House Passes 3-Month SGR Extension; Senate to Vote this Week
The U.S. House of Representatives voted this past week to extend by three months the current SGR Medicare physician payment formula thus avoiding the scheduled 24% reduction in reimbursement. The Senate will vote on the extension this coming week before adjourning for the holidays - probably tomorrow. The extension is intended to provide enough time for the Congress to enact legislation permanently repealing the SGR formula early in the new year.
The House Ways and Means Committee passed the permanent repeal bill this past Thursday on a vote of 39-0. The Senate Finance Committee followed with a near unanimous voice for its version of the proposal. The proposal was originally released jointly by the Finance Committee and House Ways and Means Committee on October 30th, and the two panels are continuing to revise their proposals. Of considerable interest to physicians is the fact that the House Committee pulled the ten year payment freeze out of the bill and provided for .05 % updates for three years ending in 2017. The Senate Finance Committee bill still contains the 10 year freeze. The AMA supports the proposals and some surgical specialties have withdrawn opposition to the House bill now that the freeze has been removed and replaced with the yearly updates.
Momentum for repealing the SGR had been building in the House. On November 22nd, 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(R-TX) and Dan Maffei (D-NY) released their Congressional sign-on letter to House leadership urging that the SGR be repealed this year.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.
Under the proposal previously released by these 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. Under the Senate Finance Committee proposal, 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 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:
- Obesity & Environmental Toxins, including Maine’s Kid Safe Product Act and reform of the Toxic Substances Control Act
- Physician Wellness
- Preserving the Fund for a Healthy Maine and the Public Health Infrastructure
- 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 email@example.com. [return to top]
Nominations Open For Hanley Center Physician Leader Program
Nominations are now open for the Hanley Center's Physician Executive Leadership Institute (PELI) Advanced Course, which will begin in May, 2014.
Sixty two physician leaders from Maine, Vermont and New Hampshire have participated in the Hanley Center's first two Advanced Program courses. Between 30 and 36 physicians will be selected for the third cohort now being assembled. Participants in the Advanced Program are named "McAfee Fellows" in honor of Dr. Robert McAfee, a founding board member of the Hanley Center and the only Maine physician ever to have been elected President of the AMA.
Physicians with five or more years of leadership and management experience are eligible for the Course, which is taught by a team of faculty from the Heller School at Brandeis University and physician leaders and other subject matter experts from Maine. The course includes six two-day sessions in the Brunswick area.
Please use this link to nominate a physician leader for the course. Physicians may also nominate themselves.
EASY ONLINE NOMINATION FORM
Three Information Calls have been scheduled for those interested in learning more about the course:
Anyone interested in the Advanced Program is welcome to take part in any of these one-hour calls:
1. Noon, Thursday, December 19 2. 7 a.m. Wednesday, January 15 3. Noon, Tuesday, January 28
The Hanley Center wants to enroll 400 physicians in Advanced and Foundational programs over a five year period to build physician leadership capacity in Maine. Since PELI was launched in late 2011, 230 providers have enrolled in the Advanced Program and the Hanley Center's Foundational Program, which is delivered to small cohorts of physicians in evening sessions at hospitals, practices, clinics and health centers across the state. Foundational courses began this fall at St. Joseph Hospital in Bangor and at MaineGeneral in Augusta. The program has been delivered at eight over sites over the past two years.
For more information about the course or the upcoming Information calls, please contact Hanley Center Executive Director Jim Harnar at firstname.lastname@example.org or visit here. [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 email@example.com.
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]
MMA Legislative Committee Holds Organizational Meeting for 2014 Session; Schedules Conference Calls
The MMA Legislative Committee, chaired by Amy Madden, M.D., held its organizational meeting in preparation for the Second Regular Session of the 126th Maine Legislature on Monday, December 9th. The Second Regular Session will begin on Wednesday, January 8th and is expected to run until mid-April. Bills considered during the Second Regular Session generally come from three sources:
- Those carried over from the First Regular Session (you can find those in the MMA legislative summary on the home page of the web site);
- Those admitted by majority vote of the Legislative Council, the 10 members of legislative leadership (you can find those on the legislature's web site here); and
- Those presented by Executive Branch agencies approved by the Governor (you can find those on the legislature's web site here).
The Governor may submit legislation at any time during the session. The effort to expand health insurance coverage for nearly 70,000 low income Mainers by accepting new federal funds made available through the ACA likely will be the most hotly contested issue of the session. The MMA is part of the Cover Maine Now!
coalition working in favor of this initiative.
