AMA has developed talking points on three important issues:  repealing the SGR, stopping ICD-10 implementation, and enacting private contracting legislation.  Information on these issues can be found here.  Also, remember to sign up for the AMA Physicians Grassroots Network to stay informed about the latest issues pending before Congress that affect physicians and patients. [return to top]

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.


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.


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

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.


Breath Easy Coalition Annual Meeting 

August 15, 2013

10 am - 2:30 pm 

Augusta, Maine 

Click here to register 

Join us for for this FREE event! Featuring presentations and discussions around how smoke-free policies are impacted by medical marijuana and electronic cigarettes, celebration of 10 years of addressing smoke-free housing, networking, and roundtable peer-to-peer discussions around addressing tobacco-use and secondhand smoke exposure in Maine.


Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here


2013 Division of Infectious Disease Annual Conference

November 13, 2013 

Augusta Civic Center

 Sponsored by the Maine Center for Disease Control & Prevention

Since 1983, the Maine Center for Disease Control and Prevention, Division of Infectious Disease, Department of Health and Human Services has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the State. Presentation topics will focus on a range of infectious diseases and immunizations. This year’s conference includes aspects from the Division of Infectious Disease’s Epidemiology, Immunization, HIV, STD and Viral Hepatitis Programs. 

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

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