February 24, 2014

 
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Prescription Monitoring Program Sees Surge in Registrations as March 1 Deadline Nears

With a March 1 deadline fast approaching and with a legislative reprieve possible but not assured, physicians and other prescribers are swamping the PMP staff with applications. In one three day period, over 600 applications were received.  Processing of applications by the small staff has slowed because of the large number of applications.  Use of the PMP has also increased 32% in the last year.

The Prescription Monitoring Program Advisory Committee met last Wednesday and heard an update on the processing of the new flood of applications.  While it is good to see the interest in registering, MMA would prefer to pass a new version of L.D. 388 which would automatically register all prescribers with a DEA number at the time of state licensure.  

The Health and Human Services Committee will receive this Thursday the report of the Substance Abuse Services Commission which handled the LD 388 Resolve from last session.  The Committee could decide to submit legislation that would implement the recommendations in the report.  If the recommendations are enacted this session, the March 1 deadline would be eliminated in favor of the automatic enrollment option.  But that action could obviously not take place before March 1.  While there is no enforcement mechanism in the law mandating registration by March 1, MMA recommends that any physician who holds a DEA license register with the Program as soon as possible.  Approximately 70% of physicians have now registered.

The Advisory Committee recently heard a presentation by Kevin S. Flanigan, M.D., Medical Director of the Office of MaineCare Services regarding the impact of the limits on opiate therapy that MaineCare imposed last year following meetings with a work group made up of physicians and patient representatives.  As a result of the rule-making requiring prior authorization at certain points and requiring patients to try alternative therapies, there has been a dramatic decrease in the amounts of opiate medication prescribed to MaineCare patients, both in terms of the number of scripts, the number of pills and the dosages.  From 2011 through 2013, there has been a 32% decrease in the number of MaineCare patients receiving prescriptions for opiates resulting in a $2 million savings to the State. On the other hand, there has actually been an increase in opiate prescribing for Medicare patients and commercially insured patients.

The biggest reduction in opiates has been for MaineCare patients with chronic conditions.  And for these patients, there has been a noticeable uptake in visits to physical therapists, occupational therapists and cognitive behavioral therapists. 

Prescriptions for MaineCare patients with cancer or in palliative or hospice care were unaffected by the policies and the prescribing data shows little change with respect to opiate prescribing for these patients.

In other positive aspects of the policies, there has been a 5% decrease in ER visits for MaineCare patients with a diagnosis of drug overdose.  And there has not been a single appeal filed by a patient for denial of an opiate medication based on the new rules.

MMA Legislative Committee Weekly Conference Call, Tues., 2/25/14, 8 p.m.; Doctor of the Day Openings

The next MMA Legislative Committee weekly conference call will take place tomorrow night, Tuesday, February 25th 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 The

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.

There are no new bills for review this week, but we will discuss the continuing negotiations about a provision of L.D. 1760 that would require health care entities to provide uninsured patients with an estimate of the total price of a medical encounter.

The MMA staff has been hard at work scheduling Doctor of the Day volunteers for the second session of the 126th Legislature.  In March, we still have the following dates available: March 5, March 12, March 19 and March 26th.  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. [return to top]

POLITICAL PULSE: Weekly Activities at the State House

Health and Human Services Committee Considers MHDO Data Bill; Works Bills on Price Transparency, Naloxone, Medical Marijuana

The Health and Human Services Committee had a busy week, holding work sessions on a number of bills that had public hearings the prior week, including L.D. 1642, An Act to Clarify the Law Governing Public Disclosure of Health Care Prices.  This bill makes several revisions to LD 990, the law that went into effect this January and requires all licensed health care providers to post the prices to an uninsured patient of procedures and services they perform more than 50 times per year.  The amendments clarify that the prices can be posted per provider or per health care entity.  They also clarify that the prices can be listed by CPT code and that the provider does not need to provide the complete list of all prices to the patient.  The Medical Association testified in favor of the changes.  A majority (12-1) of the Committee voted last Thursday to support the changes to current law and the bill will now proceed to the Senate floor. 

The Committee tabled several other bills for further consideration, including LD 1686, which authorizes the prescription, possession and administration of naloxone - an opioid antagonist that counteracts the effects of a drug overdose - and provides criminal and civil immunities for the prescription, possession and administration of the medication.   The Committee tabled further work on LD 1686 to this week and will hold a work session on the bill this Wednesday.  Please follow this link (http://petitions.moveon.org/sign/governor-lepage-main) to sign a petition to the Governor and the State House and Senate urging them to take action in favor of the proposal.  The Committee also tabled for further discussion this week LD 1739, which would clarify that physicians can write medical marijuana certificates for less than one year duration and would also allow certified nurse practitioners to write certificates for qualified patients.  MMA had testified neither for nor against LD 1739.  

