December 9, 2013

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Medicare SGR Repeal Markup Scheduled for Thursday: Time Running Out.

While time is running out on the prospect of a permanent repeal of the Medicare Sustainable Growth Rate formula this year, the bicameral-bipartisan bill being marked up by the Senate Finance Committee on Thursday continues to have wide-spread support after it was tweaked by both the Finance Committee and the House Ways and Means Committee last week.  As Congress is scheduled to adjourn by the end of this week, it is now likely that another short-term fix will be enacted to avoid the Jan. 1 reduction of 24% and to give Congress enough time in the first quarter of 2014 to enact a permanent repeal bill based on many of the concepts in the current proposal.

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(R-TX) and Dan Maffei (D-NY) released their Congressional sign-on letter to House leadership urging that the SGR be repealed this year.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.

Maria Hanley, Widow of Dr. Dan Hanley, Dies at Age 92

Maria Benoit Hanley, of Falmouth and formerly of Brunswick, died peacefully with her family by her side on Dec. 6, 2013 following a brief illness.   Maria lived a remarkable 92-year life dedicated to family, faith and community.  She was the widow of Daniel Hanley, M.D. who served as Executive Director of the Maine Medical Association from 1955 until 1979.  Dr. Hanley died in 2001.  Following his death, Maria carried on Dan's public commitment to innovation in healthcare leading to the founding of the Dan Hanley Center for Health Leadership, a charitable foundation dedicated to improving the health and health care for the citizens of Maine.  With Maria's guidance, the Center has become a national model for developing local health care leadership capabilities.

Four children and many grandchildren and great grandchildren survive to carry on the Hanley legacy.  Children Daniel Hanley, M.D., Shiela Hanley, Sharon Vitousek, M.D. and Sean Hanley, M.D. are all active in health care and involved in the Hanley Center. 

Maria was the oldest daughter of Henri and Katherine Benoit and grew up in Portland, graduating from Waynflete School in 1939.  She was fiercely proud of her French and Irish heritage and of her family's commitment to community service.  She graduated from Smith College in 1943, majoring in zoology.  Following graduation she worked at New York Hospital, Cornell Medical School where she was involved in the early research and development of oral penicillin with Dr. Walsh McDermott.  After several years in New York, she returned to Portland where she worked as a medical assistant and was introduced to Dan, who at that time was serving as the Bowdoin College physician.  They were married in 1948 and lived in Brunswick for the next 53 years where Maria, in her own words, served as a "full time spouse, mother and community advocate."  She was a vigorous partner to Dan throughout his remarkable career as college physician, US Olympic physician, Executive Director of MMA and devoted family physician to countless patients in the Brunswick area.

Visiting hours will be 3:30-7:00pm, Tuesday, Dec. 10th at Conroy-Tully Crawford Funeral Home, 172 State St, Portland.  A Mass of Christian burial will be celebrated at 10:00am Wednesday, Dec. 11 at Holy Martyrs Church, 266 Foreside Rd., Falmouth.  In lieu of flowers, the family requests contributions be made, in Maria's memory, to the Daniel Hanley Center for Health Leadership, 217 Commercial St., Suite 201, Portland, Maine 04101  ( [return to top]

MMA Legislative Committee Meeting Tonight, 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 tonight, 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.  

You can also join the meeting by phone: 

CALL IN NUMBER:  1-877-668-4493


If you are planning to join the meeting by phone and have not received an agenda, please email[return to top]

Maine Health Exchange Advisory Committee Reviews Draft Final Report

The Maine Health Exchange Advisory Committee met today (Dec. 9) for its last meeting prior to issuing its report to the Legislature on or before Dec. 15.  Committee members reviewed a draft of the final report and its seven categories of recommendations.  All members present voted affirmatively on the basic structure and language of the draft, although some final edits will take place prior to final sign-off.

The group of 18 individuals, chaired by Senator Margaret Craven and Representative Sharon Anglin Treat, are expected, based upon today's vote, to approve a final report containing the following recommendations.

  • Encourage the State to pursue federal grant funding under section 1311 of the Affordable Care Act to provide additional resources for consumer outreach and assistance.
  • Continue and expand the navigator program in 2015.
  • Support changes in federal and state law and regulation to provide more transparency and financial certainly to employers regarding composite rating for employee and dependent coverage.
  • Maintain the operation of the federally-facilitated marketplace in Maine for 2015 and consider a transition to an alternative marketplace model for 2016 if the marketplace fails to meet the needs of individuals and small businesses.
  • Ensure that notices and other communications distributed by the Department of Health and Human Services are useful to consumers and accurately reflect the health care coverage options available and all of the mechanisms to access coverage.
  • Improve the effective operation of Maine's marketplace by closing the coverage gap to ensure individuals have access to affordable health insurance coverage.
  • Develop common definitions and data elements for use by the Department of Health and Human Services, Bureau of Insurance, state agencies, navigators, certified application counselors and other entities to collect and report demographic, eligibility and enrollment data on those individuals and small businesses seeking assistance in obtaining health care coverage through the marketplace or other public programs. 

