November 18, 2013

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217 Mainers Enroll in Marketplace Plans Through Nov; Obama Announces Old Plans Can Continue

The Affordable Care Act's health insurance marketplace had another tough week with the release of numbers showing that relatively few Americans had enrolled through the marketplace website.  But by the end of the week, signs were more promising that progress was being made.  Today, the Legislature's Exchange Advisory Committee will meet for the third time and receive a report from HHS Regional Director Christine Hager on the roll-out in New England.

From Oct. 1, when enrollment started, through Nov. 2, just 271 Mainers successfully signed up for coverage through the health insurance marketplace, according to data released this week by the U.S. Department of Health and Human Services.

The website has been plagued by glitches and crashes since its launch. In the 36 states where consumers must rely on the federal system, including Maine, only 26,794 people had navigated their way through the website to select insurance plans as of Nov. 2. The success rate was far higher in the states that opted to create their own online insurance marketplaces.

However, the media reported this weekend that individuals and application assistors in Maine have in the past few days had more success submitting applications via the website.  They have also been filing paper applications in the interim.  

In other widely reported news last week, President Barack Obama announced an “administrative fix” to the Affordable Care Act that will allow health insurers to extend existing policies to current enrollees for one year, if health insurers and state insurance commissioners choose to do so.

Senior White House officials described the fix in a conference call with reporters, saying the president had directed his team to address the confusion that has arisen from cancellation letters that individuals throughout the country have been receiving from their insurers if their plans did not meet the coverage requirements set by the Affordable Care Act.  

This change could affect 15,000-plus Mainers whose policies were set to be canceled or modified next year however the Maine Bureau of Insurance has yet to comment on whether it will allow these policies to continue.  

John B. Makin, Jr, M.D. 1937-2013

The Maine Medical Association family lost a loyal member and Maine's medical community a pillar when John Makin, M.D. passed away unexpectedly at his home on Sugarloaf Mountain last Tuesday.  John had recently received his 50 year pin at the MMA Annual Meeting in October, recognizing the 50th anniversary of his graduation from Tufts University School of Medicine.  He had served the Association as President 1998-1999.  He also served as a delegate to the American Medical Association and was section chair and district treasurer of the American College of Obstetrics and Gynecology.  

Dr. Makin practiced obstetrics and gynecology from the early 70's until his retirement in 2009, beginning his career in Rumford but practicing for the majority of his career in Waterville.  During the course of his career, he delivered more than 4,000 babies.

Our thoughts go out to his wife of 31 years, Nancy and his children, step-children and grandchildren.  John will be greatly missed by his many friends at MMA.

Members wishing to make a donation in his honor may contribute to The Memphis Area Golden Retriever Rescue at

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MaineCare Releases Proposed Rule Requiring NPI, Reducing Part B Cross Over Payments

The Department of Health and Human Services, Office of MaineCare Services has released a proposed rule to implement a number of changes included in the state budget passed this summer or to comply with federal law. Of note, all MaineCare providers will now need to obtain a National Provider Identifier (NPI) and include it on all claims or in order to obtain coverage for referrals, prescriptions or medical supplies.  The rules would also reduce "cross over" payments that help dual-eligible Medicaid-Medicare patients cover Medicare out-of-pocket costs by limiting the amount MaineCare will pay to hospital and nursing home providers to the MaineCare allowed amount for a service. 

The Department is proposing the following changes to this rule, for the following reasons:  

(1)        Removed references to DirigoChoice, since the Maine Legislature has dissolved the Dirigo Health Agency (P.L. 2013, ch. 368, Sec. A-19);

(2)        As required by 45 CFR 162.410, requires that any MaineCare provider that is a “covered health care provider” must obtain a National Provider Identifier (NPI); 

(3)        Requires that MaineCare providers must include their NPI on their MaineCare Provider Agreements and MaineCare enrollment applications, and requires updates for new or changed NPIs;

 (4)        Requires that all MaineCare providers must include their NPI on all MaineCare claims, pursuant to the Affordable Care Act, Section 6402(a) as codified in 42 CFR 431.107, or those claims will be denied;

(5)        Pursuant to 42 CFR 455.410, specifies that, in order for MaineCare to reimburse for services or medical supplies or prescriptions resulting from a provider’s order, prescription or referral, the ordering, prescribing or referring (OPR) provider must be enrolled in MaineCare, and the OPR provider’s NPI must be on the claim. This change will be effective when the Maine Medicaid Management Information System (MMIS) is able to process this change, and the Department will notify all providers via the Listserve, and also serve notice on the Secretary of State’s office as required by 5 MRSA 8052(6); 

(6)        Pursuant to P.L. 2013, c. 368, Part A-34, effective January 1, 2014, if approved by CMS, the Department will limit cost sharing payments, for the Qualified Medicare Beneficiary without other Medicaid (QMB Only) population, to hospital and nursing facility providers to the amount necessary to provide a total payment equal to the amount MaineCare would pay for these services under the State Plan. The Department will seek CMS approval to amend its State Plan for this change.

