May 12, 2014

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Let MMA Do Your HIPAA Annual Staff Training: June 6, 2014

The Maine Medical Association will present its annual HIPAA Seminar on Friday morning, June 6th from 9:00 am to noon as part of the regular First Friday's Educational Series.  The program is available live at the Association offices in Manchester or via webex on line.  This program is ideal for practice staff responsible for privacy issues in the office although newly hired staff are welcome as well.

The program will provide staff training on health care practitioners' and practices' ethical and legal obligations to maintain the confidentiality of patient information, including the HIPAA Privacy Rule and the state confidentiality statute.  It will also highlight changes in the law resulting from the HITECH amendments.

The specific objectives are:

1.  To explore the practical implications to medical practices of the changes to HIPAA included in the final HITECH rules, including the regulations and obligations regarding breach notification.

2.  To discuss the impact of HIPAA and HITECH regulations on mental health providers, care for minors and other specific clinical situations.

3.  To prepare medical practices for potential HIPAA audits and other compliance activities.

Faculty includes MMA attorneys Andrew MacLean and Jessa Barnard and health lawyers Kenneth Lehman, Esq. and Steven Johnson, Esq.  In addition, a practice manager will discuss her experiences in a breach notification case and the lessons to be learned from it.

The registration fee is $70 and CME is provided for physicians and physician assistants.  Registrations materials are included with the most recent issue of Maine Medicine and you may also register on line.

Medical Mutual Insurance Company of Maine, 2014 Annual Meeting

MMA representatives were invited to attend Medical Mutual's Annual Meeting last week.  Here is a brief summary of what we learned.

  • After experiencing decreasing claim counts during the past decade, in 2013 there was an unexpected, further drop in new professional liability claims to 120 claims, the lowest in over two decades. 
  • The company had another very successful year financially allowing for the declaration of its seventh dividend in eight years.  The amount paid in dividends was $5 million.
  • Beginning on Nov. 1, 2013, hospital-employed physicians received, at no additional premium, substantial coverage for legal consultation and defense costs specifically related to cases at the medical licensing boards.This Administrative Defense coverage provides coverage limits of $2,000 each claim/ $10,000 annual aggregate of legal consultation expenses and $25,000 each claim/$25,000 annual aggregate of defense costs.  This new coverage represents an added measure of protection for both employed physicians and hospitals - a benefit that may be first in the market. The same coverage has been available to the non-employed physicians for several years.
  • As of August 1, 2013, every existing, new and renewal Medical Mutual policy will include $100,000 of free cyber liability coverage.  This is particularly important as the security of patient data is a growing, 24/7 issue with significant liabilities tied to it through federal confidentiality laws (HIPAA and HITECH amendments to HIPAA).
  • New Board members elected included former MMA President David McDermott,M.D., Sean Hanley, M.D. Matthew Dugan, D.O. and Lois Skillings, CEO of MidCoast Hospital.

Long-term Board Chair William L. Medd, M.D. chaired the meeting which marked the first for new President Frank W. Lavoie, M.D. who succeeded former President Terrance Sheehan, M.D. who retired earlier this year.

Dr. LaVoie will present a further update at the MMA Annual Meeting in Bar Harbor on September 6th.  Medical Mutual remains the endorsed professional liability carrier of MMA as it has been since its founding in 1978. [return to top]

New Laws Impacting Your Practice: LD 1760, Price Estimates

Each week MMA will be running articles highlighting new laws passed by the 126th Legislature that impact the practice of medicine in Maine.  We are also happy to present an overview of new laws to your medical staff, practice or specialty society and have posted a slide presentation overview of all health care-related legislation enacted by the 126th Legislature on the MMA website. 

