Senate & House Committees Release Basic Framework for Permanent Medicare SGR Fix
Democratic and Republican leaders of the US Senate Finance Committee and the US House Ways and Means Committee on Thursday (Oct. 31) released a discussion draft that would eliminate the sustainable growth rate (SGR) payment formula which controls Medicare payments to physicians and replace it with a system that would link physician payment to quality metrics.
While the draft did not include specific legislative language and also did not include the "pay-fors" that will be needed to make up for the $139 billion ten year cost, the draft is considered a very important step in permanently fixing the payment system inasmuch as it was a bi-partisan effort that included both a Senate and House committee. The AMA praised the draft which is open to comment by the committees until Nov. 12.
Following are some of the key provisions in the draft:
- Permanent repeal of the existing SGR formula;
- Annual fee schedule updates would be frozen for 10 years;
- Annual positive updates would begin in 2014;
- A new "value-based" performance (VBP) payment program would be used to adjust payments beginning in 2017. This new VBP program essentially combines all the current incentives and penalty programs (e.g., Value-based modifier, meaningful use, PQRS) into one budget-neutral program. Payments could be increased or decreased significantly depending on how well physician scores relative to others on a composite performance score;
- Physicians participating in certain alternative payment models, including PCMH, would be exempt from VBP program. Revenue thresholds are established for alternative payment models other than the medical home model and two-sided risk and a quality component would be required to qualify for a 5% bonus in 2016-2021;
- Several proposals to ensure accurate valuation of services under the physician fee schedule are made. Over a three-year period, misvalued codes would have to be adjusted to achieve at least 1% in total fee schedule savings to avoid reduction in the total physician payments pool. In addition, the Secretary of HHS would initiate a data collection effort on resource use requiring selected physicians to submit data (CMS is authorized to pay compensation for physicians who do this) or face a one-year 10% reduction in payments;
- Appropriate use criteria would be applied to certain imaging services, prior authorization would be imposed on outliers; and
- HHS would publish utilization and payment data for physicians on the Physician Compare Website.
The AMA and many national medical specialty societies will be making comments on the draft prior to the Nov. 12 comment period ending.
MMA representatives will be in Washington on Nov. 18 to urge members of the Maine Congressional delegation to support a permanent fix to the SGR formula. Without a fix, or temporary reprieve, physicians participating in Medicare will experience a nearly 25% reduction in the Medicare fee schedule come Jan. 1, 2015.
Frank Lavoie, M.D., MBA Named New President of Medical Mutual Insurance Co. of Maine
The Board of Directors of Medical Mutual Insurance Company of Maine has named Frank Lavoie, M.D., MPH as its new President and CEO following the retirement of Terrance Sheehan, M.D. Dr. LaVoie will begin on Feb. 1, 2014 and will transition with Dr. Sheehan for three months until his formal retirement on April 30. Dr. LaVoie is currently the Executive Vice President and COO at Southern Maine Medical Center where he formally served as an emergency physician. He is a graduate of McGill University and the University of Vermont School of Medicine and completed an internship and residency in emergency medicine at the University of Louisville. He is board certified by the American Board of Emergency Medicine.
Medical Mutual is Maine's largest medical liability insurer covering physicians and hospitals in Maine, New Hampshire, Vermont and Western Massachusetts. It is the endorsed provider of professional liability insurance for MMA members.
We extend our congratulations to Dr. Lavoie and wish him all the best in his new position. We look forward to continuing to work with the company. [return to top]
MMA Offices Closed for Veterans Day; Honor Veterans with Health Coverage
The Maine Medical Association office will be closed next Monday, November 11, for Veterans Day. We look forward to returning your emails and messages on Tuesday the 12th.
In honor of Veterans Day, please consider joining the MMA in advocating for health coverage for Maine veterans.
Approximately 2,700 uninsured Maine veterans who do not have health insurance today could be covered in 2014 if Maine accepts federal funds that have already been set aside for Maine’s uninsured. It’s estimated that about 1000 family members of veterans could also gain coverage.
