Senate Passes Bipartisan Budget Act Approving Two Year Budget
Perhaps reflecting some holiday spirit, lawmakers on both sides of the aisle came together and voted 64 to 36 to approve the legislation which the President quickly signed. The law increases Medicare payment for physicians by 0.5% and delayed the pending 24% cut in physician fees for three months. Unfortunately, the package also extended by two years (through 2023) the duration of the 2 percent sequester cut for all Medicare providers.
The three month reprieve provides federal lawmakers with the time needed to complete the full Medicare physician pay reform process, including repeal of the SGR formula. As there are important differences between the repeal bills passed by the Senate and House committees, there is no certainty that agreement can be reached and the votes achieved to finally repeal the flawed formula. There has also not been an agreement as to how to pay for the nearly $140 billion cost of repeal. It is important that physicians communicate with Maine's congressional delegation reminding them of the need to permanently repeal the SGR formula.
Transparency of Pricing Law Takes Effect on Jan. 1, 2014
Public Law Chapter 332 (L.D. 990) was enacted during the First Regular Session of the 126th Legislature but its effective date was delayed beyond October in order to give medical practices and hospitals an opportunity to get up to speed with it. The law replaces an earlier statute requiring the posting of prices. The new law, which is expected to be further clarified this coming session, requires all health care practitioners to provide copies of a price list of all services and procedures performed at least 50 times during the preceding calendar year. The prices must be those that the practitioner charges patients directly when there is no insurance coverage. The prices must be accompanied by the applicable standard medical code listed by diagnosis. Practitioners must inform patients about the availability of the price list and provide copies of the list upon request. Practitioners also must inform patients of information that may be obtained from the Maine Health Data Organization web site.
The Legislative Council has allowed into this coming session a bill that is expected to amend Chapter 332. MMA staff is working with the bill's sponsor, State Senator Richard Woodbury (I, Yarmouth) and the Maine Hospital Association to draft amendments that will clarify some of the provisions of the current law. While there are no guarantees in the legislative world, there appears to be wide-spread agreement to remove the reference to diagnosis codes and to eliminate the requirement to furnish the entire list. Other helpful clarifying amendments may be added as well.
MMA staff is available to help member practices comply with the new law. Transparency of pricing is an important component of health system reform and is seen as essential to patients knowing more about the cost of care. For more information, contact firstname.lastname@example.org, email@example.com or firstname.lastname@example.org. [return to top]
MMA Office Holiday Schedule
The Maine Medical Association wishes all of our members and Update readers the best for a happy holiday season and a healthy and prosperous new year. We very much appreciate your support all year long.
MMA staff is normally available to members and their practice staff 7:00am to 5:00pm Monday through Friday. In observance of the holidays, MMA offices will close at 1:00pm on Tuesday, Dec. 24 and will be closed on Dec. 25. Next week, the office will close at 4:00pm on Dec. 31 and be closed for New Year's Day, Jan. 1. [return to top]
Deadline is Tomorrow, Dec 24. to Enroll in Marketplace Plan for Jan. 1 Coverage
This Season, Shop for Your Health
The holidays are fast approaching, and there’s one must have for every shopping list: health insurance. And the place to get it? The Health Insurance Marketplace at HealthCare.gov. To help you with the process, CMS has compiled the top things to know when choosing and enrolling in plans through the Health Insurance Marketplace. Read on to learn more about when to sign up, what to do after you enroll, and the discounts you could receive.
If you’re looking for a health insurance plan for yourself or your family that will start providing coverage on January 1, you will have until tomorrow, December 24 to enroll online through HealthCare.gov, over the phone (800-318-2596), or in person (www.enroll207.com). You’ll have the opportunity to compare private plans side-by-side and choose the one that fits your lifestyle – and budget – best. A number of upgrades have been made to HealthCare.gov, and applying for affordable, comprehensive coverage on HealthCare.gov is faster than ever before.
Once you sign up, make sure you pay your plan premium. Don’t forget to complete the final step of enrollment and pay your plan premium to your insurance company to ensure that you’ll receive your coverage by January 1.