In an effort to increase price transparency, and as a result of the work of the Commission To Study Transparency, Costs and Accountability of Health Care System Financing, the legislature enacted LD 1760 this session. The bill includes the following requirements: 

  • At the request of an uninsured patient, all health care providers shall: 
    • Provide within a reasonable time an estimate of the total price of medical services to be rendered directly by that health care entity during a single medical encounter.
    • If the health care entity is unable to provide an accurate estimate of the total price of a specific medical service because the amount of the medical service to be consumed during the medical encounter is unknown in advance, the health care entity shall provide a brief description of the basis for determining the total price of that particular medical service. 
    • If a single medical encounter will involve medical services to be rendered by one or more 3rd-party health care entities (e.g. labs, imaging, anesthesia, pathology), the health care entity shall identify each 3rd-party health care entity to enable the uninsured patient to seek an estimate of the total price of medical services to be rendered directly by each health care entity to that patient. 
    • When providing an estimate as required by this section, a health care entity shall also notify the uninsured patient of any charity care policy adopted by the health care entity.
  • Hospitals or ambulatory surgical centers shall:
    • Upon request by any individual, provide the average charge for any inpatient service or outpatient procedure provided by the licensee.
    • If a single medical encounter will involve services or procedures to be rendered by one or more 3rd-party health care entities the hospital or ambulatory surgical center shall identify each 3rd-party health care entity to enable the individual to seek an estimate of the total price of services or procedures to be rendered directly by each health care entity to that individual.
    • Prominently display a notice informing individuals of an individual's authority to request information on the average charges 
    This law will go into effect on August 1, 2014.  You can find the full text of the law here

    The legislature also enacted changes to the price disclosure law passed last session.  The new bill, LD 1642, will be discussed in the Update next week and MMA will provide a sample price disclosure form.  

    With questions or concerns about this law, please contact MMA Attorneys Gordon Smith, Andrew MacLean or Jessa Barnard via email or at 622-3374.   [return to top]

    MHMC Healthcare Cost Workgroup Reconvenes as Part of SIM Grant

    The Healthcare Cost Workgroup of the Maine Health Management Coalition met in Augusta on April 29 to begin a process the goal of which is to reduce the cost of healthcare in Maine to the national average on a per capita basis. Working with national health care consultant, Dr. Michael Bailit, participants identified three major areas of focus for their work which is part of the State Innovation Model grant.  The areas identified were:

    1.  Price of healthcare services in the state

    2.  Infrastructure

    3.  Consumer Engagement

    In choosing these areas to focus the work on, the participants in this initial meeting reviewed the savings opportunities identified by the prior workgroup in 2012.

    Regarding the price of services in Maine, MHMC analyses of commercial market spending have found significant variation in prices for both inpatient and outpatient services.  And the same analyses have found no correlation between price and quality and have determined that many low-price providers are also providing high quality care- a finding consistent with a 2010 report on hospital prices and quality in Massachusetts. Variations in prices in Maine suggests that lower prices (and high quality) are achievable and that reducing such variation could generate significant savings.The challenge for the Workgroup will be to determine which approaches have actually yielded lower prices and create a framework of incentives and other strategies to motivate providers and purchasers to pursue similar approaches.

    With respect to delivery system infrastructure, the competing demands of capacity and local access have often made it challenging to have a constructive dialogue on "right sizing" of the healthcare delivery system in Maine.  These challenges have been heightened as health systems' attempt to transform care delivery in response to both market pressures and efforts to develop more rational payment structures.

    The workgroup intends to meet every month but the definitive dates for such have not yet been established. [return to top]

    Reports of More Breaches of Physician Data Leading to Identity Theft and IRS Scam

    Since beginning to report on the problem that several physicians were having filing their 2013 tax returns because of a previously unknown breach of their social security number and address, MMA has learned of dozens of more cases in Maine and of hundreds of cases across the country.  Most of the physicians in Maine are from the Portland area although there have also been reports from physicians in Bangor, Lewiston, Brunswick and Farmington.  The MMA would like to understand the full scope of the problem in Maine, so if you have been victimized in this way, please contact Gordon Smith, EVP, at or 622-3374, ext. 212. 

