Maine Medicine Weekly Update

March 17, 2014


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SGR Repeal Passed in House but Caught up in Partisan Gridlock; Medicaid Expansion Suffering from Same Malady

It was a bad week for the physicians and patients of Maine with the once-promising repeal of the Medicare SGR formula getting mired in partisan politics and now likely only another temporary patch will avoid a 24% reduction on April 1st. And the situation was no better at the State House in Augusta where the effort to accept nearly three quarters of a billion dollars of federal support for health care over three years failed by two votes to achieve the support it would need to overcome the veto Governor LePage has promised.

The Association has worked with more than 100 health care and related organizations during the past year to advocate for the expansion of an expanded MaineCare program that could cover 70,000 Mainers including the 25,000 who lost coverage at the end of 2013. Because the federal funds were available on January 1st of this year, the state has already lost out on more than $40 million that could have assisted patients earning under 138% of the federal poverty level. The Senate vote on the Katz-Saviello proposal (L.D. 1487) was 22 to 13 but 24 votes will be required to override the expected veto.

The House vote on expansion is expected to take place tomorrow, Tuesday, March 18th. Achieving a two-thirds vote in the House is possible, as a veto-proof margin last year failed by only 3 votes. But, it has been very difficult to find the remaining votes necessary to achieve a super-majority. Thanks to the many MMA physicians who have contacted their legislators, written a letter to the editor, or otherwise assisted in the effort. This effort can be expected to continue right into the election and into January if unsuccessful this session.

The situation with the effort to permanently repeal the sustainable growth rate formula controlling physician Medicare payments also has deteriorated with each party blaming the stalemate over the cost of paying for the repeal ($138 billion over ten years) on the other. It all got started last week with the Republican leadership in the House deciding to use as its "pay-for" savings from delaying the individual mandate in the Affordable Care Act for five years. Of course, this was immediately rejected by the Democratic leadership in the Senate and the President. The Senate Democratic leadership then retaliated in a partisan way by choosing to use the overseas contingency account (which Republicans have traditionally been reluctant to use) or to even not pay for the repeal at all. The parties are currently at an impasse.

So, while the circumstances called for the same cooperation and bipartisanship that was present when the content of the repeal was prepared by the three committees of jurisdiction, what occurred was the all-too-frequent partisanship and finger-pointing that has made physicians and other care care-givers so cynical and disappointed during these past few years. Many physicians are now opposing even a temporary patch (it would be the 17th temporary patch) feeling that taking the cut may be the only means to get the attention of Medicare patients and the public. A cut of 24% would cause many physicians to leave Medicare, create a crisis for the patients and perhaps result in responsible Congressional action. It would also cost Maine physicians and hospitals $50 million in just the nine months remaining in 2014. Such a course of action is very risky and there is really no assurance that the leadership of the parties in Washington would act to permanently repeal the SGR and replace it with an alternative formula that would be fair to physicians.

Maine's congressional delegation is well aware of the issue and all four members support a permanent repeal. We continue to urge them to reach across the isle to find solutions and to urge their party leadership to not pass up this unique opportunity to permanently repeal the flawed formula. The House and Senate are both in recess this week and will have only eight days to fix the problem before the March 31 deadline. It you should see any of Maine's congressional delegation in Maine this coming week, please impress upon them the urgency of getting back to Washington on March 24th and getting the job done!

MMA Legislative Committee Weekly Conference Call, Tues., 3/18/14, 8 p.m.

The next MMA Legislative Committee weekly conference call will take place tomorrow night, Tuesday, March 18th 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 new bills for review this week and the MMA staff also will brief participants on the latest news from the State House.

