February 10, 2014

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Positive Movement on Repeal of the SGR in Washington

The three primary committees of jurisdiction reached agreement late last week on a proposal to permanently repeal the flawed sustainable growth rate formula controlling physician compensation for Medicare.  The bill, H.R.4015, must be enacted by the Congress by March 31 when another 24% reduction is scheduled.  Most medical associations, including the AMA, expressed positive comments about the bill.  The biggest issue remaining is how to pay for the $128 billion cost of the permanent fix but supporters are also particularly concerned about efforts early this week by some Republicans to tie another nine-month patch to a vote to raise the debt ceiling.  Any temporary patch would derail the present effort to repeal the SGR once and for all.

MMA officers and staff will be communicating with all four members of Maine's Congressional delegation asking them to support the proposal.  While certainly not perfect, the new proposal is a significant improvement over the existing formula which is producing double-digit reductions in reimbursement every year, resulting in the Congress delaying these cuts on a regular basis but also partially paying for them with even more significant cuts in the future. With a higher than average number of Medicare patients in the state, Maine physicians will receive a considerable benefit from enactment of the bill.  Positive updates are proposed for the first five years of the new formula, although the updates are only one-half of 1%.  Earlier versions of the repeal bill provided only a freeze in rates for the next ten years.

The 195 page bill (H.R. 4015) does not include financial offsets needed to pay for the cost of the repeal over ten years, a cost estimated by the Congressional Budget Office to be $128 billion. The three committees intended to first get agreement on the policy issues and then move onto how to pay for the repeal.

By phasing in new payment models over a period of years, the legislation attempts to better align Medicare provider payments with medical outcomes moving away from the current fee-for-service system. Beginning in 2018, physicians participating in Medicare would be eligible to receive bonuses by participating in a new Merit-Based Incentive Payment System (MIPS), which would consolidate three existing incentive programs:  The Physician Quality Reporting System; the Value-Based Modifier, which adjusts payments based on quality and resource use; and meaningful use of electronic health records. Under the new MIPS, physicians would receive pay adjustments depending upon how well they met newly established quality measures set by HHS, in consultation with physician groups, through appropriate rule-making processes.

Beginning in 2018, the bill also provides bonuses to Medicare participating physicians who receive a significant share of their revenue by using alternative payment models, such as medical homes. The bonuses would begin at 5% in the first year.

AMA President Ardis Hoven, M.D. reported in a released statement, "Continuing the cycle of short-term patches by merely addressing the 2014 cut that is imminent on April 1 without solving the underlying problem would be fiscally irresponsible and further undermine the Medicare program. It is time for action to repeal the SGR and establish a transition to a new more stable Medicare physician payment policy to better serve America's senior citizens."

Welcome to MMA's Newest Group Member: Central Maine Medical Group

MMA welcomes this week the MDs employed by Central Maine Medical Group as CMMG has joined the association's group membership program.  With over two hundred physicians, CMMG is one of the state's largest medical groups and is associated with Central Maine Medical Center, Bridgton Hospital, Rumford Hospital and Parkview Adventist Medical Center in Brunswick.  Having CMMG join the group program results in seventy-eight (78) new physician members in MMA.

MMA has over thirty groups in the group membership program and these groups in 2013 represented over 65% of all the membership dues that MMA collected.
The program is available to any group of ten or more physicians.  Any group interested in joining the program should contact MMA Executive Vice President Gordon Smith at gsmith@mainemed.com or by calling 622-3374 ext. 212.
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POLITICAL PULSE: Weekly Activities at the State House

MMA, Provider Groups, Weigh in on Medicaid Managed Care

The Health and Human Services Committee invited the Maine Medical Association, Maine Hospital Association, Maine Primary Care Association and others to weigh in last week on the proposal to transition the MaineCare population to managed care, LD 1487.  MMA EVP Gordon Smith spoke on the MMA's behalf and stated that while the Association is open to better care management through managed care, there are a number of important initiatives that the state is pursuing to better control costs and improve health in the MaineCare population and these should not be lost in a transition to a new system.  

Public hearings on several other major bills pending before the HHS committee were postponed last week due to the weather and are rescheduled for this week - including a proposal to increase access to naloxone to prevent overdose deaths and amendments to the law that requires health care providers to post fees.  