In keeping with past practice, the Legislative Committee will hold weekly conference calls every Tuesday at 8:00 p.m. during the session beginning on Tuesday, January 14th. Look for the conference call information each week in the Maine Medicine Weekly Update beginning January 13th.
For more information about the activities of the MMA Legislative Committee, please contact Andrew MacLean, Deputy EVP at firstname.lastname@example.org or 622-3374, ext. 214. [return to top]
ICD-1O Provider Informational Series
MaineCare recently completed analyzing the results of its ICD-10 Provider Readiness Survey. As a result of feedback from survey participants, MaineCare has developed an ICD-10 Informational Series for providers in order to share information and to direct you towards preparing for transitioning from ICD-9 to ICD-10.
The informational series will include the following parts or topics:
- Part I: Overview of Provider Survey Results
- Part II: MaineCare’s Provider Outreach Plan
- Part III: ICD-10 Provider Impact
- Part IV: Example of Coding Changes and Payment Impact
- Part V: Provider Preparation/Helpful Hints
Part I: Overview of October 2013 Provider Survey Results
Overall Provider Readiness Survey results showed that providers progressed along the ICD-10 readiness continuum since the first survey was conducted in April 2013. However, some providers have not yet begun the process of designing and implementing the changes needed for ICD-10.
Key survey findings are summarized below:
• Survey Response. MaineCare received 413 responses to the October survey reflecting an increase of 209 providers from the April survey. While we are pleased to see an increase in responses, we still want to hear from more providers. Help us help you by responding to the next survey in February 2014!
• Provider Understanding and Planning. The majority of survey respondents indicated that they are at least somewhat aware of how ICD-10 will impact them. More than half of respondents indicated that they either have a plan or have started ICD-10 efforts.
• Provider Readiness. Some respondents indicated they are in the beginning phase of gaining awareness about ICD-10. Others are actively working to make the business process and technology changes needed for the ICD-10 transition. With less than a year until the ICD-10 compliance date, providers should have at least progressed to drafting proposed changes to business processes or technology to be ICD-10 ready.
· Provider Concerns and Needs. Surveyed providers shared that they are most concerned about the training and readiness of their staff, followed by ICD-10 business process changes. While some providers indicated that they are unsure about the assistance or support they may need from MaineCare, others cited training and testing as areas of need.
To see more information about the Provider Readiness Survey results, refer to the December PAG/TAG presentation which can be found under the Provider Presentation Materials on MaineCare’s ICD-10 webpage.
For more information about the ICD-10 initiative, go to MaineCare’s ICD-10 webpage or CMS’s ICD-10 Provider Resources’ webpage. Please send questions about ICD-10 to MaineCare’s ICD-10 email box.
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ACA and Health Insurance Marketplace Updates
-Maine Marketplace Sign-ups Jump to 1,800
An improved user experience on the HealthCare.gov website has contributed to a six-fold increase in successful sign-ups. Read coverage by the Portland Press Herald, "Sign-ups for health insurance pick up in Maine," and the Bangor Daily News, "Obamacare signups accelerate in Maine but short of projections."
-Maine insurance brokers now included in enroll207.com Find Help directory
ACA and SHOP-certified insurance brokers are a key resource for Mainers who need assistance to evaluate plans and complete enrollment through the Marketplace, particularly in light of the Dec. 23rd deadline to enroll in a plan for coverage that starts January 1, 2014. The Maine Health Access Foundation invited ACA- and SHOP-certified brokers to be listed in the its www.enroll207.com Find Help directory in order to help provide Mainers with additional local enrollment resources. In the first week, over 20 brokers have asked to be in the Find Help directory.
-Top Talking points on the Health Insurance Marketplace
Share these top messages with people in your life who may have questions about whether they should look into plans on the Marketplace:
All insurance plans cover doctor's visits, hospitalizations, maternity care, emergency room care, and prescriptions.
Go to enroll207.com for basic information on the Marketplace, to locate an in-person assister, or to find out about local events. When you're ready to sign up, enroll207.com has a direct link to the Marketplace at HealthCare.gov.