L.D. 1807, An Act To Restore Funding in the Maine Budget Stabilization Fund through Alternative Sources (monitor)

L.D. 1811, An Act To Appropriate and Allocate Funds To Strengthen the State's Efforts To Investigate, Prosecute and Punish Persons Committing Drug Crimes (monitor)

L.D. 1814, An Act To Create a Secure, Therapeutic Mental Health Unit (monitor or support; psychiatrists) [return to top]

MMA Payment Reform Survey Results Available

The MMA is pleased to release results from our January 2014 survey on payment reform. A total of 261 people completed the entire survey, representing a diverse selection of practice sizes, specialties, ownership and employment models, and geographic locations within Maine. Some highlights of the results include:

Most respondents (79%) agreed the current system should be restructured to align payment with optimal clinical care.
More than half (52%) said that they are prepared or are preparing for payment reform.
Nearly all respondents indicated that they understand most payment reform models, but – with the exception of pay for performance - fewer than half are currently participating in payment reform. Within 24 months though, respondents expected their participation to double.

Complete results are available on the Payment Reform by clicking here.

Finally, congratulations to Dr. Ed Pontius, the winner of our random drawing of survey participants for the prize of a $500 donation to charity. Dr. Pontius has designated Carbon Tithe, a new non-profit which will help Mainers donate to Maine causes supporting communities and the environment, as the beneficiary of the donation. Carbon Tithe, in association with Maine Interfaith Power and Light, will help accelerate and sustain projects that are already making a difference in Maine such as Window Dressers, an energy efficiency initiative that helps individuals struggling with high energy costs to reduce their energy consumption and heating bills. Thank you to Dr. Pontius and to all survey respondents. The survey was financed through the generosity of the Maine Health Management Coalition and the payment reform grant in which MMA participates.. [return to top]

POLITICAL PULSE: Weekly Activities at the State House

Between a snow closure day on Thursday and the deadline last Friday for bills to be out of Committee, Committee action slowed somewhat last week and debate will be moving to the House and Senate. Starting next week, the House and Senate begin meeting every day, trying to complete work by the scheduled adjournment date of April 16th.

Senate Votes Out LD 1487 Medicaid Expansion and Managed Care in MaineCare

On March 12, after three plus hours of intense debate, the Maine State Senate voted 22 to 13 in favor of LD 1487, “An Act to Implement Managed Care in the MaineCare Program” sponsored by Senator Roger Katz, legislation that would provide health insurance to nearly 70,000 Mainers. The Senate voted 22 to 13 to accept the majority “ought to pass as amended” report on the bill. LD 1487 now heads to the Maine House where it will likely appear on Tuesday’s calendar.

This result was 2 votes shy of the necessary 24 in order to override a Governor's veto. Cover Maine Now Coalition supporters, of which the MMA is a member, issued a press release commenting, “In recent days, the debate has focused on the politics of expanding access to health care. When the House deliberates on this bill, we hope they will focus on the people this legislation will help. They have a chance to make a real difference in the lives of thousands of hardworking Mainers by providing access to life-saving care when they need it.”

Appropriations Committee Continues work on Supplemental Budget Proposals

The Appropriations Committee continued deliberations last week on the Committee's proposals to balance the state fiscal year 2014 and 2015 budget. While the Committee typically begins working off of a proposal submitted by the Governor, Governor LePage has refused to put forth a supplemental budget. The Maine Medical Associationweighed in on several of the budget proposals:

Opposed to a 6-month limit on Suboxone and methadone

Opposed to transfers out of the Fund for a Healthy Maine

In favor of increasing the cigarette tax and equalizing the tax on other tobacco products to that on cigarettes

The Committee voted on several proposals over the weekend, including approving $5 million in transfers out of the Fund for a Healthy Maine in 2014.

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MaineHealth Releases 2013 Health Index Report

On March 6, 2014, MaineHealth released the results of the 2013 Health Index Report. The goal of the Health Index Initiative is to monitor progress on seven high priority health issues that are closely linked with the overall health status of individuals and communities. Actions are underway to address these issues by MaineHealth and many partners in the public and private sectors. The Report highlights some of these actions, presented in the categories of "Community," "Clinical," and "Policy." In addition, the report provides updates on the highest level outcome metric for each priority. While the data indicates progress is being made in many areas, there are still challenges and opportunities for improving the health of Maine's communities.

