July 29, 2013

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House Panel Approves Legislation to Repeal SGR: Full Committee Mark-up this Week

This Wednesday, July 31, the House Energy and Commerce Committee is expected to vote on a proposal to permanently repeal the flawed Medicare sustainable growth rate (SGR) formula that has annually called for significant reductions in physician payments under Medicare. With a permanent repeal now projected to cost "only" $139 billion, this year presents the best chance for a repeal.

By voice vote, the House Energy and Commerce Health Subcommittee July 23 approved bipartisan draft legislation (H.R. 2810) that would repeal the current Medicare physician payment system and replace it with one based on quality of care measures and new care models. Subcommittee Vice Chairman Michael C. Burgess (R-Texas) said the full committee will consider the legislation July 31.  

The legislation would repeal the sustainable growth rate formula in Medicare's current system and create a fee-for-service system in which providers report quality measures. Providers also would have the ability to leave fee for service and opt for new ways of delivering care, such as medical homes.

During the phase-in period, physician groups—in coordination with the Department of Health and Human Services and medical standards-setting organizations—would work on a set of quality measures that would be implemented in 2019, according to the proposal.

Physicians would receive a 0.5 percent annual increase per year for the first five years of the new payment system. Beginning in 2019, physician Medicare payments would include adjustments up or down, depending on how well their services met the new quality guidelines.

Physicians receiving the highest quality scores would receive a 1 percent payment increase over standard Medicare rates; physicians with quality scores in the midrange would receive no increase; and physicians in the lower range would receive a 1 percent payment reduction.

Providers also could opt to participate in demonstration programs featuring alternative payment models aimed at coordinating care and improving quality of care for patients.

Although the policy in the draft received bipartisan support, lawmakers have yet to identify ways to pay for the legislation, which could make the process of crafting a final bill more contentious.  House Republicans have acknowledged that funding the physician pay fix in part by taking money from the Affordable Care Act will be opposed by Democrats, as will changes to the medical malpractice system.

“We have to come up with a pay-for, and that certainly will not be easy,” Rep. Joe Barton (R-Texas) said July 22 during opening statements on the legislation.  There appears to be bipartisan agreement that Medicare reimbursement to home health care providers and nursing homes could be cut to help pay for a doc fix, but that alone would not pay for the bill.

In a July 23 statement, the American Medical Association said it was pleased the subcommittee advanced the legislation, but added, “the details matter considerably and there is still work to be done to ensure a strong future for Medicare.” 

New Laws Impacting Your Practice: Overview of Session Released, Costs of Medical Records Changes

Each week MMA will be running weekly articles highlighting new laws passed by the 126th Legislature that impact the practice of medicine in Maine.  We are also happy to present an overview of new laws to your medical staff, practice or specialty society and have recently released a summary of laws and explanatory slide presentation to the MMA website. 

In a change that impacts all medical practices in Maine, the legislature has passed a new law regarding the maximum amount that can be charged for copying patient medical records.  Practices can charge less than this, and can continue to have policies regarding who you charge for providing copies of medical records.  However, if your practice does charge for providing copies, the cap now is: 

  • For providing paper records: $5 for the first page and $.45 per subsequent page with a $250 ceiling. (Previously the law allowed $10 for the first page and $.35 per subsequent page with no ceiling). 
  • For providing records in electronic format: “Reasonable actual costs of staff time” to create or copy record plus supplies and postage.  Charges cannot include other costs such as a retrieval fee, costs of new technology, maintenance or data access or storage fees. There is a $150 ceiling. Consistent with the Omnibus HIPAA Rule, the law also requires that if a medical record exists in electronic format, the practice will provide an electronic copy, if an electronic copy is requested and it is reasonably possible to provide it. 

This new law goes into effect on October 9th.  You can find the full text of the law here[return to top]

Transforming Care with Data and Relationships: Jay Want, MD, to Speak at MMA, Aug 13

August 13, 2013, 6:00-8:30 PM

Maine Medical Association, Manchester, Maine

What happens when 40 PCPs working in 15 practices admitting to two competing hospitals enter into a risk-sharing arrangement? Health care providers, purchasers and other interested stakeholders are invited to hear national speaker Jay Want, MD discuss this case study and more in his presentation:

“Transforming Care with Data and Relationships”

Jay Want, MD, is past chair of Center for Improving Value in Health Care in Colorado, a public-private partnership purposed to catalyze health care reform in the state. Want is a CMS Innovation Advisor for the Center for Medicare and Medicaid Innovation and recognized for leadership in health policy by the Colorado Health Foundation.

