January 13, 2014

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POLITICAL PULSE: Legislature Holds Busy First Week; MMA Press Event Jan. 23

The second session of the 126th Maine Legislature opened last Wednesday.  As per tradition, the Maine Medical Association President - emergency room physician Guy Raymond, MD, of Fort Kent - served as the Doctor of the Day, along with Leigh Forbush, DO, President of the Maine Osteopathic Association from Hampden.  Several hundred advocates for increased health coverage under the Medicaid program also rallied at the state house on Wednesday, and a number of individuals spoke who would stand to gain coverage under LD 1578 being proposed this session.  Because this is the second session, legislative committees jumped right to work last week, with a number of public hearings and work sessions on topics ranging from moving Maine to a single payer health care system to allowing a mid-level dental provider.  

Health and Human Services Committee to Take up Medicaid Coverage 

LD 1578, the bill that would allow Maine to accept federal funding to provide health care via MaineCare to more low-income Maine residents, has been scheduled for a hearing this Wednesday, January 15th.  MMA will be testifying in favor of the bill.  The Medical Association has also planned a press event in favor of the MaineCare proposal for Thursday, January 23rd from 10 am - 12 pm at the Welcome Center of the State House.  Please contact Jessa Barnard at jbarnard@mainemed.com for more information or if you are interested in participating in the event. 

The HHS Committee also held a public hearing last week on two bills related to providing transportation to MaineCare recipients, LD 1626 and LD 1663.  One bill would have cancelled the contracts with the much-criticized company currently providing broker services for the rides while the other would revamp the broker system.  Just before the hearing, the Department of Health and Human Services announced that they would not be renewing their contracts with the broker when they expire this June. 

Governor Vetoes Tobacco Cessation Coverage Provision - Contact your Legislator Today

Last session, the legislature overwhelmingly passed LD 386, a bill to restore coverage of smoking cessation benefits to the MaineCare program.  Late last week, the Governor vetoed the bill, stating that because beneficiaries would not be charged co-payments for the services, the bill "expands welfare unchecked."   However, since 2011, CMS has recommended to states that they cover smoking cessation services with no copays or deductibles, citing the fact that "several peer reviewed studies have found that reductions in patient out-of-pocket costs increase both the use of cessation services and overall tobacco quit rates."  The bill would have a negligible financial cost. Please contact your legislators to urge them to override the veto of LD 386.  A vote is expected this Thursday.  You can find your representative here and senator here

Insurance Committee Hears Testimony on Single Payer Bill 

Dozens of health care providers, patients and others filled the Insurance and Financial Services Committee last Thursday to testify on LD 1345, a bill that would transition Maine to a single-payer health insurance system in the model of Vermont.  A number of individual physicians testified in favor of the proposal, including Dr. Jim Maier, Dr. Julie Pease and Dr. Janis Petzel.   The Medical Association submitted testimony neither for nor against the bill, highlighting the Association's policy in favor of universal access to health care and a poll conducted in 2008 that showed its membership closely split on the issue.  The Association is re-polling members on their position on a single payer system this month.  

Labor Committee Approves Dental Therapist Bill 

The Labor, Commerce and Economic Development Committee held a work session last week on LD 1230, a bill that will allow a dental hygienist or independent practice dental hygienist to practice as a licensed dental hygiene therapist.  The new mid-level provider would be required to have a written supervision agreement with a dentist and practice in underserved areas.  After several amendments were made, the Committee approved the modified bill in a 7-4 vote.  The Maine Dental Association strongly opposed the measure. 

MMA Legislative Committee Conference Calls to Begin Tomorrow, Jan. 14; Doctors of the Day Still Needed

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.  

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-619-326-2772 (Please note that this is a new number and is not toll free)

Passcode:  729-7185

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.  The MMA staff lists a suggested position for each bill and any medical specialty particularly affected by the bill.

If you have an opinion about any of these bills, but cannot participate in the call, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

The MMA staff has been hard at work scheduling Doctor of the Day volunteers for the second session of the 126th Legislature.  We still have openings for the following dates in January:   21st & 28th.

If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA at docoftheday@mainemed.com. You can submit your registration on line. We hope to see you at the State House for what is expected to be a very interesting session for the medical community.

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first.