    Because of the large number of cases across the country, it is likely that the breach of data was at a national level.  This is a very sophisticated scam and likely global in its scope.  Similar scams have been perpetrated in previous years but most were aimed at employees of large corporations where it was assumed that human resources files were breached and then returns fraudulently filed in the names of many of the employees. The scam this year aimed at physicians and other health professionals is much broader and while some of the physicians are employed by large groups or hospital owned practices, others affected were in small private practices. Therefore, it is the opinion of MMA's attorneys that likely source of the breach was a large national database with physician names, addresses and social security numbers.  Many such databases exist at national pharmacy chains, national health plans, the federal government itself (CMS, IRS) and professional associations.  Because of its sophistication and likely global implications, it may never be known where one or more breaches may have occurred.  It is also likely that the information that was stolen was then sold to criminal elements who then perpetrated the second crime of filing the false returns.

    Many of the physicians were not aware that elements of their identity had been stolen for the purpose of filing a tax return and seeking a tax refund in the name of physician.  Most did not know anything was amiss until filing a return and receiving information from the IRS that a return had already been filed.  In some cases, refund checks were received before a return had been filed.  An investigation is underway by the IRS, the Secret Service and other agencies but to date there have been no arrests or charges filed. The Secret Service has asked MMA to furnish the investigating office with the names of physicians who have been impacted and we intend to do so this coming week.

    MMA encourages all Maine physicians to be alert to this problem during this tax-filing season.  You’ll find more information about the Internal Revenue Service’s (IRS’) recommendations to address this threat here:  We will be continuing to gather information and making suggestions as the investigations continue.  The consumer protection division of the Maine Attorney General's Office will be weighing in on the matter this week.  That division is responsible for crimes involving identity theft.

    Physicians who are concerned that they have been or may be targeted by this scam are encouraged to visit and place themselves on a 90-day credit fraud alert.  This could potentially slow or halt further attempted identity theft activities. This is recommended as a precaution - at this time we have no reason to believe that every physician is at risk.  We understand that Experian will feed this information and fraud alert to the other two major credit reporting agencies.  If you remain concerned, investigators suggest that you go back to the Experian fraud page after 89 days and initiate a subsequent 90-day credit fraud alert.


    We realize that many physicians affected have already taken some or all of the following steps but for those physicians who may be new to this issue but affected, the following are some recommendations based on our conversations with investigators and theft identity experts.

    1.  Contact the IRS.  If you are impacted, be sure to follow up directly with the IRS in order to verify your identity and avoid penalties for the fraudulent filing.  Call the IRS Identity Protection Specialized Unit at 1-800-908-4490.  You will need to file a paper copy of your tax return, along with  completed IRS Form 14039, Identity Theft Affidavit, which should be faxed to the IRS at 1-855-807-5720.  Ask your accountant if you need an Identity Protection Personal Identification Number (IP PIN) for the paper return.

    You can also contact Special Agent Rodney Giguere who works out of the IRS Criminal Investigation Division in South Portland.  He is seeking to hear from Maine physicians who have been impacted to assist with an investigation into the issue.  His contact information is (207) 253-6479 or

    The U.S. Secret Service recommends accessing some of the information available on the IRS identity protection information page.  Tax-related identity theft information is also available on the Federal Trade Commission website.

    2.  Contact the Social Security Administration.  Call the Social Security Administration's fraud hotline at 800-772-1213 to report fraudulent use of your Social Security number.  

    3.  File a report with local police.  Bring all documentation available, including state and federal complaints you filed.  This will likely be necessary if there is financial account fraud as a result of the identity theft.  However, if the only fraud is tax fraud, the police report would only be necessary if requested by the IRS.  There is some risk that once your social security number has been stolen with perhaps other elements of your identity, that criminals will attempt to open up credit card accounts or other accounts in your name.

    If you have questions or need additional information, please contact Gordon Smith, Esq., MMA's Executive Vice President at or by calling 207-622-3374 ext. 212. 

    [return to top]

    AMA Issues Grace Period Guide to Assist Physicians

    A rule published by Centers for Medicare & Medicaid Services (CMS) provides individuals who purchase subsidized coverage through the health insurance exchanges with a 90-day grace period before their coverage is cancelled for non-payment.  The AMA has released new resources that offer step-by-step help for minimizing risk to physician practices because of this rule. 

    Under the CMS rule, insurers in health exchanges are required to pay any claims incurred during the first 30-days of the grace period, but insurers are not required to pay claims incurred during the last 60-days for any patient whose coverage is terminated. Patients are considered to be covered for care during the entire grace period, but insurers are allowed to place all the claims during the last two-thirds of the period in a pending status and retroactively deny them when coverage is terminated at the end of the grace period. 