Hard copies of the Report are available by contacting Karen Stowe at stowek@mainehealth.org. A pdf of the Report is available at www.mainehealthindex.org.

The priorities include the following seven areas:

Increase childhood immunizations
Decrease tobacco use
Decrease obesity
Decrease preventable hospitalizations
Decrease cardiovascular deaths
Decrease cancer deaths
Decrease prescription drug abuse and addiction

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CME Opportunities and Consultations Available on Prescribing for Pain and Appropriate Use of the PMP

MMA has grant funds available through the end of June to assist members and practices with the difficult area of prescribing for acute and chronic pain and including specifically the appropriate use of the state's Prescription Monitoring Program. These resources can include CME presentations or in-office consultations. The funding is available through existing grants from the Offices of Substance Abuse and Adult Mental Health Services and the Maine Board of Licensure in Medicine. Contact MMA Executive Vice President Gordon Smith if you or your practice would like to take advantage of these free resources before the two grants expire. Gordon can be reached at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

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Enrollment in the Health Insurance Marketplace Climbs to 4.2 million, 25,000 in Maine

Enrollment in the Health Insurance Marketplace continued to rise in February to a five-month total of 4.2 million, according to a report released last week by HHS.

As in January, the percent of young adults who selected a Marketplace plan was 3 percentage points higher than it was from October through December (27 percent versus 24 percent). Based on enrollment patterns in other health care programs, it is expected that more people will sign up as we get closer to the March 31st deadline.

“Over 4.2 million Americans have signed up for affordable plans through the Marketplace,” said HHS Secretary Kathleen Sebelius. “Now, during this final month of open enrollment our message to the American people is this: you still have time to get covered, but you’ll want to sign up today – the deadline is March 31st.”

The numbers enrolled in Maine top 25,000, with 25,412 individuals enrolling through February.

The full report is available here. [return to top]

Health Insurance Marketplace Resources for Patients and Staff - Enrollment Closes March 31

Affordable Care Act Resources for Patients and Staff
Do your patients have questions about Maine’s Health Insurance Marketplace and the Affordable Care Act (ACA)?

The 2014 Open Enrollment period ends on March 31, 2014. Patients can visit www.enroll207.com or call 1-800-318-2596 to

Find a Certified Application Counselors to answer questions and help them apply.

Find dates and locations for walk-in sessions where they can get in-person assistance .

Interested in resources for staff or patients and families?

Susan Kring is the new ACA Outreach Coordinator at the Maine Medical Association, and can provide your practice, unit or office with information, resources and training about the health insurance Marketplace and the ACA. Call 662-2364 or email Sue for more information. [return to top]

Improving Chronic Pain Management in Primary Care Practices - Application Deadline Mar. 19

A Request for Applications has been released for participation in the "Maine Chronic Pain Collaborative," a partnership between Maine Quality Counts, the Maine Primary Care Association, the Maine Medical Association, and Penobscot Community Health Care. Like many states, Maine faces enormous challenges with supporting the effective management of chronic pain and the safe prescribing of prescription opioids. In order to expand the adoption of evidence-based best practices, this initiative looks to provide structured quality improvement support for up to ten (10) NCQA-recognized Patient Centered Medical Home (PCMH) practice sites to implement standardized, patient-centered and team-based processes to improve comprehensive chronic pain management. Interested practices must complete an online application by Wednesday, March 19. Additional information is available at the Quality Counts website by clicking here. [return to top]

CMS Suspends RAC Audits; Sets Up Physician Safeguards

Physicians and hospitals will get a short reprieve from Medicare’s recovery audit contractors (RAC), the Centers for Medicare & Medicaid Services (CMS) recently announced. The agency is temporarily halting audits as it reevaluates its contracts and implements improvements for physicians.

The suspension, which is expected to last until sometime in the fall, comes as CMS procures new RAC contracts and transitions down current contracts. The AMA has advocated for changes to the RAC contract guidelines to protect physicians against burdensome audits and erroneous determinations.