This event is made possible by generous support from the Maine Health Access Foundation and is co-sponsored by the Hanley Center for Health Leadership, the Maine Medical Education Trust/Maine Medical Association and Quality Counts.

Remote participation will be made available via WebEx.  If you plan to attend, please contact Jennifer Reck at jreck@mainemed.com by August 9 and indicate if you will attend in person or online.  [return to top]

22nd Annual Practice Education Seminar Addresses Current Issues for Practices

MMA held its 22nd Physician Practice Education Seminar at the Augusta Civic Center on July 24, 2013.  The Seminar attracted the participation of approximately one hundred physicians and practice managers from across the state.  Keynote presenters included Jack Lewin, M.D., Chairman of the Board of the National Coalition on Health Care and a former CEO of both the American College of Cardiology and the California Medical Association, DHS Commissioner Mary Mayhew and social media guru Rich Brooks.  

Dr. Lewin presented an overview of the current issues nationally regarding health care reform and discussed the opportunities to both improve the quality of care and to moderate costs through the initiatives of the Affordable Care Act and other national, state and local programs.  On a similar theme, Commissioner Mayhew, accompanied by MaineCare Medical Director Kevin Flanigan, M.D., spoke of the opportunities within the State Innovation Model grant provided to DHS through CMS.  This three-year $33 million federal grant will be overseen by a steering committee chaired by Dr. Flanigan, who also spoke of the objectives of the grant.  Rich Brooks of flyte new media (http:www.flyte.biz) presented attendees with some practical tips on using social media to advance the interests of a medical practice, including search engine optimization, e-mail marketing, blogs and state of the art websites.  

In addition to the three plenary session speakers, there were a dozen breakout sessions on topics ranging from preparing for the conversion to ICD 10 to preventing prescription drug abuse.  Copies of some of the presentations will be placed on the MMA website at www.mainemed.com.

MMA wishes to thank and acknowledge the exhibitors at the seminar:

  • Maine Independent Clinical Information Service (MICIS), Academic Detailing
  • Maine Community Health Options
  • Baystate Financial Services
  • Maine Quality Counts
  • Medical Professionals Health Program 
  • IWP (Injured Workers Compensation Pharmacy
  • Sebago Technics

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Preparing for Health Reform in Maine

As we approach the October 1st beginning of open enrollment in the Health Insurance Marketplace, it is important that Maine physicians know how the changes coming will impact you and your patients.  To learn more, consider attending one or more of the following trainings.  Please contact Jessa Barnard at jbarnard@mainemed.com with questions.  

7/31   Marketplace Stakeholder Teleconference with HHS and CMS on the Maine Health Insurance Marketplace beginning at 11:30 a.m.  To register, go here.  Visit the CMS Open Door Forums website for registration and information on future calls.

8/19 Muskie School Colloquium, "The Affordable Care Act: What's Next for Maine?" 4-5:30 p.m. at Lee Hall, Wishcamper Center, University of Southern Maine. To register click here. 

8/22  "Health Care Reform Forum" sponsored by Mainebiz, HarvardPilgrim HealthCare, Maine Community Health Options and PierceAtwood LLP. 8:00-11:00 a.m. at Holiday Inn By the Bay, Portland.  For more info contact Donna Brassard at 761.8379 x327 or click here. 

9/13  "What's Up with Health Care Reform?"  Free seminar for employers on the ACA by  Healey & Associates.  8:30 a.m.-11:00 a.m. at The Harraseeket Inn in Freeport. Topics covered will include: information on the HIM, employer penalties, and the benefits the ACA provides employers with over 50 employees that partially self-fund their employee health care programs.  For more information or to register, contact Peggy Williams at Healey & Associates.

9/17  "Successfully Implementing the ACA in Maine," Augusta Civic Center, organized by Maine Consumers for Affordable Health Care and other leaders of Maine's consumer health advocacy community.  The half-day program will focus on the Marketplace opening, new insurance options, and MaineCare changes.  Breakout sessions will spotlight changes and new benefits for: people with low income, patients and families with behavioral health needs, and women.  For more information, contact Mitchell Stein at CAHC.