Here are 5 key facts about veterans and health coverage:
1. Not all veterans are eligible for health care services through the Department of Veterans Affairs. The Department of Veterans Affairs (“VA”) considers a veteran’s active duty status, condition of discharge, and length of service in determining eligibility for health care services. In addition, the VA uses a priority enrollment system to facilitate the management and delivery of health care services. There are eight priority groups that determine a veteran’s eligibility and priority for using health care services. Priority status is based on several factors, such as service-related disabilities and income-level. Depending on the VA’s medical care budget, veterans in lower priority groups may face restrictions on new enrollment or lose their eligibility.
2. Uninsured veterans have substantial medical needs. Uninsured veterans have a disproportionate amount and complexity of health issues. Over 40 percent of uninsured veterans report having unmet medical needs. About one third of uninsured veterans have at least one chronic health condition, while over 15 percent have physical, mental, or emotional health problems.
3. Nearly half of today’s uninsured veterans would get the coverage they need with additional Medicaid coverage. There are approximately 1.3 million uninsured veterans nationwide. Nearly half of the uninsured veteran population reports family income below 138% of the federal poverty level, and would get coverage if states accept federal funding to expand Medicaid. Only 10% of these veterans appear eligible for Medicaid under current law.
4. Rural veterans often have no VA facilities near them. Veterans eligible for VA health care services usually receive those services at facilities operated and staffed by the Veterans Health Administration. Proximity to VA facilities may impact the likelihood of veterans seeking health care services. This is particularly true for those in rural communities located far from VA facilities. If these veterans had additional coverage through Medicaid, they could access local providers and get regular care.
5. For some veterans availability of Medicaid coverage automatically improves their standing in the VA’s priority system. Veterans eligible for Medicaid benefits may be placed in a higher priority group in the VA’s priority enrollment system. Therefore, if a state expands Medicaid, in addition to receiving Medicaid coverage, many veterans will also automatically have improved access to health care through the national VA system. [return to top]
2014 First Friday Educational Program Line-up
Announcing the Maine Medical Association's
2014 First Fridays Educational Programs
8:30 AM – Registration and Breakfast; All Programs 9:00 AM to Noon
All sessions take place at the Maine Medical Association Building in Manchester, Maine or remotely via WebEx, unless otherwise noted. Please look for a registration flyer in the upcoming edition of the Maine Medicine newsletter.
February 7 Payment Reform Readiness
Presented by Benjamin Townsend, Esq., Kozak and Gayer, P.A.
April 4 Annual Coding Seminar/Transitioning to ICD 10
Presented by Laurie Desjardins, PCS, CPC-I, Coding Strategies, Inc.
May 2 New Laws from the 126th Legislature
June 6 Annual HIPAA Update
June 18 Annual Practice Education Seminar, Augusta Civic Center, Augusta, Maine
August 1 Ethical Issues in Contemporary Medicine
October 3 Risk Management Seminar
Presented by Medical Mutual Insurance Company of Maine
December 5 Annual Compliance Seminar [return to top]
MHCO Proposes Bypassing Federal Health Insurance Marketplace Website
A Maine insurer has approached the Centers for Medicare & Medicaid Services (CMS) about bypassing the troubled federal marketplace website, HealthCare.gov, and instead selling its marketplace health insurance plans through its own website.
Maine Community Health Options (MCHO) is one of two health insurers in Maine selling health insurance through the federal health insurance marketplace created under the Affordable Care Act. The federal website has been fraught with well-publicized technical problems that are interfering with people's ability to enroll for insurance.
The MCHO, a Consumer Operated and Oriented Plan, has a functioning website, which sells other plans and showcases the plans it is selling on the federal marketplace website HealthCare.gov. MCHO would like to be able to begin selling its marketplace plans directly through its website, Kevin Lewis, chief executive officer at MCHO, told Bloomberg BNA Oct. 25.
The MCHO has not made a formal request to the CMS, but has had conversations with officials at the agency about the idea, Lewis said. The MCHO has not heard from CMS yet about its idea.