On Thursday, the Committee also held a public hearing on LD 1740, An Act To Amend Laws Relating to Health Care Data.  The bill would permit the Maine Health Data Organization to release idenfied patient health information for certain specific purposes, such as back to a health care provider.  MMA testified in support of this provision of the bill, as it would enhance certain quality improvement activities if physicians have access to identified patient claims data. On the other hand, MMA expressed concerns about existing statute that allows MHDO to increase its data collection efforts to include clinical data, thereby imposing new administrative costs on physician practices. MMA supported a Maine Hospital Association amendment that would address this concern and overall took a position of "neither for nor against" the bill. 

Insurance Committee Takes Up Price Transparency 

The Insurance and Financial Services Committee held a public hearing last week on LD 1760, a bill that would implement several recommendations of the Commission to Study Transparency, Costs and Accountability of Health Care System Financing that met over the fall.  MMA expressed no opinion on several elements of the bill, however testified overall in opposition and particularly objected to a section of the bill that would require physician practices to provide an individualized health care estimate for any service or procedure to be provided to a patient, taking into account any insurance coverage and out of pocket costs.  MMA explained that while the Association supports patients having access to meaningful costs information, it is unreasonable for physician practices to have access to patient health insurance information, such as remaining deductibles and all cost structures.  Consumers for Affordable Health Care testified in favor of the bill.  The MHA, an individual consumer advocate, the insurance agents' association, and several health insurance carriers spoke "neither for nor against" the bill.  The MMA has been working with the sponsor of the bill to draft an amendment and the Committee will hold a work session on the bill this week. 

Judiciary Committee Holds Public Hearing on Involuntary Commitment Bill 

The Judiciary Committee held a public hearing last week on LD 1738, An Act To Improve Maine’s Involuntary Commitment Process.  The bill intends to address problems arising from the fact that the state does not have enough mental health beds and so often patients are held longer in emergency rooms than current involuntary commitment laws envisioned when drafted.  The Hospital Association fears that the current situation is creating a liability risk to non-designated mental health hospitals and physicians and proposed the bill aims to address the concerns for, by example, amending the time periods a hospital may hold a patient involuntarily in an emergency room based on a medical certification when no inpatient psychiatric beds are available.  MMA is currently monitoring the bill on behalf of the Maine Association of Psychiatric Physicians.  [return to top]

MMA Officers to Hold Listening Session in South Portland on Saturday, March 8

MMA officers will hold an informal "listening session" with MMA members on Saturday, March 8 from 5:00 to 7:00pm at the SeaDog Brewery in South Portland.  All members are invited to stop by for appetizers and beverages and share their concerns whether they be local, state or federal.  

While any MMA member is welcome, an individual invitation is being sent to each member in Cumberland County.

There is no cost to attend but an RSVP would be appreciated to Ashley Bernier at abernier@mainemed.com or call Lisa Martin, MMA Membership Coordinator at 622-3374 ext. 221. [return to top]

Your Calls to Congress Needed to Help Put SGR Repeal over the Goal Line

Please take action to support legislation (H.R. 4015/S. 2000) that will repeal the SGR by sending an email and calling your lawmakers via the AMA's Physicians Grassroots Network (PGN) hotline at (800) 833-6354. As of Friday, Maine physicians had generated only 12 emails to Congress.  Please send one today so we can at least double that. 

The three primary committees of jurisdiction reached agreement earlier this month 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." [return to top]

EMHS Names Robert Thompson, M.D. as Senior VIce President and Chief Medical Officer

Eastern Maine Health System announced this past week that Robert Thompson, M.D. will become its Senior Vice President and Chief Medical Officer.  Dr. Thompson is currently the Chief of Quality and Medical Officer of Asante Health System in Medford Oregon.  In his position at EMHS, he will be helping EMHS lead transformation efforts. 

Dr. Thompson is board certified in internal medicine and allergy/immunology and has actively practiced medicine for more than 20 years.  In addition, he has 20 years years of administrative experience spanning the patient care spectrum, including both outpatient and inpatient care.

Dr. Thompson begins his duties at EMHS on May 5.   [return to top]

ICD-10 Training and Education for Coding Staff, March 25-26, Openings Still Available

The Maine MGMA and the Maine Medical Association have teamed up to arrange for CSI Coding Strategies to present a two day training session on ICD-10 CM on March 25 & 26, 2014 at the Maine Medical Association office 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. This two day multi-specialty training session will cover ICD-10 CM coding fundamentals and ICD-10 code assignment.

Sign up early, as registration will be limited to the first 50 PAID registrations. If there are more requests then we have seats, we will consider holding another session.

For more information or to register, click here.

Registration fee: $545 per person and will include a training manual and a 2014 ICD-10 Manual. [return to top]

March 2014 ICD-10 Regional Forums

MaineCare will be hosting regional forums for providers about ICD-10 during the week of March 10th. The purpose of the forums are to help Maine’s provider community get ready for the ICD-10 transition and answer questions you may have. Each forum will consist of a presentation about ICD-10. Topics include explanation of ICD-10, how it will impact providers, what providers can do to prepare, and a Q&A session.

All providers, including administrators, billing staff, and clinicians, as well as other members of the health care community seeking information about ICD-10, are encouraged to attend.

