December 30, 2013

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President Signs the Pathways for SGR Reform Act of 2013

On Thursday, Dec. 26, President Obama signed into law the Pathway for SGR Reform Act of 2013.  This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on Jan. 1, 2014.  The new law provides for a 0.5 percent update for such services through March 31, 2014.  Chances have never been better for achieving a permanent repeal of the SGR by the end of March.

The new law also extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012 as well as provisions of the Affordable Care Act.  Specifically, the following Medicare fee-for-service policies have been extended:

Section 1101 - Medicare Physician Payment Update - the new law provides for a 0.5 percent update for claims with dates of service on or after Jan. 1, 2014 through March 31, 2014. CMS is currently revising the 2014 Medicare Physician Fee Schedule to reflect the new law's requirements as well as technical corrections identified since publication of the final rule in November.  The 2014 conversion factor is $35.8228. 

Section 1103 - Extension of Medicare Physician Work Geographic Adjustment Floor - The existing 1.0 floor on the physician work geographic practice cost index is extended through March 31, 2014.  As with the physician payment update, this extension will be reflected in the revised 2014 Medicare Payment Fee Schedule. This provision is of particular interest and value to Maine physicians.

Section 1105 - Extension of Medicare Inpatient Hospital Payment Adjustment for Low-Volume Hospitals - The Affordable Care Act allowed qualifying low volume hospitals to receive add-on payments based on the number of Medicare discharges from the hospital.  To qualify, the hospital must have less than 1,600 Medicare discharges and be 15 miles or greater from the nearest like hospital.  This provision extends the payment adjustment through March 31, 2014, retroactive to Oct. 1, 2013.

Section 1106- Extension of the Medicare-Dependent Hospital Program - The MDH program enhanced payment to support small hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges.  This provision extends the MDH program until March 31, 2014 and is retroactive to Oct. 1, 2013. 

MMA will be working with the AMA and other medical associations toward the goal of achieving permanent repeal of the SGR prior to the next deadline of April 2014.  All of Maine's Congressional delegation are committed to a permanent repeal.  

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 come into compliance.  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 new law was featured in a front page article in the Bangor Daily News this past week on Dec. 26.

The Legislative Council has allowed a bill to be introduced this coming session 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, or [return to top]

HHS Extends EHR Donation Exception/Safe Harbor Rules through 2021

The U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) have published companion rules which extend the ability for physicians to accept donations of almost free (must pay at least 15% of the cost of the technology) electronic health records (EHRs) from certain health care entities without violating STARK and Anti-kickback rules.  The exception/safe harbor was scheduled to sunset on December 31, 2013.  The American Medical Association is pleased to announced that due to the AMA's advocacy, HHS has extended the time physicians can accept donated EHRs under this exception/safe harbor through 2021.  They had proposed 2016 as an earlier date but recognized that this was too soon.  While the AMA advocated for a permanent exception, the extension of the sunset through 2021 brings welcomed relief for physicians as they continue to adopt EHRs and struggle to with the high cost of implementation.  The rules also made several other notable changes:

  • Excludes labs from the types of entities that may donate EHRs
  • Updates the definition of what type of software is considered interoperable for the purposes of donations
  • Clarifies the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services
  • Removes from the exception the requirement related to electronic prescribing capability

HHS accepted the argument made by several others that labs should be removed from those types of entities permitted to donate EHRs to physicians due to concerns that EHR donations are being used to secure inappropriate referrals.  The AMA, however, advocated that a preferable approach would be one that focused more on the need for better education around the limits of the safe harbor and exception for EHR donations. 