Anthem Blue Cross Blue Shield, the other insurer selling plans in Maine through the federal health insurance marketplace website, declined to say whether it also would seek to bypass the federal website. [return to top]
CMS Webinar on Open Payments Sunshine Rule, Nov 19
The Centers for Medicare & Medicaid Services will host a webinar on the Open Payments Sunshine Rule, noon to 1 p.m. on Tuesday, November 19.
The webinar will include an overview of the Physician Payments Sunshine Rule. Section 6002 of the Affordable Care Act requires the establishment of a transparency program, now known as Open Payments. The program increases public awareness of financial relationships between drug and device manufacturers and certain health care providers.
This call is intended for association/medical society staff, physicians, practitioners, and practice managers located in CMS Regions 1 through 4.
The speaker will be Louisa Carey of CMS. The presentation will be followed by a question-and-answer period.
Webinar Link (URL): https://webinar.cms.hhs.gov/ro1-4openpayment/
Dial-In: 1-877-267-1577; Meeting ID Number: 998 023 973
This meeting does not require a password. [return to top]
MMA Webinar: Payment Reform Readiness for the Independent Physician, Nov 21
Webinar: Payment Reform Readiness for the Independent Physician
Nov. 21, 12:00-1:00 pm
Ben Townsend, JD, Shareholder, Kozak & Gayer
Beverly Neugebauer, Executive Director, Coastal Women’s Healthcare
Attorney Ben Townsend of Kozak & Gayer will discuss the publication he recently authored for the MMA entitled “Payment Reform Readiness: A Legal Toolkit for Physicians”. He will provide an overview of current payment reform initiatives as well as the sometimes unexpectedly complicated business, legal and compliance issues that such initiatives may raise, particularly for independent physicians.
Beverly Neugebauer, Executive Director for Coastal Women’s Healthcare in Scarborough, will give a first hand account of how Coastal Women’s Healthcare has navigated many challenges of the changing healthcare payment environment, remaining a viable, independent practice owned by eight physicians.
To join this webinar, please email Jennifer Reck at email@example.com. The legal toolkit document and other payment reform resources are available at: https://www.mainemed.com/cme-education-info/payment-reform. The webinars and resources are made possible through a generous grant from the Maine Health Access Foundation. [return to top]
Maine Quality Counts Schedules Regional Meetings
Maine Quality Counts will be offering regional meetings in November and December to promote the critical role of primary care practices in effective transitions of care and introduce “The Role of Primary Care in Improving Care Transitions: A Roadmap for Change.”
The target audience for these forums are those participating in the Maine Patient Centered Medical Home Pilot and/or MaineCare Health Homes initiative, along with others who are critical to improving care transitions (e.g. hospitalists, hospital care managers and discharge planners; emergency department staff; skilled nursing and/or rehab facility staff; home care agencies; area agencies on aging, or other community partners).
The meeting schedule is:
- Tuesday, November 12, Portland, University of Southern Maine Glickman Library, 5 p.m. to 8 p.m.
- Monday, November 18, Presque Isle, The Aroostook Medical Center, 5 p.m. to 8:00 p.m.
- Monday, December 2, Augusta, MaineGeneral Medical Center, 5 p.m. to 8 p.m.
- Thursday, December 5, University of Maine, Wells Conference Center, 5 p.m. to 8 p.m.
- Tuesday, December 17, Lewiston, Central Maine Medical Center, 5 p.m. to 8 p.m.
Please contact Donna Trussell at firstname.lastname@example.org with any questions. [return to top]
MICIS Can Help Physicians Save Time and Practice More Effectively
The Maine Independent Clinical Information Service (MICIS), the academic detailing program of the Maine Medical Association, has been helping busy physicians keep up with medical literature since 2009. MICIS provides high-quality, rigorous and independent modules on a range of topics that are offered to you by trained clinicians at your convenience, at your work site, at no cost. CME is available.
Currently available topics are:
- Obesity Management (NEW!)
