December 2, 2013

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Bureau of Insurance Gives 8,500 Mainers Another Year to Find an ACA Compliant Policy

Bureau of Insurance Superintendent Eric Cioppa announced on Nov. 26 that Maine will permit Anthem BlueCross BlueShield to renew current non-grandfathered health plans that are not ACA-compliant for terms that extend beyond Dec. 31, 2013.  Anthem announced later in the day that it would allow such plans to renew.

The U.S. Department of Health and Human Services (HHS) announced a transitional policy on Nov. 14 that would permit health insurance companies to renew existing individual and small business health plans that do not comply with certain provisions of the Affordable Care Act (ACA).  Plans in force when the ACA was enacted, and unchanged since that time, are "grandfathered" and therefore exempt from those provisions.  The HHS announcement postpones the federal requirement for existing non-grandfathered plans to comply with those ACA provisions.

Superintendent Cioppa noted that allowing the non-grandfathered plans to continue into 2014 will lessen the anticipated premium increase for grandfathered plans.  Anthem had proposed an average premium increase of 16.5% for its grandfathered plans.  By allowing the non-grandfathered plans to continue, the average premium increase in 2014 for all current individual policies is expected to be 12.6%.  

"This decision is meant to give several thousand Maine policyholders another option for 2014," Cioppa said.  "It will also result in a smaller premium increase for those choosing to continue their current plan, and provide more time for those individuals to evaluate plans for future years."

Anthem is required to send notices to its non-grandfathered policyholders to explain the options and premium increase.

Any individual, family, or small business, including those covered by an Anthem individual plan, may choose to purchase any ACA-compliant plan sold by an insurer in Maine.  Open enrollment continues until March 31, 2014.  After that date, new coverage will not be available until Oct. 2014 unless an individual has a qualifying "special circumstance."  Details about plans and federal subsidies to lower premium costs are available through the federal Health Insurance Marketplace at  

Maine consumers can also contact the Bureau of Insurance at 1-800-300-50000 or visit

Medicare SGR Repeal Markup Scheduled for Dec. 12

Last week, the Senate Finance Committee announced that it would markup its bipartisan, bicameral proposal to repeal the sustainable growth rate (SGR) formula and reform the Medicare physician payment system on Dec. 12.  This proposal was originally released jointly by the Finance Committee and House Ways and Means Committee on Oct. 30, and the two panels are expected to issue a revised draft prior to the markup.  It is not yet known when the Ways and Means Committee will consider the proposal but it has announced that it will adjourn on Dec. 13 and not return to Washington until Jan. 7, 2014.  If legislation is not passed by the end of the year, physicians will be subject to a 24.4% reduction in Medicare reimbursement on Jan. 1, 2014.  It is likely that a temporary fix will be passed to avoid the cut in order to provide Congress with more time to work on a larger repeal measure.

Momentum for repealing the SGR has been building in the House.  On Nov. 22, Reps. Bill Flores (R-TX) and Dan Maffei (D-NY) released their Congressional sign-on letter to House leadership urging that the SGR be repealed this year.  The letter was co-signed by 259 Members of Congress, including 141 Republicans and 118 Democrats.  Both Chellie Pingree and Mike Michaud signed on to the letter. 

Although the AMA and many national medical societies support repeal of the SGR, there is concern with some of the provisions in the bill being marked up.  Central to the opposition is a ten year freeze in payment rates for physicians who choose to be paid under the traditional fee for service system.  With physicians currently being paid at roughly the same rate as 2002 (not considering the 2% sequestration cut), most medical societies believe an increase in reimbursement is overdue.

Under the proposal previously released by the two most significant congressional committees of jurisdiction, physicians would have the option to stay in Medicare's traditional fee-for-service system or move to alternative payment models, such as patient-centered medical homes, accountable organizations and bundled payments.  Physicians would not begin receiving any positive annual updates until 2024, with those participating in alternative models receiving a 2% pay increase each year  and those opting to remain in traditional Medicare receiving only a 1% increase.  During this 10 year freeze period, physicians who assume some financial risk by participating in one of the alternative models would be eligible for a 5% bonus, starting as early as 2016. 