    More information and new AMA resources for physicians are available from the AMA here

    View the AMA press release here.  

    The American Academy of Family Physicians has also created a resource with frequently asked questions about the 90 day grace period. [return to top]

    CMS Announces October 1, 2015 as New ICD-10 Implementation Date

    As part of the Medicare hospital inpatient prospective payment system (IPPS) rule released April 30th, CMS has set October 1, 2015 as the official implementation date for the ICD-10 code set.  The proposed IPPS rule will be published in the Federal Register on May 15th and comments are due by June 30th.  The proposed rule also requested comments on how the ICD-10 transition will affect the hospital value-based performance (VBP) payment program.   [return to top]

    Maine - National Drug Take Back Initiative Final Results

    The local representatives of the US Drug Enforcement Agency would like to thank everyone for their participation during the eighth National Drug Take Back Day held on Saturday, April 26, 2014. They completed the incineration process last Monday at Covanta Haverhill Inc. in Haverhill, ME. (Waste to Energy Facility). The statewide collection results have reached yet another new bar:  27,040 pounds. This is the largest amount collected during any collection in Maine to date. 

    The total for all eight collections in Maine to date now stands at 133,660 pounds.  This will likely continue Maine's standing as the #1 ranking state for the largest collection per capita in the US. The US DEA is planning an additional drug take back event in the fall. 

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    Save the Date: MMA's 23rd Annual Practice Education Seminar June 18 in Augusta

    The Augusta Civic Center will once again be the site of the Association's 23rd Annual Practice Education Seminar which is intended to present physicians and practice managers with the information and trends in medical practice in Maine and across the country.  The program will be held on Wednesday, June 18 from 8:15am to 4:00pm.

    The theme of this year's program is "Preparing Your Practice for the Rough Road Ahead."  The focus will be on payment reform and best practices.  Carol Vargo from the American Medical Association will present data from the Rand survey conducted for the AMA which asked physicians questions about their level of satisfaction with their work and also elicited opinion about practice sustainability.  Kevin Flanigan, M.D., Medical Director for MaineCare will present a keynote luncheon talk on the State Innovation Model grant and its role in reforming the payment and delivery system in the state.  Other speakers will be announced shortly and the complete program will be included with the April-May-June issue of Maine Medicine. Registration will also be available on the MMA website at after May 1.

    This year's program is supported by the Payment Reform grant from the Maine Health Access Foundation (MeHAF). [return to top]

    Uncompensated Care Costs Totaled Between $75 and $85 Billion in 2013

    According to a study by Urban Institute researchers published in the May issue of Health Affairs, the cost of providing medical care to the uninsured in the U.S. in 2013 was between $75 and $85 billion.  The study found that more than 60% of this uncompensated care cost was offset by government payments, including the disproportionate share (DSH) hospital program.  Private insurance payments also offset another $10.5 billion.  Because the "targeting of programs that fund uncompensated care is not perfectly aligned," noted the study, "some providers likely incur costs caring for the uninsured for which they receive little or no compensation."  Furthermore, the ACA decreases DSH funding over time because it was enacted envisioning all states pursuing Medicaid expansion to offset the loss of DSH dollars.   [return to top]

    Job Openings

    BC/BE Family Practice Physician

    Lovejoy Health Center (Albion, ME) seeks a BC/BE family practice physician to provide primary care including obstetrics (optional) to patients of all ages. As a NCQA-Patient-Centered Medical Home, we offer accessible, high quality healthcare with integrated behavioral health services focused on the patient’s care experience. Founded in 1978, we serve over 4,000 residents and visitors each year. We reside in the peaceful, picturesque, and welcoming central Maine region near four-season recreational opportunities and the Maine coast. We offer competitive compensation, incentive plan and malpractice coverage. Position is eligible for loan repayment. EOE. Contact: Recruiter, HRCHC, 10 Water Street, Suite 305, Waterville, ME  04901 ~ 207.660.9913 ~ Fax 207.660.9901 ~ ~


    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 psychiatrists to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

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

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

    Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to  Please reference search number PS0314D.