Locations, dates, and times are listed below:

  • Monday, March 10th, 2-4 PM: Presque Isle Hampton Inn, Katahdin Room (Presque Isle)
  • Tuesday, March 11th, 10 AM-12 PM: Ramada Inn, Theater Room (Lewiston)
  • Wednesday, March 12th, 10 AM-12 PM: Lucerne Inn, Overlook Building (Dedham)
  • Thursday, March 13th, 10 AM-12 PM: Augusta Civic Center, Penobscot Room (Augusta)
  • Thursday, March 13th, 10 AM-12 PM: Webinar option (details will be sent upon registration)
  • Friday, March 14th, 10AM-12PM: Fireside Inn & Suites, Sebago Room (Portland)

Register Now! Because space is limited, please register by March 7th by clicking here. You will have several forums and a webinar option to choose from. You will be asked to provide your name, role, contact information, the name of your organization, NPI, and provider type. You will also have an opportunity to submit questions about ICD-10. Those selecting the webinar option will receive an email with the link after registration. If you have questions about registration, please send them to Mainecaretng.DHHS@maine.gov.

For more information about ICD-10, 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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SAGE Maine Clinician Survey

The link below will connect MMA members to a brief & anonymous 7 minute survey conducted by SAGE (Services and Advocacy for GLBT Elders) Maine to gain an understanding of the older adult Gay, Lesbian, Bisexual & Transgender (GLBT) health care service environment in Maine.

We are specifically seeking the candid opinions of physicians, advanced practice nurses, and physician assistants.

Here is the link to the survey: https://www.surveymonkey.com/s/Y3K52B8

The survey will remain open until February 28th, 2014. It is perfectly fine to forward this email to other physicians in the state of Maine. We only ask that each provider complete the survey once.

With questions, please contact Marilyn R. Gugliucci, Ph.D, University of New England College of Osteopathic Medicine, 207-602-2453 or mgugliucci@une.edu. 

Thank you for your participation. 

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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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Upcoming Events


The Maine-Africa Connection:  A Conference and Community Dialogue

Sponsored by the University of New England College of Osteopathic Medicine Global Health Club

Saturday, March 1, 2014

9:00 a.m. to 4:00 p.m.

Ludke Auditorium, UNE Portland Campus

The event is free and open to the public, but registration is required, www.maineafrica.org

***

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.

***

Maine Concussion Management Initiative Trainings 

March 14, 2014 in Bangor at Husson University
June 13, 2014 in Waterville at Colby College (Date tentative)
October 21, 2014 in Portland in conjunction with the Maine Brain Injury Conference

All sessions 7:30 a.m. - 12:00 p.m. 

Includes An Introduction to Concussions and Concussion Management & Interpreting Neurocognitive Testing (including using ImPACT)

$100 for Health Care Professionals  (CEUs/CME available); $40 for school personnel and all other attendees

For more information or to register, contact Jan Salis, jsalis@aol.com, (207) 577-2018

***

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  

***

Registration Now Open! 

Quality Counts 2014 Annual Conference 

Wednesday, April 2, 2014

Augusta Civic Center

Click here to register.

This year's conference, a collaborative effort of Maine Quality Counts, the Maine Primary Care Association, and the Maine Public Health Association, is titled, Innovation to Transformation:  What Will it Take?

As health care providers, payers, and consumers increasingly effectively work collaboratively as communities to bring together "medical neighborhoods" as private-public partnerships that align efforts to transform health care delivery and payment systems.  QC 2014 will help inform and advance these efforts.

More information can be found on the QC website.

***

Save the Date & Call for Nominations: 

2014 Hanley Center Honors for Leadership in Health Equity & Health Disparities

Wednesday, April 16, 2014

 Reception & Dinner

 Portland Marriott at Sable Oaks, South Portland

The keynote speaker at the recognition dinner will be Dr. Lori Alviso Alvord, the first Navajo Woman Surgeon and author of "The Scalpel and the Silver Bear."

CALL For Nominations

The Daniel Hanley Center for Health Leadership will recognize Maine-based organizations and individuals who have provided outstanding leadership in health equity & health disparities in Maine. Go online and nominate an Individual, an Organization or a Collaborative Project.  Deadline for nominations is March 14, 2014.

***

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

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.

2/24/14

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.

Training:

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.

Requirements:

  • 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.

2/24/14

Part-time BC FP Physicians

Provide modern medicine in a traditional Maine town at Bingham Area Health Center.  

  • Serve patients ranging from newborns to retirees.  Discover a unique opportunity for a BC FP physician one-day-per-week, year-round.
  • Join a NCQA-PCMH level-3 certified community health center.
  • Practice in a facility that offers dental services and counseling within one medical practice.
  • Work alongside a committed clinical and administrative support team.
  • Enjoy a network of 11 practices and a dedicated local board.
  • Receive  competitive compensation and malpractice coverage.

Contact: Recruiter, HealthReach Community Health Centers, 10 Water Street, Suite 305, Waterville, ME  04901

Phone:  207.660.9913 ~ Fax 207.660.9901 ~ Email:  Communications@HealthReach.org

Website: www.BinghamCHC.org

3/17/14

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