 (7)        Finally, the Department made some additional changes to the 1.07-5 (Medicare provision), all to comport with the current State Plan, and these changes also reflect the Department’s current practice: (a) adding hospitals and nursing facilities to the list of MaineCare providers who may bill MaineCare for cost sharing, however, the cost sharing is limited in that it cannot exceed the lowest rate that Medicare determines to be the allowed amount; (b) deleting references to “Medicare Part B” in provisions where the provisions related both to Medicare A and B, pursuant to the State Plan; (c) deleting a provision regarding claims received from January 1, 1997 to February 29, 2000, since that time period has long passed.

See  for rules and related rulemaking documents.

A public hearing is scheduled for November 25, 2013 at 9 am at the Burton Cross Building in Augusta and written comments are due by December 5th.  Contact Andrew MacLean at the MMA with questions or comments:[return to top]

Reception Held Last Week for MMA President Guy Raymond, M.D. and AHA Board Member Kris Doody

The Eureka House Restaurant in Stockholm, Maine was the site of a reception last Tuesday night honoring MMA President Guy G. Raymond, M.D. and Cary Hospital President and CEO Kris Doody, RN.  Ms. Doody was recently elected to the Board of Directors of the American Hospital Association, one of the first hospital administrators from Maine to ever achieve this honor.

Several area Legislators attended along with MMA EVP Gordon Smith and Vanessa Santarelli, CEO of the Maine Primary Care Association.

Both Dr. Raymond and Ms. Doody are natives of Aroostook County and both returned to The County to serve the needs of county residents and their families. [return to top]

Dec. 6 First Friday Presentation to Focus on Accountability, Transparency & Public Reporting

The Association's final First Friday educational program of 2013 on Dec. 6 will focus on the topic of practice accountability, transparency and public reporting.  The data from your practice, whether it is claims data, administrative data or clinical data, is becoming increasingly important and will eventually be linked to payment. The program is offered from 9:00am to noon at the offices of the Association in Manchester, Maine but participation is also available on-line through webex. This particular program is part of MMA's effort to educate physicians on payment reform and is presented with financial support from the Maine Health Access Foundation.

Registration is available on the MMA website.  Flyers will also be send out to practices once the faculty and topics are finalized.  Among the topics being considered are the following:

  • The difference between claims data, administrative data and clinical data.

  • Clinical data registries offered by various specialties including cardiology, surgery and ophthalmology.

  • State attempts to place data on public websites.

  • Data initiatives included in the State Innovation Model (SIM) grant.

  • Use of data emanating from HealthInfoNet.

The First Friday presentations offered in 2014 are also now on the Association's website.

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Sign up to be Doctor of the Day

During the 1996 legislative session, the Maine Legislature asked the Maine Medical Association and the Maine Osteopathic Association to furnish a physician for each day of the legislative session to assist in the event of a medical emergency.  Now the “Doctor of the Day” program is well established and respected, and legislators are enthusiastic about it.  This is a unique opportunity to observe the legislative process in action and to interact with the lawmakers.  We need your help to continue our presence and to ensure the continued success of this program.

The scheduling of volunteers for the second year of the 126th Legislative Session has already begun.  We would like to invite you to participate in the upcoming session that is scheduled to convene in January and is expected to run through April.

Upon receipt of your registration, MMA staff will contact you to arrange and/or confirm the most convenient date for you to serve.  The House Clerk’s office staff then will mail you a packet with a legislative parking pass and confirmation letter informing you about your scheduled date.  On the day of your participation, a Maine Medical Association or Maine Osteopathic Association staff representative will meet you at the State House and will be available to guide you throughout the State House. 

This is an effective grassroots contact program for organized medicine in Maine and it has established substantial "good will" for organized medicine at the State House.  The “Doctor of the Day” program gives you the unique opportunity to observe the process in which your legislators make decisions affecting you as a physician and as a citizen of the State of Maine. 