Insurance Committee Focuses on "Narrow Networks" 

The Insurance and Financial Services Committee continued there conversation last week on two bills this week related to health insurance company provider networks.  Both bills stemmed from concerns over certain hospitals and providers being omitted from the Anthem plans being offered on the new health insurance marketplace and initially proposed for all Anthem individual and small-group plans.  LD 1629 would require that if an insurance company creates a so-called "narrow network" of providers, providers would have a right to know the basis for creating the network and have certain appeal rights if not included.  LD 1676 was amended by the sponsor before the hearing to state that insurance companies would have to contract with "any willing provider" who meets the criteria established by the carrier.  The Committee held a work session last Thursday during which they discussed at length the history of insurance carrier network adequacy standards dating back to the enactment of the Health Plan Improvement Act and Bureau of Insurance Rule Chapter 850, Health Plan Accountability in the 1990s.  The Committee will continue its work session on these bills on Tuesday, February 18th.  

During a work session on Tuesday of last week, a majority of members voted in favor of LD 347, a bill that would expand the private insurance coverage requirement for autism spectrum disorders to persons 10 years of age or under, rather than 5 years of age and under.

Education Committee Supports HIV Education Bill

The Education Committee held a work session today on LD 1699, a bill that would replace lost funding in the Department of Education that provided training in evidence-based HIV prevention curricula for educators throughout the state and supported youth-lead initiatives around HIV. MMA submitted written testimony in favor of the measure. A majority of the committee supported the bill, while amending it to begin the funding in the next fiscal year.  [return to top]

MMA Legislative Committee Weekly Conference Call, Tuesday, 2/11/14, 8 p.m.

Tthe next MMA Legislative Committee weekly conference call will take place tomorrow, Tuesday, February 11th at 8:00 p.m. 

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 

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

LD 1760, An Act To Implement the Recommendations of the Commission To Study Transparency, Costs and Accountability of Health Care System Financing (support in part, oppose in part)

LD 1762, An Act Related to the Report of the Tax Expenditure Review Task Force (monitor)

LD 1766, An Act To Clarify and Update a Nurse's Authority To Administer Medication (monitor)

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New MICIS Module Available: Helping Patients with COPD Breathe Easier

Helping Patients with COPD Breathe Easier, a new module offered by the Maine Independent Clinical Information Service (MICIS), is now available. This module is an up-to-date, evidence-based review for optimizing the management of COPD in the primary care setting.  Its content includes using spirometry and clinical symptoms to diagnose and follow COPD patients, as well as matching drug therapy with disease severity according to the new GOLD-4 stage system. 

MICIS is an innovative academic detailing service that offers independent, evidence-based clinical information directly to health care providers at their practice site in one-on-one or group educational sessions. CME is available.  For more information, or to request an education session at your practice site at no cost, please contact the Maine Medical Association at 207-622-3374 or academicdetailing@mainemed.com

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CVS Caremark Ends Sale of Tobacco Products

CVS Caremark Corp. recently announced that it will stop selling cigarettes and other tobacco products at its more than 7,600 CVS/pharmacy stories across the country by October 1, 2014. The Maine Medical Association applauds the company for its leadership in helping to make the next generation tobacco-free. The Association membership passed a resolution in 2013 opposing the sale of tobacco products in any location where health care services are provided, including pharmacies.

The company's announcement that CVS/pharmacy stores will no longer sell tobacco products is an unprecedented step in the retail industry. We look forward to seeing other stores and chains follow suit. 

To see the related article in the Journal of the American Medical Association, click here.

To see the statement by HHS Secretary Sebelius, visit here

 For support and resources related to tobacco cessation, visit http://tobaccofreemaine.org/ or call 1-800-207-1230 [return to top]

HHS Rule Allows Patients to Directly Access Lab Test Reports

As part of an ongoing effort to empower patients to be informed partners with their health care providers, the Department of Health and Human Services (HHS) has taken action to give patients or a person designated by the patient a means of direct access to the patient’s completed laboratory test reports.