The CMS rule can be found here and the OIG rule can be found here. [return to top]

Advisory Committee Maintains Protection for Sentinel Event Reports

At their meeting on Dec. 17 an advisory committee charged with reviewing and making recommendations on Maine's Freedom of Access Laws voted not to weaken Maine's confidentiality protections for sentinel event reporting.  The vote capped several years of advocacy by the Maine Medical Association, Maine Hospital Association and Medical Mutual Insurance Company of Maine to maintain the protection, arguing that the protection has increased patient safety and created a culture of no-blame investigation of quality concerns.  Maine Statue currently states that sentiel event reports are confidential and privileged although data from the reports that do not identify or permit identification of the health care facility can be shared publically. In 2012, subcommittee of the Right to Know Advisory Committee proposed to abolish the protection. After many meetings of the subcommittee at which they received information on how other states treat such reports, written testimony from advocates and comments of hospital staff and others, the subcommittee voted Dec. 10 not to eliminate the protection and the full committee accepted that recommendation on Dec. 17.  [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.

For more information about the activities of the MMA Legislative Committee, please contact Andrew MacLean, Deputy EVP at or 622-3374, ext. 214. [return to top]

Payment Reform Readiness Webinar Series: Connecting to HealthInfoNet, Jan 21

Payment Reform Readiness Webinar Series: Connecting to HealthInfoNet for Better Care Coordination and Outcomes

January 21, 2014, 12-1pm

Shaun Alfreds, MBA, COO, HealthInfoNet

David Hallbert, MD,  & Molly Stevens, RN, Martin’s Point Health Care

Data is at the heart of payment reform efforts intended to reward outcomes rather than volume. Practices preparing for payment reform are making improvements to their systems for data collection, exchange and analytics. Within this spectrum, HealthInfoNet is a valuable tool for exchanging data necessary for informed decision-making, care coordination and improved outcomes.

Shaun Alfreds, MBA, COO of HealthInfoNet will give an overview of HealthInfoNet, emphasizing its practical value for primary care.

David Hallbert, MD and Molly Stevens, RN will explain how they put HealthInfoNet into practice at their work site, Evergreen Woods Primary Care in Bangor.

To join this webinar, please email Jennifer Reck at  This webinar was made possible through a generous grant from the Maine Health Access Foundation. Other payment reform related resources are available at: [return to top]

First Friday's Programs Resume in Feb. and April; New Program on Employment Contracts Announced

MMA's educational programs offered the first Friday of selected months and available at the office in Manchester or via Webex will resume in February.   On Friday, Feb. 7, Attorney Ben Townsend of the firm of Kozak & Gayer will lead a program entitled, Payment Reform and the Legal Toolkit.  The program will be presented from 9:00 am to noon and will feature a toolkit exploring how physician practices can prepare for payment reform.  The program is presented with grant support from the Maine Health Access Foundation (MeHAF).

On Friday, April 4th, the topic has been changed from ICD-10 (which is the subject of a two-day program being held March 25-26) to physician employment contracts.  With many residents and physicians already in practice receiving new contracts, the need for education in this area has become clear.  A balanced panel of attorneys working on these contracts will present to attendees the common elements in these contracts and the pros and cons of having a contract at all versus being treated as an employee at will.

The cost of each First Friday program is $70 per attendee ($60 if attending three or more programs in one calendar year).  Registration is available on the MMA website or by calling Lisa Martin at 622-3374 ext. 221. A list of all the First Friday programs for 2014 is included on the website. [return to top]

One Hundred Years Ago Today in the Maine Medical Journal

(Editor's note:  In continuing celebration of the Association's 160th anniversary, we will periodically publish in the Update and in Maine Medicine notes of interest from the Maine Medical Journal of 1914).

From Cumberland County:  Although the membership of the Cumberland County Medical Society at the beginning of 1913 was 140 physicians,  97 members attended the April county society meeting, which was a record attendance.  At the Dec. 19th, 2013 meeting, the speaker was Dr. J. Madison Taylor of Philadelphia who read a paper written by a Dr. Sajous (who was to attend but fell ill).  The subject of the paper was "The Various Forms of Goitre and their Treatment."