          The Advisory Committee will continue to meet in 2014 once the Second Regular Session of the 126th Legislature adjourns (scheduled for early April).  While the primary focus for the Committee in 2014 will be whether Maine's federally-facilitated marketplace is effective for individuals and small businesses, the Advisory Committee also plans to consider the following issues:

  1. Whether the State should transition to a partnership exchange or state-based exchange in 2016.
  2. Whether the State should establish a Basic Health Plan.
  3. Whether the State should consider changes to its designated benchmark plan for essential health benefits to the extent permitted by federal law and regulation.
  4. Whether the State should consider changes to its designated rating for geographic areas to the extent permitted by federal law and regulation.

Health care providers were represented on the Committee by Gordon Smith, MMA Executive Vice President.  A second provider slot was filled by Laurie Kane-Lewis, CEO of D.F.D. Russell Health Center in Leeds, who represented the interests of federally-qualified health centers.           [return to top]

MMA Board of Directors Approves Resolutions Supported at Annual Session

The 24-member MMA Board of Directors met last Wednesday (Dec. 4) and unanimously approved the five Resolutions presented and approved at the Annual Meeting in October.  The five resolutions covered subjects ranging from bicycle safety to the Choosing Wisely Initiative.  The Resolutions, which are now MMA policy, can be found on the MMA website.

In other Board business, the Board:

  • Heard a report from RBC Wealth Management on the current status of the Association's reserves and the Maine Medical Education Foundation reserves;
  • Approved a budget for the Medical Professional Health Program in 2014;
  • Reviewed an agenda for the President's retreat in January;
  • Elected Kenneth Christian, M.D., of Holden, to an at-large position on the Executive Committee; and
  • Approved a new marketing plan for the MMA Peer Review Committee.

The Board meets next on January 24, 2014 as part of the annual President's retreat. [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 prices, 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]

MMA Public Health Committee Seeks Members

The Maine Medical Association Public Health Committee is an active group of approximately 30 physicians who are passionate about population health.  The Committee meets every-other month in person or by phone.  

The Committee has currently identified the following priorities: 

  1. Obesity & Environmental Toxins, including Maine’s Kid Safe Product Act and reform of the Toxic Substances Control Act 
  2. Physician Wellness 
  3. Preserving the Fund for a Healthy Maine and the Public Health Infrastructure 
  4. Domestic Violence 

The Committee focuses significant energy in these four areas, as well as responding to various public health issues that come up throughout the year and during the legislative session - such as vaccination rates, antibiotic stewardship, and considering a tax on sugar sweetened beverages.

The work of the Committee is relevant to physicians of all specialties – from primary care to cardiology, surgery and infectious disease -  and we encourage MMA Members to join us in our work, regardless of whether you consider yourself a public health “expert.” The upcoming meeting dates are Dec. 11, Feb. 12, April 9, June 11, Aug. 13, Oct. 8, Dec. 10, all from 4-6 pm.  If you are interested, please contact Jessa Barnard at [return to top]

MaineCare Health Homes Initiative: Re-Opening of Practice Application for Participation

In order to support partnerships between primary care practices and community mental health agencies interested in participating in the Behavioral Health Homes initiative, MaineCare is re-opening its application for primary care practices that are not currently participating in Stage A Health Homes for MaineCare members with chronic conditions. 

Practices interested in participating in Stage B Behavioral Health Homes (for individuals with serious mental illness or serious emotional disturbance) are encouraged to apply.  Practices that apply and qualify will be eligible to participate in both Stage A and Stage B Health Homes initiatives as of April 1, 2014.  Practices that are already participating in Stage A Health Homes do no need to apply to participate in Stage B Behavioral Health Homes.  MaineCare will be following up separately with the existing Stage A practices to confirm participation in Stage B Behavioral Health Homes.

MaineCare currently has 159 Health Home practice sites across the state that, in partnership with Community Care Teams, delivers Health Home services to MaineCare members with chronic conditions through Stage A.  Stage B of MaineCare's Health Home initiative, being implemented in April 2014, requires partnerships between a primary care Health Home practice and one or more licensed community mental health providers (the Behavioral Health Home Organization or BHHO) to manage the physical and behavioral health needs of individuals with significant mental health needs. Through this application, practices may participate in both Stage A and Stage B of the Health Home initiative beginning in April 2014.

Completed applications are due by Friday, January 10, 2014. For practices with more than one location, a separate application must be completed for each location.