L.D. 1428, An Act To Protect Religious Freedom (oppose)*

L.D. 1578An Act To Increase Health Security by Expanding Federally Funded Health Care for Maine People (support; Cover Maine Now bill)*

L.D. 1580An Act To Use the Dorothea Dix Psychiatric Center To Provide Inpatient Mental Health Services for Forensic Patients (support; psychiatrists)*

L.D. 1582Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 32: Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders, a Major Substantive Rule of the Department of Health and Human Services (monitor; pediatricians)

L.D. 1583Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 29: Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder, a Major Substantive Rule of the Department of Health and Human Services (monitor; psychiatrists)

L.D. 1584Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 21: Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder, a Major Substantive Rule of the Department of Health and Human Services (monitor; psychiatrists)

L.D. 1592An Act To Improve and Modernize the Authority of Local Health Inspectors (monitor or support; Public Health Committee)

L.D. 1593Resolve, To Eliminate Financial Inequality in MaineCare Reimbursement for Community-based Behavioral Health Services (monitor; psychiatrists)*

L.D. 1594Resolve, To Improve Access to Emergency Behavioral Health Services and Increase Public Safety (monitor or support; psychiatrists)*

L.D. 1596Resolve, Directing the Department of Health and Human Services To Amend MaineCare Rules as They Pertain to the Delivery of Covered Services via Telecommunications Technology (monitor; psychiatrists)*

L.D. 1598An Act To Improve Hospital-based Behavioral Health Treatment for Persons with Intellectual Disabilities or Autism (monitor or support; psychiatrists)*

L.D. 1599Resolve, Directing the Commissioner of Health and Human Services To Advance the Safe Handling of Hazardous Drugs To Protect Health Care Personnel (monitor)

L.D. 1600An Act To Require Health Insurers To Provide Coverage for Human Leukocyte Antigen Testing To Establish Bone Marrow Donor Transplantation Suitability (monitor)

L.D. 1624An Act Concerning Pricing Disclosure Requirements and Oversight of Pharmacy Benefits Managers (monitor)

L.D. 1629An Act To Amend the Laws Governing the Provider Profiling Program (monitor or support)*

L.D. 1636An Act To Provide a More Efficient and Reliable System of Nonemergency Transportation for MaineCare Members (monitor)

L.D. 1640An Act To Enhance the Stability and Predictability of Health Care Costs for Returning Veterans and Others by Addressing the Issues Associated with Hospital Charity Care and Bad Debt (monitor)

L.D. 1641An Act To Amend the Workers' Compensation Laws as They Pertain to Employee Representation (monitor; physical medicine & rehab specialists)

L.D. 1642An Act To Clarify the Law Governing Public Disclosure of Health Care Prices (support)*

L.D. 1656An Act To Increase Safety for Victims of Domestic Violence (support; Public Health Committee)

L.D. 1659An Act To Amend the Uniform Deceptive Trade Practices Act (monitor)

L.D. 1663Resolve, To Terminate a MaineCare Transportation Contract (monitor)

L.D. 1664An Act To Encourage Charitable Contributions to Nonprofit Organizations (monitor)

L.D. 1669An Act To Standardize and Simplify the Process for Employers To Provide a Drug-free Workplace (monitor; physical medicine and rehab specialists)

L.D. 1676An Act To Strengthen Access Requirements and Review Standards for Health Insurance Plans (support)*

L.D. 1682An Act To Preserve Head Start and Child Care Services (support; pediatricians)

L.D. 1685An Act To Ensure That All Maine Children Are Protected from Abuse and Neglect (monitor or support; pediatricians)*

L.D. 1686An Act To Address Preventable Deaths from Drug Overdose (support)*

L.D. 1699An Act To Fund the Maine HIV Prevention Education Program within the Department of Education (support; Public Health Committee)

L.D. 1704An Act To Increase the Use of Dental Services by MaineCare-eligible Children (monitor or support; pediatricians)*

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PMP Enrollment Becomes Mandatory for all Prescribers in Maine

The Office of Substance Abuse and Mental Health sent a communication last week to all physicians, dentists, physician assistants, podiatrists and advance practice registered nurses licensed in the State of Maine stating that because fewer than 90% of practitioners were participating in the Prescription Monitoring Program (PMP) as of January 1, 2014, all licensed individuals in the above disciplines are now required  by state law to register with the Prescription Monitoring Program by March 1, 2014. See 22 M.R.S. § 7249(5).  In addition, Chapter 21 of the Joint Rules of the Maine Boards recommends the utilization of the PMP (§III.1 Principles of Proper Pain Management: Evaluation of the Patient).

Therefore, if you have not done so already, please take a moment right now to go to the PMP website  for registration  forms and further information.  Any questions or inquiries can be directed to the  Substance Abuse and Mental Health Services/PMP office at  207-287-2595 or  osa.ircosa@maine.gov.   For technical and registration questions please contact the PMP Help Desk  directly at 1-866-792-3149 or email mepmpinfo@hidinc.com.