The final rule announced last week amends the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to allow laboratories to give a patient, or a person designated by the patient, his or her “personal representative,” access to the patient’s completed test reports on the patient’s or patient’s personal representative’s request. At the same time, the final rule eliminates the exception under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to an individual’s right to access his or her protected health information when it is held by a CLIA-certified or CLIA-exempt laboratory. While patients can continue to get access to their laboratory test reports from their doctors, these changes give patients a new option to obtain their test reports directly from the laboratory 

The patient or the personal representative may have to put their request in writing and pay for the cost of copying, mailing, or electronic media on which the information is provided, such as a CD or flash drive. In most cases, copies must be given to the patient within 30 days of his or her request.

Physician groups including the American Medical Association and the American Academy of Family Physicians had expressed concern that patients might overreact to results without a doctor's interpretation, and urged that the data carry a disclaimer.

The final rule didn't include such a notice, but said doctors could still proactively report the results to patients and would likely receive them before patients do, since the law gives labs 30 days to comply with a patient request.

The final rule is available for review at: http://www.federalregister.gov.

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SAVE THE DATE: MMA's 2014 Golf Tournament on July 21 Dedicated to John Makin, M.D.
MMA's 12th Annual Benefit Golf Tournament on July 21, 2014 will be dedicated to the memory of John Makin, M.D., former MMA President and avid golfer and skier who died unexpectedly last November.  Dr. Makin and his wife Nancy regularly played in the tournament and supported MMA in a number of other ways as well.  Dr. Makin also served several terms as one of Maine's two delegates to the American Medical Association and had received his honorary 50 year pin in October at the Annual Meeting.

Nancy Makin and other family members will join us for the golf tournament and one-half of the day's proceeds will be donated to Dr. Makin's requested charity.
The tournament will, once again, be held at the Augusta Country Club in Manchester and a traditional scramble format will be played.  Lunch will be served at 11:00am on the deck with a shot gun start at noontime.  Watch your mail for registration materials or call Lisa Martin in the membership office to save your spot today (622-3374 ext. 221).
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April 4 First Friday Program to Focus on Physician Employment Contracts
MMA's second First Friday educational program for 2014 will be held on Friday, April 4 and will feature the timely topic of physician employment contracts.  Featuring attorneys from Maine's largest employers of physicians, the program has the following objectives:

1.  To explain the standard terms in a physician employment contract and discuss the implications of each.
2.  To examine the pros and cons of working as an employee at will, without a contract.
3.  To review current trends in the state in the area of contracts.
The program will be held from 9:00am to noon at the MMA offices in Manchester but is also available through webex.  There is a $70 fee and registration is available on the MMA website at www.mainemed.com or by calling 622-3374 and asking for a registration form to be faxed or otherwise sent.
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Connecting to HealthInfoNet Webinar Available

Did you miss the January 21 MMA Payment Reform Webinar on “Connecting to HealthInfoNet (HIN) for Better Coordination and Outcomes” featuring Shaun Alfreds from HIN followed by a hands-on demonstration of how David Hallbert, MD and Molly Stevens, RN use HIN to enhance their primary care practice at Martin’s Point Health Care in Bangor? A recording of this webinar is available here. [return to top]

Upcoming Events

The Maine Chapter of the American Academy of Pediatrics (MAAP)“Visiting Professor” Program

Dr. Kenneth Ginsburg on Building Resilience

Wednesday, February 19th (Waterville/Augusta) and 
Thursday, February 20th (Bangor)

To learn more about Dr. Ginsburg and register for the opportunities in February in Maine, please click here.

Registrations will close by Friday, February 7th and registrants will be notified by Monday, February 10th.  


ICD-10 CM Training Session for Coders, March 25 & 26

Maine Medical Association Offices, Manchester, ME 

Registration fee: $545 per person and will include a training manual and a 2014 ICD-10 Manual.

For more information or to register, click here.

This two day multi-specialty training session for coders will be presented by Laurie Desjardins, PCS, CPC-1 and others from CSI Coding Strategies.  The training will cover ICD-10 CM coding fundamentals and ICD-10 code assignment.


The Maine Public Health Association (MPHA) Tobacco Webinar Series  

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  


CODEquest 2014 - Conquering ICD-10

Sponsored by the American Academy of Ophthalmic Executives, a division of the American Academy of Ophthalmology, and the Maine Society of Eye Physicians and Surgeons.

