July 28, 2014

Subscribe to Maine Medicine eNewsletters
Manage Your Subscriptions
Email our Editor...
Maine Medical Association Home Page
. Search back issues
. Plain Text Version
Printer Friendly

Medical Mutual Insurance Company Announces Rate Decrease

In a letter to insureds dated July 25th, Medical Mutual Insurance Company of Maine announced that premium rates for all new and renewal business in Maine will drop an average of 3.2%, effective September 1, 2014.  This marks the fourth rate reduction for physicians and surgeons in Maine since 2008 resulting in a nearly 20% reduction off the 2005 rates. 

The July 25th letter, signed by new President and CEO Frank W. Lavoie, M.D., MBA, announced that the Company had received approval from the Maine Bureau of Insurance to reduce physicians' and surgeons' base rates and modify the relativity factors for all new and renewal business effective September 1, 2014.  Because of some changes in class relativities, although the vast majority of physicians will see a premium rate reduction, a few specialties will see a rate increase.  This occurs as a result of those few specialties having a less favorable loss experience over the last several years than has been expected.  

This rate reduction comes on the heels of the announcement earlier this year that the company was declaring the largest dividend - more than $5 million - in the Company's history.

In additional comments, Dr. Lavoie attributes the declines in the number of claims from 2005 to 2013 to the collective record of quality care provided by the insureds.  He notes, "The fact is, you, the physicians and surgeons we insure, have effectively driven rates down by providing high quality care and emphasizing patient safety within your practices."

Dr. Lavoie will provide further remarks about the announcement during his remarks to be delivered at the MMA Annual Meeting on Saturday, September 6th, in Bar Harbor.

Medical Mutual is the endorsed carrier of medical liability insurance for the members of the Maine Medical Association.





Health Insurers Return $332 M to Consumers Under the ACA's Medical Loss Ratio (MLR) Provision

DHHS reported on July 24th that the nation's health insurers who didn't meet the ACA's medical loss ratio provisions in 2013 must refund $332 million to 6.8 million consumers by August 1st.  This is an average of $80 per family.  The ACA MLR provisions require carriers in the individual and small group markets to spend $0.80 of every dollar on medical care or health care quality improvement while carriers in the large group market must spend $0.85.  The Department reported that since 2011 the refund total is more than $1.9 billion.  More carriers are meeting the MLR requirements, so the refunds are decreasing.  The refund amounts were $504 million in 2012 and $1.1 billion in 2011.  In addition to these refunds, the Department said that consumers saved $3.8 billion in premiums in 2013 because carriers improved their efficiency and charged lower premiums. [return to top]

10.3 M Got Coverage During the ACA's First Open Enrollment HHS Says

In a study published in the New England Journal of Medicine, DHHS said on July 23rd that 10.3 million uninsured adults obtained health insurance coverage during the ACA's first open enrollment period.  The study found that the uninsured rate for adults 18-64 decreased from 21% in September 2013 to 16.3% in April 2014.  The decrease in the uninsured rate was significant across all age, race/ethnicity, and gender groups, but the greatest changes took place among Latinos, African-Americans, and adults 18-34 who were a focus of ACA outreach efforts.  The study found a 5.1% decrease in the uninsured rate associated with the Medicaid expansion and found no statistically significant decrease in the uninsured rate among low-income adults in states that have not expanded their Medicaid programs. [return to top]

Health Insurance Marketplace Update: Recent Court Decisions Have No Immediate Impact on Subsidy Payments

Last Tuesday, the US Court of Appeals for the DC Circuit ruled that the federal government cannot administer health insurance subsidies in states like Maine that use the federally facilitated Marketplace.  Also on Tuesday, the Fourth Circuit of Appeals in Richmond, VA upheld the subsidies.  Click here for more information from Kaiser Health News.

According to Consumers for Affordable Healthcare, there is no immediate impact on Mainers’ ability to use subsidies – also known as premium tax credits -  to lower the cost of their health insurance plans purchased through the Marketplace. Subsidies will also continue to be available during the next open enrollment period, which starts on November 15, 2014.  

Questions? Contact MMA ACA Outreach Coordinator Sue Kring at 662-2364 or skring@mainemed.com. [return to top]

MMA Leadership "Listening Session" Scheduled for July 31st in Bangor

Members of the MMA's Board of Directors and senior staff invite physicians in Penobscot, Piscataquis, and Hancock counties for a "listening session" at a restaurant to be announced in Bangor from 5:30 - 7:30 p.m. on Thursday, July 31st.  Drinks and hors d'oeuvres will be on MMA.  The MMA leadership very much would like the opportunity to mingle with physicians in the Bangor area in an informal, social setting and to hear what's on your mind.  This is a great opportunity for you to speak up about how MMA can better serve you.

For more information, please contact MMA EVP Gordon Smith at gsmith@mainemed.com or at 622-3374, ext. 214.  [return to top]

Ethical Issues in Contemporary Medicine is next First Friday Program on August 1

The final presenters have been named for the upcoming First Friday presentation entitled, "Ethical Issues in Contemporary Medicine" on August 1, 2014 from 9:00 am to noon.  The program is available live at the Association offices in Manchester or via webex.  The $70 registration fee is the same regardless of location. Two and one half hours of category one CME are available.