Also at the meeting, the following resolution was read:  Resolved that the Cumberland County Medical Society, with its guests, assembled from all parts of the State, disapprove of any action directed against Dr. Henry Miller, superintendent of the Insane Asylum at Augusta, as detrimental to the interest of the insane of our State."  (It is not clear from the minutes whether the Resolution was passed).

More, next week.  [return to top]

Medical Practice Insider Features Content from MMA Payment Reform Readiness Webinar Series

Ben Townsend, JD, of Kozak & Gayer and Beverly Neugebauer, Executive Director for Coastal Women’s Healthcare spoke Nov. 21 on “How to Prepare Your Practice for Payment Reform" as part of the MMA’s Payment Reform Readiness webinar series.  Their thoughts and expertise were captured in the following article that appeared in Medical Practice Insider on Dec. 19:[return to top]

Assister Regional Roundtables: Marketplace Enrollment in Maine

Starting in January, Consumers for Affordable Health Care will convene Assister Regional Roundtables for navigators, certified application counselors, and others assisting with Marketplace enrollment in seven regions throughout the State: Sagadahoc, Penobscot, Cumberland, Washington/Hancock, Androscoggin, York, and Aroostook counties.

Come to your local roundtable and you will:

  • Hear Marketplace updates and enrollment best-practices,
  • Troubleshoot problems, and
  • Network with other assisters in the area.

There may also be opportunities to be part of public information or enrollment sessions in the afternoon after these sessions. Details about these opportunities will be available in early January.  

Who should attend:

  • Navigators
  • Certified Application Counselors
  • Insurance agents and brokers

When and where:

*Details to follow for the Washington/Hancock, Androscoggin, York, and Aroostook regional roundtables in early 2014.

Sagadahoc Regional Roundtable   
Midcoast Maine Community Action   
34 Wing Farm Pkwy, Bath   
Conference Room  
9 am- 12:30 pm  
Wednesday, January 8th (Snow date: Thursday, January 16th) 
Penobscot Regional Roundtable  
262 Harlow Street, Bangor  
Piscataquis Room  
9 am- 12:30 pm  
Tuesday, January 21st (Snow date: Tuesday, January 28th) 
Cumberland Regional Roundtable  
The Opportunity Alliance  
50 Lydia Lane, South Portland  
Timbers Room  
9 am- 12:30 pm  
Monday, February 3rd   (Snow date: Wednesday, February 5th) 

Questions? Please contact Kate Ende, Consumers for Affordable Health Care,, 207-622-7083. Registration will be available starting January 2, 2014. [return to top]

Job Openings

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:


Medical Director/Chief Medical Officer

An exciting leadership opportunity with a diverse mission-focused community health center for a family practice or internal medicine MD.

The 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 population.

The 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.

The 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.

To apply, please email your cover letter, resume, and salary expectations in confidence by January 16th to:


Department of Psychiatry Faculty Position

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, in a productive collaboration with the State of Maine, is seeking a psychiatrist to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

Riverview Psychiatric Center is a 92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient treatment center for Maine’s public mental health system.  Psychiatrists with expertise in general inpatient psychiatry or forensic psychiatry are encouraged to apply.

Academic duties can include teaching and supervision of medical students and residents. Research opportunities available and encouraged.

Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to  Please reference search number PS1013D.

The Geisel School of Medicine at Dartmouth is an Equal Opportunity/Affirmative Action Employer and encourages applications from women and members of minority groups.


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Upcoming Events

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 

Register Now 

Speakers: MaineHealth and MPHA


The Answers Are Out There: Best Practice Strategies to Reduce Tobacco Use

February 27th, 2014 at 2:00 pm 

Register Now 

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 

Register Now 

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 

Register Now  


Save the Date!   

Quality Counts 2014 Annual Conference 

Wednesday, April 2, 2014

Registration materials and information will be available in February at or by calling QC at 207.620.8526, ext. 1004. 


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