To access the online application, please click here or go to:

Maine Quality Counts will be hosting a webinar for practices interested in becoming a MaineCare Health Home Practice and seeking additional information.  This webinar will be held on Thursday, December 17, from 12:00 -1:00.  You can register for this webinar online.

Questions about the MaineCare Health Homes initiative should be referred via email to Kitty Purington at OMS or to Lisa Letourneau, at Maine Quality Counts.

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MeHAF Supports Efforts to Strengthen Safety Net for Uninsured People

The Maine Health Access Foundation (MeHAF) has awarded $349,000 to six nonprofits across the state that will support the development of better strategies that can expand access to quality care for uninsured people. “Providing this support is central to MeHAF’s mission to promote access to quality health care, especially for uninsured and underserved people,” said Dr. Wendy Wolf, MeHAF’s President and CEO. “This initiative will promote collaborative approaches from an array of health care and social service organizations to ensure that uninsured people have access to more stable, continuous health care to promote better health. One of the goals of the program is to reduce the use of the emergency department for people who are uninsured by developing better coordination and use of primary care services.” 

MeHAF Access to Quality Care Grant Recipients include: 

Islands Community Medical Services, Inc., Vinalhaven: $50,000 planning grant to improve the continuity of care and patient experience for the vulnerable population of the islands especially during transitions of care.

MaineHealth, Portland: $98,825 grant to expand access to care to uninsured and underinsured adults in York County through the highly collaborative and sustainable CarePartners model that currently being used in Cumberland, Lincoln, Waldo and Kennebec Counties.

Mercy Hospital, Portland: $50,000 planning grant to expand and scale Mercy's "Medical Neighborhood" model which uses seamless data sharing and intensive care coordination to establish and maintain a medical home for uninsured and vulnerable patients. 

Mid-Coast Health Net, Inc., Rockland: $50,000 planning grant to expand access and improve delivery of free and low-cost integrated care to uninsured and underinsured residents of Knox County.  

Penobscot Community Health Care, Bangor: $49,997 grant to lead a comprehensive planning process involving a coalition of 26 community and health care organizations to strengthen the health care safety net for uninsured residents of the greater Bangor area. 

Portland Community Health Center, Portland: $50,000 planning grant to create a coordinated system of care model for uninsured low-income immigrants and asylum seekers residing in Cumberland County. 

Click here to learn more. 

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New National PMP Report to Congress Identifies Some Challenges

A new report delivered to Congress by the Department of Health & Human Services on November 14th makes a series of recommendations of best practices for prescription drug monitoring programs (PDMPs), particularly health IT connectivity and integration.  The report is a product of the PDMP Center for Excellence at Brandeis University. The report suggests that PDMPs "apply the latest advances in health IT to incorporate PDMP data directly into the workflow of prescribers and dispensers" and ensure these systems can exchange data with clinical EHRs.  The report also suggests that state programs use existing IT infrastructure, such as regional health information exchanges, to support data exchange.   [return to top]

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]

Job Openings

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


Family Medicine Physicians

Northern New England Primary Care, LLC is seeking board certified or board eligible Family Medicine Physicians to join our independent, multispecialty group totaling 6.5 providers in Manchester, Maine.

NNEPC specialties include: Family Practice, Internal Medicine, OB/GYN, Pediatrics, Pain Management, Osteopathic Manipulation and Fluoroscopic Interventional procedures. The clinic provides an array of ancillary services including full service lab, MRI, Ultrasound, and Physical Therapy.

Inpatient services are supported by the local hospitalist group.  NNEPC is interested in recruiting to support the community need for primary care

The Kennebec Valley region has a catchment of 250,000 and is located in the lakes region of central Maine.

For more information, contact Lisa Avery at 207-629-5522 or email


Case Manager - Maine Medical Professionals Health Program

Applications Open: December 3, 2013 to January 10, 2014

We are seeking an experienced full time Case Manager for a quality healthcare related organization.  This position will require discretion and sensitivity to confidential information. The position of Case Manager is critical to ensure the ongoing oversight of active participants in the Maine Medical Professionals Health Program (MPHP). It is the primary responsibility of the Case Manager to oversee and monitor participants’ compliance with the care and reporting requirements of their Monitoring contracts. This position reports to the Director of the Medical Professionals Health Program.

Primary Responsibilities:

  • Documenting regular communication with MPHP participants.
  • Monitoring MPHP participants’ progress in the program.
  • Establishing and assessing participants' recovery monitoring programs.
  • Overseeing and documenting compliance issues.
  • Keeping MPHP team informed of any caseload changes and issues.
  • Keeping regulatory boards fully informed regarding mandated participants.
  • Supporting outreach and development work to assure early intervention.

Bachelor’s Degree/Masters preferred.  Regular Full time Position located in Manchester, Maine. Salary commensurate with education and experience.

For more information and to apply, visit:


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