Friday, March 7, 2014

11:00am - 4:15pm

Harraseeket Inn, Freeport, ME

Details and Registration are available at:  http://www.aao.org/aaoe/coding/codequest-maine.cfm or contact Peggy Coakley at pcoakley@aao.org or 415-561-8561.


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. 


Maine Society of Eye Physicians and Surgeons Spring Educational Program and Business Meeting

Friday, May 2, 2014

12:00pm - 4:45pm

Harraseeket Inn, Freeport, ME

For more information, please contact Shirley Goggin at sgoggin@mainemed.com or 207-445-2260.


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Job Openings

ED Provider Jobs

Challenging, Lucrative, ED Provider jobs in central Maine - honoring and serving Veterans.  ED Physicians are needed in Augusta. Must-have an unrestricted medical license (from any U.S. state), and current ACLS certification. This is your opportunity to use and develop your skills of diagnosing, treating, and managing patients according to standard, usual, and acceptable methods and techniques.

B/C or B/E specializing in EM, IM, or FP by the appropriate accrediting agencies (EM preferred).

This is the opportunity for you to receive a competitive salary, a generous leave package, excellent health & life insurance benefits, and retirement benefits. You'd be eligible to participate in a pension program as well as a matching Thrift Savings Plan which is similar to a 401K. If you are a veteran, you may be able to combine accrued military retirement credit with VA pension benefits.

Your salary will be determined by local Physician/Dentist Compensation Panel (commensurate with education, experience and qualifications). By law, U.S. Citizens will be given 1st preference but non-citizens will be considered in the absence of qualified citizens. A signing bonus may be available.  Equal Opportunity Employer. Disabled persons and/or veterans are encouraged to apply.

FMI, call John Poulin at (877) 421-8263 x6913, or email him at john.poulin@va.gov

To apply, go to https://www.usajobs.gov/GetJob/ViewDetails/328066200


Psychiatrist, Psychiatric Nurse Practitioner and/or Physician’s Assistant 

Assistance Plus is seeking a full time psychiatrist, psychiatric nurse practitioner and/or physician assistant for the Medication Management Program in Wilton.  The professional team is overseen by Robert Gordon, medical director.  Our primary focus is to assist those with behavioral health disorders. 

Applicant must be a graduate of an accredited degree program and licensed to practice in the State-of-Maine.  A minimum of three years experience required. 

We offer a generous benefit package of full coverage for health, dental, and 401K.  This position is Monday through Friday and no on call coverage is required.

Please submit resume and cover letter to Kelly Negm 453-4708 ext 303 or email knegm@assistanceplus.com


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.


Seeking Contract Academic Detailer / Prescriber Educator

The Maine Medical Association, on behalf of the Maine Independent Clinical Information Service (MICIS), is seeking a clinical health professional to serve in the role of a contract “academic detailer.”  Academic detailing entails offering independent, scientific evidence on prescription drugs at the request of prescribers working in primary care.

The part-time contract academic detailer will conduct face-to-face educational outreach visits to discuss the current evidence on best clinical prescribing practices.  The candidate will be available to do one-on-one consultations with prescribers and group teaching sessions in practices, hospitals and at conferences, per request, across the state.

Hours required will vary from month to month, based on demand, and may range anywhere from 5 to 35 hours a month. Flexibility is required. One-year contract subject to renewal.


Candidates must be available to attend a two-day training session in Boston on the principles and techniques of academic detailing.  Additional trainings on specific clinical topics to be detailed will take place in Maine or Boston periodically.


  • Clinical background: MD, PA-C, RN, CNP, or PharmD or similar.
  • Two or more years of clinical experience.
  • Therapeutic competency.
  • Strong interpersonal skills including service-orientation.
  • Excellent presentation and public speaking skills.
  • Ability for light lifting when delivering presentation materials to sites.
  • Ability to travel throughout the state including occasional long days driving and overnight stays in Maine and Boston.
  • Ability to attend monthly work group meeting (mornings) and quarterly advisory committee meetings (afternoons) in Manchester.

Pay:  The contractor will be paid on an hourly basis commensurate with the candidate’s background and skills.

Contact:  Please send cover letter and resume by Feb. 28 to Jennifer Reck, MA, MICIS Program Manager, at jreck@mainemed.com.


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