If you’re losing coverage, check with your insurance company. If your insurance company has informed you that your current plan is being cancelled, contact them – you may be able to keep your old plan through 2014. Or, find a new plan through the Health Insurance Marketplace at HealthCare.gov.
You’ll likely find better coverage at a lower cost. You, like most people signing up for coverage through the Health Insurance Marketplace, may qualify for financial assistance with your health plan. And that plan will come with new “essential health benefits,” such as preventive care benefits, ensuring that you have the coverage you need to stay healthy, and protection against big medical bills when you get sick. The Marketplace is currently the only place where you can receive financial assistance with health insurance, so be sure to check your eligibility before the December 24 deadline for January 1st coverage.
So this season, give yourself and your family the gift of security and confidence that comes with a reliable, private health insurance plan. Don’t delay this important decision. Now is the time! Remember, enroll by December 24 for coverage starting January 1. Visit HealthCare.gov or call 800-318-2596 today.
If you are a small business, find out if you qualify for small business health care tax credits
If you’re a small employer with fewer than 25 full-time equivalent employees, you may qualify for a tax credit worth up to 50% of your premium costs when you buy health insurance through the Small Business Health Options Program (SHOP).
Non-profit employers may qualify for a tax credit worth as much as 35% of premium costs.
Here’s how you can get access to the credit through the SHOP in 2014:
- Contact an agent, broker, or insurer about enrolling in a SHOP Qualified Health Plan.
- Fill out a paper application for SHOP eligibility. You can get an agent, broker, Navigator, or assister to help you, if you want.
- Send the application in to the SHOP Marketplace.
- After it receives a completed application, the SHOP Marketplace will notify you about eligibility by phone or email and by regular mail if you request it.
- Apply for the tax credit when you fill out your business tax returns for the 2014 tax year.
For more information on the SHOP Marketplace, visit HealthCare.gov or call 1-800-706-7893, 9:00 a.m. – 7:00 p.m. EST, Monday through Friday. TTY users should call 1-800-706-7915. [return to top]
MMA Legislative Committee Conference Calls to Begin Jan. 14
In keeping with past practice, the MMA 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.
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.
For more information about the activities of the MMA Legislative Committee, please contact Andrew MacLean, Deputy EVP at email@example.com or 622-3374, ext. 214. [return to top]
RiteAid Plans to Begin Reporting Immunizations to ImmPact
At a Dec. 12 meeting of the Maine Immunization Coalition, a representative for RiteAid pharmacies announced to the Coalition that RiteAid pharmacies plan to begin reporting immunization doses to the Maine Immunization Information System/Registry (ImmPact) starting in 2014. Representatives of the Maine Medical Association and Maine Immunization Coalition raised the issue of participating in ImmPact with RiteAid after being approached by several physicians expressing concern about not receiving reliable reports when patients seek various immunizations in the pharmacy setting. RiteAid hopes to pilot participation in early 2014 and have all 79 locations in Maine participating by the end of the year. The Maine Medical Association will continue conversations with other pharmacy representatives with the goal of primary care practices receiving complete information via ImmPact regardless of where a patient may seek an immunization. For more information, please contact Jessa Barnard at firstname.lastname@example.org. [return to top]
50th Anniversary of the Surgeon Generalís Report on Smoking and Health
Fifty years after the release of the first Surgeon General's report on smoking and health, remarkable progress has been made. Since 1964, smoking prevalence among U.S. adults has been reduced by half. Unfortunately, tobacco use remains the leading preventable cause of disease, disability, and death in the United States. In January 2014, the Surgeon General will release the 50th anniversary Surgeon General’s Report (SGR) on smoking and health. The report will highlight 50 years of progress in tobacco control and prevention, present new data on the health consequences of tobacco use, and detail initiatives that can end the tobacco use epidemic in the U.S. Click here for more information. [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]
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]
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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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 email@example.com.
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 firstname.lastname@example.org.
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: email@example.com
Department of Psychiatry Faculty Position
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
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 firstname.lastname@example.org. 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.
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The Maine Public Health Association (MPHA) will be launching a Tobacco Webinar Series starting in December.
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