Upcoming topics are:
Contact Program Manager Jennifer Reck today at email@example.com for more information or to schedule a visit. [return to top]
- Antibiotic Stewardship (Nov. 2013)
- COPD (Jan. 2014)
Save the Date: MMA Legislative Committee Meeting, Dec. 9
The MMA Legislative Committee, chaired by Amy Madden, M.D., will hold an organizational meeting in anticipation of the Second Regular Session of the 126th Maine Legislature on Monday, December 9th from 6:00 p.m. to 8:30 p.m. at the MMA office in Manchester. Dinner will be available at 6:00 p.m. Any MMA member or practice management staff person who is interested in our advocacy work is welcome to attend. Medical specialty societies are strongly encouraged to have a representative at the meeting to ensure their members are aware of policy initiatives that may affect their specialty. For our meal planning, please RSVP to Ashley Bernier (firstname.lastname@example.org; 622-3374, ext. 213) if you plan to attend.
MMA is not planning to hold a Physicians' Day at the Legislature this year. However, the Cover Maine Now! (CMN) Coalition, (www.covermainenow.com), a broad based group of health care and consumer advocacy organizations supporting the acceptance of federal funds to provide health coverage for low income Mainers, plans a rally at the State House in support of that initiative on January 8th, the opening day of the second session. The MMA is a member of the Steering Committee of the Coalition and encourages physicians to attend on the 8th. The MMA will publish more information about the CMN rally in the Maine Medicine Weekly Update as it becomes available.
The MMA is also seeking physicians who are willing to serve as "Doc of the Day" for the Legislature in 2014. To learn more about the program or sign up, please visit: http://www.mainemed.com/doctor-day. [return to top]
Ambulatory Surgery Center Manager
Central Maine Orthopaedics (CMO) is recruiting for a full-time Manager for our ASC. The foremost duty of this position is to ensure the day-to-day operations and management of the ASC run smoothly and efficiently. This position requires a professional with strong leadership characteristics with an associated broad skill set who will serve as role model, mentor, and coach/facilitator.
This position is responsible for delivery on the organization's strategic plans, benchmarks, and critical success factors and therefore must demonstrate accountability and responsibility for own work and expected outcomes for those supervised. This position is responsible for maintaining requirements for State licensure, Medicare certification, and accreditation by the Accreditation Association for Ambulatory Health Care (AAAHC).
AAAHC/JCAHO experience in an ASC or hospital free-standing outpatient surgery setting, required.
Please see the full listing for this opportunity on the Careers section of our website www.cmogroup.org.
Interested candidates, please send cover letter, résumé, and salary requirements to: Janine Valliere, HR Manager, Central Maine Orthopaedics, 690 Minot Ave, Auburn, ME 04210 or e-mail to email@example.com.
Chief Medical Officer at Portland Community Health Center
The Portland Community Health Center, located in the heart of Portland Maine, is seeking an experienced physician leader/chief medical officer to join our mission driven team. As a Federally Qualified Health Center, we offer a great opportunity to provide patient centered holistic care to a highly diverse patient population. An interest in teaching and international medicine is preferred. Position is full time, extended hours, outpatient only and no call.
The Chief Medical Officer is responsible to the CEO. She/he also makes direct reports to the monthly Board of Directors meeting and the quarterly Board Quality Management Committee. The Chief Medical Officer is accountable for the delivery and quality of all PCHC’s health care clinical services.
Portland Community Health Center, 180 Park Avenue, Portland, ME 04102 http://portlandcommunityhealthcenter.org
Submit resume and letter of intent to: Leslie Brancato, CEO: Lbrancato@portlandchc.org or 207.874.2141 Ext: 5028.
Practice Administrator at Maine Nephrology Associates in Portland, Maine
Maine Nephrology Associates (MNA), an independent
physician practice located in Portland, Maine,
is seeking a Practice Administrator. MNA
is comprised of eleven nephrologists and two physician extenders supported by
approximately 25 employed staff. We provide specialist care for kidney disease
and hypertension in a single private office location that includes its own
laboratory, in four area hospitals and in five dialysis centers. MNA Physicians hold Tufts University School
of Medicine faculty positions to teach trainees at Maine Medical Center. MNA physicians also serve as principal investigators
on numerous research grants.