According to the US DHHS, as of December 11th nearly 1.2 million people have selected a plan or had a Medicaid or CHIP eligibility determination in the first two months of open enrollment in the health insurance marketplaces. The 1.2 million people include 364,682 people who have selected plans from the state and federal marketplaces and 803,077 who have been assessed to be eligible for Medicaid or CHIP. [return to top]
Exchange Advisory Committee Releases Draft Report
On December 9th, the Maine Health Exchange Advisory Committee considered a draft final report with recommendations including that the state consider moving from a federal exchange to one that is fully or partly run in the state in 2016. The Advisory Committee is a bipartisan group of legislators, health care experts, provider representatives, and patient advocates established by a Joint Study Order (H.P. 1136) during the 2013 legislative session. MMA EVP Gordon Smith is a provider representative on the 18-member group chaired by Senator Margaret Craven (D-Androscoggin) and Representative Sharon Anglin Treat (D-Hallowell).
You will find the draft report on the legislature's web site here. [return to top]
FAME's Advisory Committee on Medical Education Holds Annual Meeting
The Finance Authority of Maine's (FAME's) Advisory Committee on Medical Education held its annual meeting at the FAME office on Wednesday, December 11th. The group is created by statute to advise the FAME staff about the various health professions financing programs under FAME's auspices. The current members of the Advisory Committee include:
- Gordon Smith, MMA EVP
- Jerald Hurdle, D.O.
- Robin Pritham, M.D.
- Jane Ham, Director of the Maine Recruitment Center
- Caroline Zimmerman, Maine Primary Care Association
- Karen O'Rourke, M.P.H.
- Noah Nesin, M.D.
- Cynthia Robertson, M.D.
- Gail Lamb, D.O.
- Adam Normandin, MMC-TUSM student
- Patrice Thibodeau, M.D.
- Patricia Kelly, UNECOM
During the meeting, the FAME staff provided a status report on the Access Program, the Health Professions Program, and the Doctors for Maine's Future Program. With the advent of the Doctors for Maine's Future Program, the Access Program is winding down. Because of the change in the nature of the health professions financing programs, the group discussed at length an appropriate role for the Advisory Committee in the future. The next meeting of the Advisory Committee is likely to be in June 2014 and the role of the Committee in the future will be an agenda item. The Committee has several vacancies, so if you are interested in serving, please contact Gordon Smith at email@example.com or 622-3374, ext. 212 to discuss the eligibility criteria for the vacant positions. [return to top]
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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 www.mercyhospital.com or
contact Alison Salerno, Provider Recruiter firstname.lastname@example.org.
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.
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
For more information please contact Alison C.
Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 396-8683
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
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 email@example.com.
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.
regular communication with MPHP participants.
MPHP participants’ progress in the program.
and assessing participants' recovery monitoring programs.
and documenting compliance issues.
MPHP team informed of any caseload changes and issues.
regulatory boards fully informed regarding mandated participants.
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
For more information and to apply, visit: http://www.jobsinme.com/seek/resultdetail.aspx?jobnum=923038
Director/Chief Medical Officer
exciting leadership opportunity with a diverse mission-focused community health
center for a family practice or internal medicine MD.
Medical Director/CMO will provide leadership and medical expertise to our
dynamic team of providers, assure system infrastructure and processes that
support our patient centered, holistic approach to a diverse patient
position will be shared between administrative and clinical responsibilities.
Experience in a community health center, teaching and international medicine is
preferred. Part-time will be considered;
full-time is preferred.
Portland Community Health Center is a federally qualified health center located
in the heart of beautiful Portland, Maine. We offer competitive compensation and
a full benefits package.
apply, please email your cover letter, resume, and salary expectations in confidence
by January 16th to: firstname.lastname@example.org
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The Maine Public Health Association (MPHA) will be launching a Tobacco Webinar Series starting in December.
Secondhand Smoke and Current Tobacco Laws: the Fight Continues
December 19, 2013, 2:00 pm
Speakers: Breathe Easy Coalition and the American Lung Association
The Raw Numbers:
Tobacco Use and Control Data Review—The Maine Story
January 16, 2014, 2:00 pm
Speakers: MaineHealth and MPHA
The Answers Are Out There: Best Practice Strategies to Reduce Tobacco Use
February 27th, 2014 at 2:00 pm
Speakers: American Cancer Society Cancer Action Network and American Heart Association
Consider the Source: The Intersection Between the
Fund for a Healthy Maine and Tobacco Prevention and Control
March 20, 2014, 2:00 pm
Speakers: Friends of the Fund for a Healthy Maine and MPHA
Sex Sells: the Wild, Wild East—Emerging Tobacco Trends
May 15, 2014, 2:00 pm