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Update from MaineCare on Section 65, Behavioral Health Services for Dual Eligible Members

On June 28, 2013, an Office of MaineCare Services listserv notified providers that as of August 1, 2013, dual eligible members will no longer be able to receive Section 65, Behavioral Health Services from Licensed Clinical Professional Counselors (LCPCs) or Licensed Marriage and Family Therapists (LMFTs) because they must receive services from a Licensed Clinical Social Worker (LCSW).   However, if a dual eligible member lives further than 30 minutes from an LCSW or has other extenuating circumstances, they may qualify for an exception to continue services with their LCPC/LMFT. 

In order to maintain continuity of care, if a dual eligible member has requested an exception in order to continue receiving services from an LCPC/LMFT, please do not discharge the member from your care on or after July 31, 2013 until a determination is made to approve or deny the exemption request. Please do not discharge dual eligible members without an appropriate transition plan.  Claims will continue to be accepted by MaineCare and subject to all other requirements as outlined in the MaineCare Benefits Manual Chapter 65.

If you have questions or need additional information, please contact the MaineCare provider call center at 1-866-690-5585.

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Vector-Borne Disease Updates from MeCDC

Tick-borne diseases 

Lyme disease continues to be a growing concern in Maine, with 1,111 cases reported across the state in 2012. Health care providers should remember:  

  • Prompt removal of ticks is important, as the tick must be attached for at least 24 hours to transmit the bacteria; 
  • All cases of Lyme disease should be reported, including cases clinically diagnosed by an erythema migrans rash; 
  • Lyme disease should be treated immediately upon recognition; 
  • Anaplasmosis and Babesiosis are both endemic in Maine, and should be considered along with Lyme disease. PCR is the preferred testing method for both diseases. 

Maine CDC issued a health alert May 30 with this and other information in it. The health alert is available at http://go.usa.gov/bnhR

For general information about tick-borne diseases, visit http://go.usa.gov/jCKw

Arboviral diseases 

Summer is here and arboviral activity has already been detected in the New England region, with a mosquito collection testing positive for West Nile virus in Massachusetts. Arboviral diseases, including Eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.   

Maine CDC issued a health advisory for health care providers on July 8 to alert them to the potential for human disease activity in Maine, and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis, or fever (≥100.4°F or 38°C) during the summer and early fall. 

For more information, see the health advisory at http://go.usa.gov/jCX9  

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Hospital Groups, IT Execs Lobby for Delaying Next Phase of EHR Incentive Program

The nation's two leading hospital groups are urging the administration to make changes to the “meaningful use” program to ease the pressure on their members trying to meet a compressed timeline for Stage 2 of the incentive program.

The American Hospital Association and Federation of American Hospitals July 24 sent separate statements to the Senate Finance Committee in response to a hearing the same day where information technology vendors and hospital executives said delaying the Medicare and Medicaid electronic health record incentive programs was warranted to address a host of concerns 

Siemens Healthcare Chief Executive Officer John Glaser told the Senate Finance Committee there is not enough time before the 2014 start date of Stage 2 of the Medicare and Medicaid EHR Incentive programs to make necessary EHR software upgrades and roll them out to hospitals and doctors, particularly small and rural providers.

Marty Fattig, CEO of Nemaha County Hospital in Auburn, Neb., and a member of the Health IT Policy Committee's meaningful use workgroup, likewise said a delay was needed to mitigate the risk of a digital divide that could prevent rural and small providers from progressing in meaningful use implementation because of a lack of resources.

The renewed call to halt the program came a week after federal officials told the Finance Committee they were reluctant to support a delay. “A pause in the program would stall the progress that's been hard-fought,” National Coordinator for Health IT Farzad Mostashari said at a July 17 hearing.

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Register Now for MMA's 160th Annual Meeting in Portland, Oct. 4-6, 2013

The Maine Medical Association will hold its 160th Annual Meeting in downtown Portland Oct. 4-6, 2013.  In addition to celebrating the 160th Anniversary of the founding of the Association, the meeting will also include educational sessions focused on the theme of The Changing Face of Medical Education. The educational sessions, which will also include tours of the simulation lab at the Brighton Campus of the Maine Medical Center, will focus on three aspects of medical education:  undergraduate, graduate and continuing education for physicians in practice.

Keynote speakers include Edison Liu, M.D., President of Jackson Labs, Peter Bates, M.D., VP at Maine Medical Center and Steve Stack, M.D., immediate past chair of the American Medical Association Board of Trustees.