As a result of the AMA’s comments on the RAC statement of work, CMS announced program changes that act as much-needed safeguards, including:

RACs must wait 30 days before asking a Medicare administrative contractor (MAC) to adjust a claim payment. The delay will allow physicians to discuss the audit with the RAC. Previously, physicians had to choose between initiating a discussion and filing an appeal.
While auditors previously were not required to let physicians know they had received a request for discussion, RACs now must confirm that they have received such requests within three days.
RACs no longer will receive their contingency fee directly following the recoupment of payments they deemed “improper.” Rather, if a physician chooses to appeal an audit, the RAC must wait until the physician has exhausted the second level of appeal.

“We strongly oppose the RAC program, as we believe that the contingency fee compensation structure incentivizes RAC ‘fishing expeditions’ that are exceedingly burdensome for physicians and often lead to erroneous overpayment determinations,” the AMA stated.

The AMA also urged CMS to restrict reviews to no more than one year after a claim payment was made, penalize RACs for erroneous overpayment determinations and prevent RACs from extrapolating their findings to claims they have not audited.

Although the RAC audits are suspended, automated reviews that do not require additional medical record documentation will continue through June 1. RACs also will complete audits for which they sent requests for additional documentation through Feb. 28. Physicians have 45 days to respond to a documentation request, and RACs have up to 60 days to make a determination on the claim.

The AMA will continue to press CMS to eliminate physicians’ burdens under the RAC program.

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Workers' Compensation Board Addresses ICD-10 Implementation

This item is reprinted from a recent newsletter of the Maine Workers' Compensation Board.

From the Office of Medical/Rehabilitation Services: ICD-10

The Office of Medical/Rehabilitation Services receives several inquiries each week from workers' compensation providers and payors regarding the implementation of ICD-10 effective October 1, 2014.

In accordance with Section 209-A of the Workers' Compensation Act, the medical fee schedule must be consistent with the most current medical coding and billing systems, including the International Statistical Classification of Diseases and Related Health Problems report issued by the World Health Organization (ICD).

Due to the implementation of ICD-10, the Board is planning to complete the annual update required by statute in phases - the first phase will be updating the Board's inpatient facility fee schedule for dates of discharge on or after October 1, 2014 to coincide with the implementation of ICD-10. As reimbursement rates for physician and outpatient facility services are not affected by diagnosis, it is likely that providers will have the option of submitting ICD-9 or ICD-10 diagnosis codes for these services until the remainder of the annual update is complete for dates of service on or after January 1, 2015. [return to top]

Job Openings

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 ~ Fax207.660.9901 ~ Email: Communications@HealthReach.org

Website: www.BinghamCHC.org

3/17/14

Physician - Wound Care, part time

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. We are seeking a Physician to join our Wound Healing Center. This is a part-time, 20 hour per week benefited position.

Mercy's Wound Healing Center provides advanced wound healing techniques, two hyperbaric oxygen therapy chambers and state-of-the-art assessment, testing and treatment for people suffering from acute and chronic wounds. The successful candidate must be an MD, DO or DPM, eligible to be licensed in the State of Maine and board certified or eligible in the physician’s specialty. Broad and in-depth technical knowledge and skills related to the practice of medicine and wound care and relevant training and experience in hyperbaric medicine is desirable.

Mercy offers a competitive salary and benefits package. The beautiful Greater Portland area is a community rich in cultural resources with an active, working waterfront, in a region that abounds in year-round outdoor recreation from the ocean to the mountains. E.O.E.

FMI, and to apply for this position, please visit our website at www.mercyhospital.org or contact Alison Salerno, Provider Recruiter at salernoa@emhs.org , or 207-879-3804.

3/31/14

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

3/31/14

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Upcoming Events

Free On Demand CME: Motivational Interviewing

Basic Skills and Clinical Applications of Motivational Interviewing

This online activity consists of two-30 minute modules on using motivational interviewing techniques to help patients change health behaviors. Specifically, the program addresses four different problems that negatively affect health: non-adherence to treatment guidelines, poor eating habits, lack of exercise, and smoking. The activity also provides scenarios that demonstrate how MI is used in clinical settings.