The proposal would combine the three existing Medicare quality programs - the Physician Quality Reporting System, the value-based modifier and the EMR incentive program under a new Value-Based Performance program starting in 2017.  Penalties in place under the current programs would remain through 2016 and then be replaced with new penalties in the Value-Based Performance program.  Providers would receive either positive or negative payment adjustments based on a composite score of the assessment categories.  The program is budget neutral, which means that payment increases to providers with high performance scores would be offset by payment reductions to poor-performing providers.  Providers who treat few Medicare patients or who participate in an alternative payment model would be excluded from the Value-Based Performance program.

MMA will report on the results of the markup and will keep members posted on this important work until resolved. [return to top]

How Important is Your Clinical Data? Attend Dec. 6 First Friday CME Program to Find Out

The Association's final First Friday educational program of 2013 on Dec. 6 will focus on the topic of practice accountability, transparency, public reporting and the importance of your data.  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 9:00 am to noon at the offices of the Association in Manchester 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 or by calling 622-3374.

The final agenda for the program is as follows:

8:30am   Breakfast and Networking

9:00am   Welcome and Introductions:  Gordon H. Smith, Esq., 

9:10am   Price Transparency and the 126th Legislature:  MMA Attorneys Smith, MacLean and Barnard

10:00am  Break

10:15am  Collecting, Analyzing and Publicly Reporting Healthcare Data:  Nancy Morris, Maine Health Management Coalition

11:00am  Maine's Healthcare Information Exchange:  The Use of Clinical Data by HealthInfoNet:  Philip Profenno, HealthInfoNet

11:45am  Questions and Answers:  All faculty.

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

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Save the Date: ICD-10 CM Training Session for Coders, March 25 & 26 at MMA

In partnership with the Maine Chapter of MGMA, MMA has arranged for CSI Coding Strategies to present a two day training session on ICD-10 CM on March 25 & 26, 2014 at the Association offices in Manchester.  This two day multi-specialty training session for coders will be presented by Laurie Desjardins, PCS, CPC-1 and others from CSI Coding Strategies where Laurie now works as Director of Consulting.  The training will cover ICD-10 CM coding fundamentals and ICD-10 code assignment.

The fee for the two-day training will be $545 per person and will include a training manual with examples and exercises and a 2014 ICD-10 Manual.  The fee also includes lunch each day and other refreshments during the breaks. Marketing materials will be developed shortly but you may reserve a spot now by communicating with Gail Begin at 485-1341 or via e-mail to

The transition to ICD-10 from ICD-9 will occur on Oct. 1, 2014 unless delayed by Congress (there are bills pending that would delay the transition further but passage is considered unlikely given that the transition has already been delayed by one year previously).

The change allows for greater specificity in describing medical conditions and the addition of new codes as medical knowledge and technology evolve.  ICD 10 was endorsed by the World Health Assembly in May 1990 and came into use in 1994.  Most other countries are now using ICD-10.  The 11th revision is expected to be available in 2015, causing some observers and coding experts to call for not only a delay in ICD 10 implementation but to skip over it entirely and wait for ICD-11.

While the transition will be very difficult for medical practices already dealing with a lot of change and uncertainly, the greater specificity will allow for better quality measurement and better analysis of disease patterns by expanding the number of diagnosis codes from 14,000 to 68,000 and the number of procedure codes from 4,000 to 87,000.  While these numbers seems overwhelming, remember that no physician or coder will need to learn anywhere near all these codes.  Rather, physicians will become familiar with the codes most commonly used in their specialty and many of the codes will be embedded in the drop-down menus of electronic medical records systems.  Nonetheless, it has been estimated that the cost of the transition for a small medical practice will be $87,000 and for large practices in excess of $2 million!

Watch for future articles on this important transition in both the Weekly Update and the printed quarterly version of Maine Medicine. [return to top]

Agenda Largely Set for 2014 Legislative Session

During the Second Regular Session, also known as the "short session," the Maine Constitution limits the types of bills that can be considered to budgetary matters, Governor's bills, "legislation of an emergency nature," bills that are the result of legislative studies, and bills introduced through the citizen initiative process. Last week, the Legislative Council largely completed its work determining which bill requests cleared this hurdle.