The Practice Administrator’s oversight responsibilities
include all aspects of practice management: planning, implementing,
controlling, contracting, financial, legal and regulatory compliance,
administrative services, physician credentialing, human resource policies and
benefits, organizational design, supervising, training, billing, scheduling and
medical records functions.
The Practice Administrator reports to the Managing Partner
and this pair in turn works with the Physician Steering Committee to implement
the strategic goals of the group. The
ideal candidate is an experienced healthcare management professional with
competence to lead this medical practice through organizational change to
ensure efficient, effective and safe operations of all aspects of clinical and
Interested candidates are invited to forward a resume or
CV along with a cover letter detailing how your experience meets the
expectations of this position along with salary requirements to firstname.lastname@example.org.
Department of Psychiatry Faculty
The Geisel School of Medicine at Dartmouth,
Department of Psychiatry, in a productive collaboration with the State of
Maine, is seeking a psychiatrist to join our faculty for inpatient
responsibilities at the Riverview Psychiatric Center.
Riverview Psychiatric Center is a
92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient
treatment center for Maine’s public mental health system. Psychiatrists with expertise in general inpatient psychiatry or
forensic psychiatry are encouraged to apply.
Academic duties can include teaching
and supervision of medical students and residents. Research opportunities
available and encouraged.
Candidates should be board certified or
eligible in Psychiatry. This position will include a faculty appointment at The
Geisel School of Medicine at Dartmouth at a rank and salary commensurate with
experience. Curriculum vitae and three letters of reference, addressed to Dr.
William Torrey, Search Chair, should be e-mailed to email@example.com. Please reference search number PS1013D.
The Geisel School of Medicine at
Dartmouth is an Equal Opportunity/Affirmative Action Employer and encourages
applications from women and members of minority groups.
Family Medicine Physicians
[return to top]
Katahdin Valley Health Center is recruiting dedicated Family Medicine 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 firstname.lastname@example.org or visit our website at www.kvhc.org. KVHC is an equal opportunity employer.
Maine School Administration District No. 75 seeks a Nurse Practitioner
for our School Based Health Center at Mt. Ararat High
School. The position is a Part time (.5 FTE) salaried
position with a flexible schedule.
Nurse Practitioner will provide
administrative and supervisory oversight of our School Based Health Center and administration of the funding grant. Responsibilities include providing
comprehensive primary health care services to enrolled High School students and
coordination of care with their Primary Care Clinicians. This position works collaboratively
with the School Nurses, Medical Director and SBHC Advisory Committee.
have State of Maine Nurse Practitioner license and be certified in Family Practice of
Pediatrics. At least two years Nurse Practitioner and Supervisory experience
Please forward a MSAD # 75 Professional
employment application, cover letter, resume and copy of license to: Human Resources, M.S.A.D. No. 75, 50 Republic Avenue, Topsham, Maine 04086. Applications
can be found at: www.link75.org. (Departments/Human
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.
Medical Group Management Association of Maine Presents:
MGMA Seminar: Generational Differences in the Workplace & Advanced Excel 2010 Tips and Tricks
Wednesday, November 13, 2013
8:30 a.m. - 4:00 p.m.
Fireside Inn & Suites, 81 Riverside Street, Portland
For more information or to register, visit: http://www.memgma.com/site/events-calendar.htm
Muskie School Health Policy Colloquium
The Future of Medicaid: Building Sustainability through Program Innovation
Friday, November 22, 2013
8:30 am - 12:30 pm
Augusta Civic Center
Speaker: Diane Rowland, Executive Vice President, Henry J. Kaiser Family Foundation; Additional program details and speakers coming soon.
To register, click here.
MaineGeneral Medical Center
2013 Fall Coding & Compliance Conference: Precision and Quality with Surgical and E & M Coding
Waterville Elks Banquet & Conference Center
Friday, December 6, 2013
7:30 a.m. – 3:00 p.m.
Cost: $75 (includes continental breakfast, lunch and breaks) CEUS: 6
For more information or to register, contact Cindy Sturtevant, Physician Office Relations Liaison, (207) 872-4058 or email@example.com [return to top]