Faculty: Michael Bierer, MD, MPH

Provided by Lunder Dineen Health Education Alliance of Maine - In Collaboration with Massachusetts General Hospital

Click here for more information or to take the course.

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University of Maine School of Law

3rd Annual Justice for Women Lecture

Dr. Sima Samar, physician and Chair of the Afghanistan Independent Human Rights Commission

Tuesday, March 18, 2014 at 7 p.m.

Abromson Community Education Center, 88 Bedford Street, Portland

Please register online or by calling 207-780-4344.

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Bangor-area ACA Small Business Forum

March 19, 2014

7:00 - 9:15 am

Jeff's Catering, Brewer

Will include general information on ACA issues relevant for small businesses, followed by a summary of the key features and differences between the plans offered by the three Marketplace insurers (Anthem, Maine Community Health Options and Northeast Delta Dental)

Free to attend but please register here.

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athenahealth Webinar: What Health Care Can Learn From Amazon

Wednesday, March 19, 2014, 12:15 p.m.

athenahealth EVP and COO Ed Park will discuss how health care can apply Amazon's pioneering philosophies and cloud technology to activate big data at a national scale, and to embrace collaboration in the face of competition—all to help deliver greater value to patients and caregivers.

Click here to register.

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The Maine Immunization Coalition cordially invites you to:

Preventing Meningococcal Disease

Presented by: Dr. Sydney R. Sewall, MD MPH, Pediatrician Kennebec Pediatrics and Jeri Brooks Greenwell, National Meningitis Association Advisory Committee

Thursday March 20, 2014, 9:00 am

Maine Health, 110 Free St, Portland

Or call in: 1-877-273-4202, conference ID 8187268

RSVP to Caroline Zimmerman at czimmerman@mepca.org 207-621-0677 Ext. 222

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Effective Delivery of Buprenorphine Services In Maine

Thursday, March 20, 2014, Portland

Thursday, March 27, 2014, Bangor

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

$20 Registration fee

Please join the Maine Office of Substance Abuse and Mental Health Services, the New England Addiction Technology Transfer Center (ATTC) and AdCare Educational Institute of Maine, Inc. for a training on the medication, Buprenorphine.

To learn more or register, please click here.

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The Maine Public Health Association (MPHA) Tobacco Webinar Series

Consider the Source: The Intersection Between the Fund for a Healthy Maine and Tobacco Prevention and Control

March 20, 2014, 2:00 pm

Speakers: Friends of the Fund for a Healthy Maine and MPHA

Sex Sells: the Wild, Wild East—Emerging Tobacco Trends

May 15, 2014, 2:00 pm

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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.

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Transforming Health Care: Patients as Partners

March 31, 2014

5:30-7:30 pm

On March 31st, Maine Quality Counts and its partners will present free “Health Care Town Hall Meetings” throughout Maine to discuss how patients and providers can Choose Wisely. John Santa, MD, MPH will be presenting live at Maine General Medical Center’s Alfond Center for Health, Education Pavilion with live stream webcast out to the following locations:

Brewer - EMHS, Cianchette Auditorium
Lewiston - University of Maine campus
Machias - University of Maine campus
Presque Isle - University of Maine campus
Portland - University of Maine, Wishcamper Center
Waterville -Thayer Center for Health, Dean Auditorium

For more information on the event and to register, click here. Or call Judy Ward at 207.620.8526, ext. 106 or email: jward@mainequalitycounts.org

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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.

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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.

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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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Inter Professional Collaborative Practice Summit

May 28th, 2014

University of New England Harold Alfond Forum, Biddeford, Maine

Funded by the Josiah Macy, Jr. Foundation and the Maine AHEC network, the summit will host national experts to address the relationship between health professions education, clinical practice, and national healthcare reform. 4.25 hours CME credit expected.

Click here for more information.

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Maine Concussion Management Initiative Trainings

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

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