On November 21, the Legislative Council met to hear appeals from fellow legislators whose bill requests were previously rejected by the Council.  Roughly 100 appeals were considered by the Council, which ultimately reconsidered its position on 29 bill requests.  With this week's decisions, the Council has authorized the introduction of 128 new, legislator-initiated bills during the Second Regular Session of the 126th Legislature. 

Of particular interest to the MMA, a bill regarding expanded scope of practice for Certified Registered Nurse Anesthetists was not allowed in and neither was a bill to mandate providing women information about their breast density.  Other bills that were rejected include a bill to require doctor's office be accessible by those with disabilities, and several public health measures dealing with the Kids Safe Products Act, seat belts, helmets and fireworks. A proposal to clarify the requirements for self-identification for health care providers was also rejected, though MMA plans to work to improve the law in 2015. 

A number of bills MMA was watching were allowed in, including: one clarifying the recently-enacted legislation dealing with transparency of health care costs; accepting federal funding to expand health care through the MaineCare program; changing the way the state can recover for MaineCare fradulent claims; a bill to increase availability of naloxone for overdose prevention; bills related to narrow insurance networks and provider profiling; changes to the medical marijuana program; restoring funding to Head Start and other Fund for a Healthy Maine programs; and bills dealing with topics such as domestic violence, mental health services, epinephrine in schools, DHHS' abuse and neglect investigatory authority, reimbursment for telemedicine services by nurses and behavioral health specialists, replacing the current MaineCare transportation services and improving dental care for children on MaineCare. 

With this process largely complete, we know which carryover legislation, legislator-initiated legislation, and agency legislation will be considered next year. Study committee-generated bills, after-deadline bill requests and Governor's bills will also be introduced during session to round out the legislative agenda for 2014. [return to top]

L.D. 388 Work Group Proposes Automatic PMP Registration via Medical Licensing & Renewal

As a result of legislation passed in 2012, registration with the Prescription Monitoring Program (PMP) of prescribers of controlled substances in Maine is required by March 1, 2014 unless 90% of that class of prescribers is registered by Jan. 1, 2014. While there is no enforcement of this requirement in the law, MMA has been working with the legislature and the Substance Abuse Services Commission (SASC) to find an alternative to mandatory registration. At the request of MMA, legislation was introduced into the first regular session of the 126th Legislature (L.D. 388) authorizing the establishment of a work group to determine the cost and feasibility to having PMP registration occur automatically with the issuance or renewal of a license.  The legislation was amended into a Resolve which asked the Substance Abuse Services Commission to convene a work group to complete this evaluation.

The work group was formed and has now reported back to the SASC that such a system is feasible with a one-time cost of about $25,000.  Legislation is now being prepared to repeal the original mandate and substitute the automatic registration which would require the prescribers to do nothing except watch their e-mail for their user ID and password.  In order to accomplish this, we still need to pass amendments to the law and acquire the funding from the general fund or some other source.  Passage of the bill will be a high priority for MMA this session.

MMA encourages all prescribers of controlled substances to register for the PMP.  Do not wait for the automatic registration as the vagaries of the legislative and appropriations processes do not guarantee that we can get the ball over the goal line. [return to top]

Health Insurance Marketplace Website Improves; Use Delayed for Small Businesses

The White House yesterday (Sunday 12/1) declared victory on the promise that by the end of November, the website would "work smoothly for the vast majority of users”.  We know that this does not mean that everyone will have a perfect experience and there are no more problems.  However, it does mean that most people should be able to complete the process most of the time.  The deadline for consumers to enroll in health insurance through the Affordable Care Act's marketplaces to have coverage by Jan. 1 is now Dec. 23.

Here is the official report released by the administration: Progress and Performance Report

Also last week, the announcement was made that no on-line enrollment would be available through the SHOP (Marketplace for small businesses) this year.  Like earlier delays, it was announced that full functionality for the SHOP would be postponed until November 2014 for January 2015 enrollments.  Months ago the functionality of small employers offering multiple plans for their employees to choose from was also delayed until then.