Registration materials will be mailed these week to all MMA members but you can also find more information and register online at the MMA website. The primary venue for the meeting is the Holiday Inn by the Bay on Spring St. in Portland.

Watch future issues of this Update and your copy of Maine Medicine to learn more of the details of the Annual Session, being held in Portland for the first time in at least a half century. [return to top]

Job Openings

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.


Department of Psychiatry Chief of Geriatric Psychiatry

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, is seeking an academic geriatric psychiatrist to join its faculty as Chief of Geriatric Psychiatry.

This position, Chief of Geriatric Psychiatry, will develop and lead a geriatric psychiatry clinical neuroscience research program and oversee clinical care and teaching in geriatric psychiatry. The successful applicant will provide clinical consultations and supervise geriatric specialty care at Dartmouth-Hitchcock Medical Center and affiliated sites. He/she will oversee geriatric psychiatry training for medical students, residents, and fellows. In addition, he/she will spearhead a geriatric psychiatry clinical neuroscience research program.

The ideal candidate will be a skilled clinician and enthusiastic teacher, with strong interest and experience in neuroscience research in geriatric psychiatry. Candidates should be board certified or board eligible in Geriatric Psychiatry. Academic rank and salary will be consistent with experience.  A letter of interest, curriculum vitae and three letters of reference should be addressed to Alan I. Green, MD, Chair of the Department of Psychiatry, and sent to Psychiatry.Jobs@Dartmouth.edu.  Please reference Search Number PS1411D.

Dartmouth College is an Equal Opportunity/Affirmative Action Employer and encourages applications from women and members of minority groups.



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Upcoming Events

Breath Easy Coalition Annual Meeting 

August 15, 2013

10 am - 2:30 pm 

Augusta, Maine 

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.

To register, click here.


Breasts: A Natural& Unnatural History with author Florence Williams

Thursday, August 15

7:00 p.m.

The Strand, Rockland

Book Signing follows

Tickets: $25 (General Admission)

Preferred Seating & Private Reception, 5:30-6:30 pm, 

Tickets: $50

Online: mainewomenevent.bpt.me

Or call: (207) 622-0851 x22

Presented by the Maine Women's Lobby, www.mainewomen.org 


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

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


Attend Commercial Driver Medical Examiner Training - 2 Dates/2Locations

The Maine Academy of Family Physicians is pleased to announce two more opportunities to complete the newly Federally required “Commercial Driver Medical Examiner (ME)” training here in Maine.

Sept. 7th in Portland

Oct. 26th in Bangor. 

This day-long program will be eligible for AMA Cat I CME credits (as well as AAFP Prescribed credits)

For more information or to register, click here.


4th Annual Patient Safety Academy

Friday, September 13th

9:00am – 4:00pm

University of Southern Maine, Portland Campus, Abromson Center

Cost: $50, with a discounted rate of $25 for students

12 workshops, including the USM School of Nursing Simulation Lab! The Patient Safety Academy is returning for its fourth year! Last year over 150 health care professionals representing Maine hospitals, physician practices, pharmacies, long-term care facilities, agencies, organizations and advocacy groups participated in knowledge and skill building workshops. Any individual interested or engaged in patient safety activity is invited to attend.

To learn more or register, click here


Maine Dental Access Coalition Fall Conference

Friday, October 18, 2013

8:00 am - 4:00 pm

Morgan Hill Event Center, Hermon, Maine

 All One Body:  Creating Optimal Health Outcomes A Symposium for Medical and Dental Health Providers

Keynote: Medical Dental Collaboration:  Why it Matters and How It Works by Dr. John R. Luther, DDS, Senior Vice President of Dental Management and Chief Dental Officer at DentaQuest

Registration information to follow.  Visit http://www.mainedentalaccess.org/events.php


Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here


Maine Cardiovascular Health Council's 2013 Cardiovascular Summit

Stroke - The First 3 Hours: Bridging the Health System and the Community

   Thursday, November 7, 2013

8:00 am - 4:00 pm

Samoset Resort, Rockport, Maine

In this one day event, we are combining scientific sessions with population health.  As we move into a more collaborative healthcare environment, this is the ideal conference to learn about the newest information regarding stroke care, along with resources available through our state and local programs.

For more information or to register, 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


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