If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA at You can submit your registration on line. We hope to see you at the State House for what is expected to be a very interesting session for the medical community. [return to top]

Last Chance to Register: Payment Reform Readiness Webinar, Nov 21

Webinar:  Payment Reform Readiness

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  The legal toolkit document and other payment reform resources are available at:  The webinars and resources are made possible through a generous grant from the Maine Health Access Foundation. [return to top]

MICIS Launches Free Antibiotic Stewardship CME Module for “Get Smart about Antibiotics Week”

A new educational module on antibiotic stewardship is being offered by the Maine Independent Clinical Information Service (MICIS) in conjunction with the Maine CDC.  This module includes patient-centered techniques for reducing antibiotic use while maintaining patient satisfaction.  “Get Smart” week runs November 18-24, however an educational session for this module can be scheduled anytime through 2014.

Contact Program Manager Jennifer Reck today at for more information or to schedule a visit by one of our trained clinicians at your convenience, at your work site, at no cost. CME is available.  

Other available topics are:

Antipsychotics (through Jan. 2014)

Obesity Management

COPD (starting Feb. 2014)

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Plaque at State Medical Examiner's Building Dedicated to Longtime Chief Examiner

A plaque recognizing the many years of dedicated service by Dr. Henry Ryan, the long-time Chief Medical Examiner, has been unveiled at the Medical Examiner's building in Augusta. Dr. Ryan is credited for making the Office an integral part of the State's law enforcement efforts and for being the driving force in the creation of a permanent facility dedicated to post-mortem examinations. 

Dr. Ryan began serving as the Chief Medical Examiner for the State of Maine in 1976 and conducted autopsies at funeral homes and hospitals until 1992, when the State of Maine finally provided a permanent location for these examinations to be conducted. 

Attorney General Janet T. Mills credited Dr. Ryan's leadership for the creation of the facility and ushering a new era in the field. "Henry Ryan transformed the practice of Forensic Medicine in Maine," said Attorney General Mills. "He brought a new level of sophistication and advanced thinking to the practice. Working in conjunction with law enforcement, I have no doubt that his efforts have resulted in solving cases that might not otherwise have been resolved. We owe him a huge debt of gratitude and it is very fitting that this plaque will recognize his efforts for many years to come."

Dr. Ryan has been a long time member of MMA and we offer our heartiest congratulations on the occasion of this recognition. [return to top]

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 (; 622-3374, ext. 213) if you plan to attend.

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Job Openings

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

Submit resume and letter of intent to: Leslie Brancato, CEO: 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 administrative operations.

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


Department of Psychiatry Faculty Position

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  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

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 or visit our website at  KVHC is an equal opportunity employer.


Nurse Practitioner

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.

The 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.

Must have State of Maine Nurse Practitioner license and be certified in Family Practice of Pediatrics. At least two years Nurse Practitioner and Supervisory experience preferred.

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: (Departments/Human Resources/Employment applications).


MaineHealth Director of Government Affairs

The Director of Government Affairs reports directly to the Senior Vice President of Government and Employer Relations; and under the supervision of the SVP, will research and coordinate MaineHealth’s position on state and federal legislation and communicate with policymakers on behalf of MaineHealth..

We seek candidates with excellent written and verbal communication skills; strong analytic capacity; and  background in legislative process. The position requires the ability to accommodate a flexible work schedule (some nights and weekends). Working knowledge of health care policy preferred.

The position requires a thoughtful and keen individual to execute the following:

  • Research, monitor and analyze federal and state legislation and regulation;
  • Work with internal advocacy and clinical advocacy committees to coordinate development of positions on proposed legislation;
  • Attend committee hearings and work sessions and maintain written summaries;
  • Maintain files for bills, including handouts and testimony;
  • Draft testimony and supporting materials. Occasionally testify on legislation;
  • Develop and maintain strong relationships with legislators and their staff;
  • Work collaboratively with other organizations to promote MaineHealth’s interests;
  • Participate in Maine Hospital Association’s advocacy calls;
  • Work with contract lobbyists to ensure the effective coordination of legislative activities;
  • Distribute regular internal communications on legislative activities and issues of concern.

To apply, please contact Shawn-Elise Lapomarda, Executive Recruiter, at or 207-662-5936.

Additional information regarding MaineHealth and its members can be found at: or

Equal opportunity employer.


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Upcoming Events

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  [return to top]

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