Small employers may still enroll in SHOP plans directly through the insurer or an agent/broker.  A small employer must still enroll “through” the SHOP in order to receive the small business tax credit (available to employers with 25 or fewer FTEs that meet maximum average salary and other requirements).  At this point the only reason to use the SHOP is if you believe you may be eligible for the tax credit.  It bears repeating that small employers - those with fewer than 50 FTEs - are under no obligation to offer coverage.

You can view the HHS announcement here.

And here is the FAQ released on the topic.  

For patient-friendly materials regarding the Marketplace, please contact the MMA at[return to top]

Supreme Court Grants Review in Two Contraceptive Cases

The U.S. Supreme Court Nov. 26 announced it will hear arguments on the validity of one of the most controversial provisions implementing the Affordable Care Act—the women's preventive services mandate (Sebelius v. Hobby Lobby Stores, Inc., U.S., No. 13-354, review granted 11/26/13; Conestoga Wood Specialties v. Sebelius, U.S., No. 13-356, review granted 11/26/13).

At issue is the constitutionality of the contraceptive mandate, as applied to for-profit, wholly secular corporations. The mandate requires large employers that provide employee health plans to ensure the plans cover contraceptive drugs, devices and related counseling at no charge to the employee.

The court granted review in Hobby Lobby v. Sebelius, in which the en banc U.S. Court of Appeals for the Tenth Circuit held that two corporations and their owners were likely to succeed on their claims that the Department of Health and Human Services regulation under the ACA violates the Religious Freedom Restoration Act (RFRA), by requiring the corporations to provide insurance coverage for contraceptives in violation of their religious beliefs or pay hefty fines.

It also granted review in Conestoga Wood Specialties v. Sebelius, in which the U.S. Court of Appeals for the Third Circuit held that the plaintiffs were unlikely to succeed on the merits of their RFRA and free exercise claims, given that “for-profit, secular corporations cannot engage in religious exercise.”

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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]

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

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.


Medical Director of Primary Care - Mercy, Portland, Maine            

Mercy, a member of the Eastern Maine Healthcare System (EMHS), is the Greater Portland regional health care system representing the highest standards of clinical excellence and compassionate care. 

The Director has overall responsibility for the performance, staffing, operations, and programmatic direction for Mercy Primary Care.  Serves as the liaison between the primary care physicians, specialists and community resources and develops continuity of care processes across the system. Participates in strategic planning and provides leadership in the development and implementation of productivity systems, quality improvement and practice protocols to ensure the efficient delivery of health care services. Responsible for the recruitment, selection, retention and continuing education of physicians and other clinicians. 

MD or DO and board certification in Pediatrics, Family Care or Internal Medicine required. Minimum 5 years progressively responsible experience in physician group practices, including management functions.  Experience in utilization review, care management and NCQA insurance plan quality metrics desired. Computer proficiency, outstanding interpersonal skills, strong analytical and problem solving skills required.  EOE

FMI and to apply, visit or contact Alison Salerno, Provider Recruiter


Family Medicine Physician - Maine Medical Partners

Maine Medical Partners (MMP) is seeking an experienced BC/BE Family Medicine physician for one of their well-established outpatient practices located in Scarborough, Maine, with opportunities to also participate in hospital care as well as teaching of medical students and residents.

MMP is a high quality team of more than 370 physicians providing a wide range of hospital-based, primary, specialty and sub-specialty care delivered through a network of more than 30 locations in and near Greater Portland.  Scarborough Family Medicine is redesigning care in alignment with the Patient Centered Medical Home care model to provide more convenient care with patient centered continuity.  We are looking for a physician with at least 3-5 years of experience who wants to play an important role in making the care team of the future a reality for the people of greater Portland.

Maine Medical Center has 637 licensed beds and is the state’s leading tertiary care hospital, with a full complement of residencies and fellowships and an integral part of Tufts University Medical School. 

For more information please contact Alison C. Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 396-8683 or


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Upcoming Events

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