As shared in prior editions of the Weekly Update, the MMA is also working with the licensing boards to make registration an automatic part of the license renewal process. 


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Transparency of Pricing Law in Effect as of January 1, 2014

Seeking more price transparency and hoping to encourage consumers to pay more attention to prices and costs, the 126th Legislature in 2013 enacted legislation requiring 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 effective date of the legislation was January 1, 2014.

Public Law 2013, Chapter 332 (L.D. 990) was enacted during the First Regular Session of the 126th Legislature but its effective date was delayed to January 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 December 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.  The MMA is interested in physicians' opinions on this law, so please participate in this month's poll question on the topic.  See the MMA web site here.  For more information, contact gsmith@mainemed.com, amaclean@mainemed.com or jbarnard@mainemed.com. [return to top]

Physician Assistant Christopher R. Ross First PA Appointed to Board of Licensure in Medicine
In late December, Maine Governor Paul LePage appointed Christopher R. Ross, PA-C to the Maine Board of Licensure in Medicine, filling the new seat established by legislation enacted in the First Regular Session of the 126th Legislature.

Christopher lives in Winthrop with his family and works at Maine Dartmouth Family Practice Residency Program in Augusta.  He is a former officer in the Maine Association of Physician Assistants and is a current member of the PA Advisory Committee to the Board.
Christopher will be participating in his first board meeting tomorrow, Jan. 14.
There is also a PA seat available on the Osteopathic Board of Licensing.  That seat has not been filled and any PA interested and meeting the qualifications should submit a letter of interest to the Governor's office.
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CMS Announces Estimates of Health Care Spending in 2012: A Fourth Year of Low Growth
On January 6, the Office of the Actuary at the Centers for Medicare and Medicaid services (CMS) released its analysis of data on health care spending in the U.S. in 2012.  Spending in the health sector grew in 2012 at a rate of 3.7 percent to reach a total of $2.8 trillion.  That level of annual growth is similar to spending growth rates since 2009, which increased between 3.6 and 3.8 percent annually.  These rates are the slowest rates ever recorded in the 53 year history of the National Health Expenditure Accounts.

Total health care spending in 2012 grew more slowly than did the gross domestic product, which means that the share of the economy devoted to health care fell slightly from its 2011 level of 17.3 percent to 17.2 percent.
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90-day Premium Grace Periods Under ACA Require Close Eye for Physician Offices

Beginning with marketplace health policies active on January 1, 2014, federal regulations allow patients participating in the exchange plans a 90-day grace period for missed premium payments; health plans are then allowed to deny or later recoup payments from doctors for services provided if those patients end up delinquent on their plan payments.  Encourage your patients to remain current on their premium payments to retain their insurance coverage.  Additionally, while participating in an exchange may be voluntary, physicians may not be certain what plans they are participating in, and should review their contracts or directly contact insurance companies to determine what marketplace plans include them as part of the network.  More information is available in the following two articles: Docs Need Info on 'Grace Period,' AMA Says and Docs May See Pay Delay Under ACA Exchanges. [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 jreck@mainemed.com.  This webinar was made possible through a generous grant from the Maine Health Access Foundation. Other payment reform related resources are available at: http://www.mainemed.com/cme-education-info/payment-reform-resources [return to top]

First Friday's Programs Resume in February 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, February 7th, 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]

Member Survey Ongoing: Let us Know Your Thoughts on Payment Reform

Last week MMA members received a short, confidential survey on payment reform.   One randomly drawn member participant will be able to designate a charity to receive a $500 donation in appreciation for your time.  MMA members only please are requested to respond by January 29. Click here to link to the survey. [return to top]

Job Openings

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: atucker@portlandchc.org


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 psychiatry.jobs@dartmouth.edu.  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

Medical Group Management Association of Maine

2014 Third Party Payer Seminars

January 21, 2014 (Storm Date January 22, 2014) 
Fireside Inn & Suites, 81 Riverside Street, Portland, ME 


January 28, 2014 (Storm Date January 30, 2014) 
Waterville Elks Club, 76 Industrial Street, Waterville, ME

8:30 am - 4 pm 

Plan to join us for our most popular program of the year, our annual Third Party Payer Seminar.  Payer representatives from the major plans will be speaking at this seminar and providing updates that affect your practice.  Come learn about the new products offered on the Health Care Exchange and how they can help your patients.

For questions or more information, contact Linda Tardif, Education Chair, (207) 783-1449, LTardif@CentralMaineKidneys.com 


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 www.mainequalitycounts.org or by calling QC at 207.620.8526, ext. 1004. 

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