    Dartmouth College/Dartmouth Hitchcock Clinic/Geisel School of Medicine is an equal opportunity/ affirmative action employer with a strong commitment to diversity. In that spirit, we are particularly interested in receiving applications from a broad spectrum of people, including women, persons of color, persons with disabilities, veterans or any other legally protected group.


    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

    To apply, go to


    [return to top]

    Upcoming Events

    Free Colorectal Cancer Webinars

    Maine CDC Colorectal Cancer Control Program offers three educational webinars with opportunity for FREE CMEs!

    Office Strategies for Increasing Colorectal Cancer Screening Rates in the Primary Care Practice
    Evidence-Based Guidelines to Improve Colon Cancer Screening Quantity and Quality in Maine
    There is No One "Best" CRC Screening Test: The Proof and the Benefits of Getting FIT

     Viewing each webinar and completing the pre- and post-tests will grant the participant one free CME. Click here to get started.


    The Affordable Care Act: What’s in it for my Nonprofit?

    Tuesday, May 13, 2014

    8:15am - 10:15am

    Senator Inn, Augusta, ME

    The Maine Association of Nonprofits, in partnership with the Maine Health Access Foundation, is holding a free Affordable Care Act (ACA) forum where nonprofits can get the answers they need to make good decisions about Obamacare. 

    For more information or to register, click here.  Must register by May 9th. 


    Maine Harm Reduction Conference

    Wednesday, May 14, 2014

    9 am - 4:30 pm 

    Kaplan University, Augusta, ME

    Keynote Speaker, Jon Zibbell, Medical Anthropologist with the U.S. Centers for Disease Control will explore the intersection of culture, stigma, drug use behaviors and infectious diseases such as HI and hepatitis C. Jon's anthropologcial fieldwork immersed him in the subculture and lives of persons who inject drugs.

    For more information, visit:


    Promoting Workplace Safety: Addressing the Use of Medical Marijuana, Drugs and Alcohol

    Presented by the New England College of Occupational and Environmental Medicine

    Thursday, May 15, 2014

    5:30 pm - 8 pm 

    Cumberland Club, Portland

    Click here for more information or to register. 


    The Maine Public Health Association (MPHA) Tobacco Webinar Series  

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

    May 15, 2014, 2:00 pm 

    Register here:

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

    June 3, 2014, 2:00 pm 

    Register here:

    For more information, visit:


    Maine Medical Directors Association Spring Conference 

    Friday, May 16th, 2014

    DiMillo’s Floating Restaurant, Portland, ME 

    11 am -3:30 pm

    Topics Include Fall Prevention and Providing Excellent Care While Reducing Costs at Skilled Nursing Facilities 

    To learn more or register, click here.


    Inter Professional Collaborative Practice Summit 

    May 28, 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.


    Maine Cancer Consortium Community Meetings 

    Thursday, May 29, 10 am - 12 noon, Portland

    Thursday, June 5, 12 noon - 2 pm, Brewer

    To share information and get your thoughts and suggestions about the the next version of the Maine Comprehensive Cancer Control Plan and to prioritize how to best address cancer issues in Maine. Refreshments will be served.

    Please click here for more information or to register.


    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,, (207) 577-2018


    Maine Association of Physician Assistants Summer CME Conference

    June 20 & 21, 2014 

    Portland Marriott at Sable Oaks, So Portland, ME 

    Friday June 20 - ED Primer and Potpourri for the PCP 

    Saturday June 21 - Commercial Driver Medical Examiner Workshop - open to all medical professionals

    For more information and to register, visit



    The Maine Public Health Association’s (MPHA) 30th annual 2014 Fall Conference

    October 7, 2014

    Augusta Civic Center

    MPHA Call for Abstracts for breakout sessions: Abstracts from all areas of public health are welcome.  We encourage abstracts focusing on the theme of building on 30 years of public health progress. All abstracts must be submitted via e-mail no later than Wednesday, May 21 at 5:00 p.m. to

     The Call for Abstract form is available at:

    [return to top]

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