Presenters include ethicist Frank Chessa, Ph.D. from the Maine Medical Center, Stephen Johnson, Esq., of the law firm of Kozak & Gayer, P.A., and Melanie Cutler, J.D., M.D., a practicing psychiatrist who is a member of the clinical ethics committee at the Maine Medical Center.  Before receiving her medical training, Dr. Cutler was a practicing attorney in Washington, D. C.  Rounding out the panel will be MMA attorneys Gordon Smith and Andrew MacLean.

Topics being addressed during the program include ethical implications of quality metrics; definitions of medical futility in the context of end of life care, POLST as an additional tool in health care decision making; and the Maine version of the Uniform Health Care Decisions Act.  Dr. Cutler will discuss the operation of clinical ethics committees in an era of declining resources.  AMA officials will discuss the recent rewrite of the Code of Medical Ethics and its annotations.  

Registration is available on the MMA website at www.mainemed.com or by calling 622-3374.

[return to top]

Harborside Hotel Room Block Closes August 5th for MMA's 161st Annual Session

The MMA's 161st Annual Session will take place at the beautiful Harborside Hotel & Marina in Bar Harbor, Maine from September 5-7, 2014.  Our room block at the hotel will close August 5th and we have been advised that there will be no extensions.  You can find information about the meeting, including registration information, the agenda, and hotel reservation information on the MMA web site here.  The code for the MMA room block is "MMA2014."  We encourage you to take a look at the meeting materials because we have made some changes this year in hopes of providing a better experience for physicians and their families.  The changes include:

  • A shorter time commitment.  The meeting will begin with an opening reception on Friday, September 5th and will close mid-morning on Sunday, September 7th;
  • Child care will be available throughout the meeting;
  • The business part of the meeting, the General Membership meeting, has been shortened from a half a day on Saturday to two hours;
  • Free time.  You will have some opportunities to network with your colleagues from other parts of the state and/or to enjoy Mount Desert Island with your family - MMA will make some group dinner reservations at local restaurants for Friday evening and Saturday afternoon is free time;
  • More relaxed.  Rather than the formal Saturday evening banquet, we will have a casual lobster bake at the Bar Harbor Club on Saturday evening;
  • Relevant CME.  The CME agenda for the meeting includes presentations through MMA's Academic Detailing program, by a national expert on health care economics and payment systems, and by professionals focused on physician health and wellness; and
  • Exercise.  You will have a chance to walk or run in the 34th Edmund Hardy, M.D. Road Race on Sunday morning!
[return to top]

Protect Against Inaccurate Reporting Under the Sunshine Act

Financial interactions between physicians and manufacturers of drugs and medical devices—including everything from research and ownership interests to reprinted journal articles and meals—soon will be made public under the Physician Payments Sunshine Act (also known as the Open Payments Program).  Doctors need to act quickly to make sure they're protected from inaccurate reporting.

The AMA successfully convinced the Centers for Medicare & Medicaid Services (CMS) that physicians should be able to review and dispute the financial data drug companies have reported about them prior to publication, but the agency has left very little time for physicians to do so.

The MMA would like members to know they have a way to protect themselves and understand the steps to take.

Time is of the essence.  There are three steps physicians must take in order to review and dispute the data reported about them:

  • Step 1: Complete CMS' e-verification process, which opened June 1st and must be finished before physicians can take the next step.
  • Step 2: Register with CMS' Open Payments system, which should be available in a matter of days.
  • Step 3: Review and dispute their data within 45 days.

Disputes that are filed before a yet-to-be-announced August cut-off date will be flagged as such in the initial public release September 30th.  Physicians will have until December 31st to retrospectively file disputes about their data.

Physicians can access the practical information they need to navigate the Sunshine Act data release in a free online toolkit from the AMA. 

Download a package of ready-made communications materials, including sample articles, an infographic and social media postings.  Additional materials will be added as steps 2 and 3 become available.

Possible changes to the continuing medical education (CME) exemption: In the proposed Medicare Physician Fee Schedule for 2015, CMS has proposed revoking the Sunshine Act exemption of financial transfers made to organizations that offer independent CME accredited by the Accreditation Council for Continuing Medical Education or when credit is granted by the AMA, American Academy of Family Physicians, American Osteopathic Association or American Dental Association. 

The agency instead is proposing to exempt third-party financial transfers for CME only when an industry donor is unaware of the recipients or beneficiaries before and after the funds are transferred.  This raises concerns because the industry potentially could learn the identities of speakers and participants through brochures, programs and other publications related to a CME event after the funds have been transferred. 

The AMA is concerned that the proposal will have a chilling impact on accredited CME.  The proposed fee schedule rule also includes two other options that address CMS' concerns about the current structure of the CME exemption.  The AMA is evaluating these options and will be in communication with the Federation as it prepares comments.

   [return to top]

Prepare Your Practice for Compliance with New Laws, Effective August 1, 2014

Under the Maine Constitution, most bills enacted by the Legislature and signed into law by the Governor take effect 90 days after adjournment of the Legislature.  This year, adjournment was in late May and the effective date of legislation is August 1st.  Not all the new laws are effective on this date as emergency legislation takes effect immediately upon the Governor's signature and some bills include a different and specific effective date.  

Among the laws taking effect next week which are of most significance to physician practices are the following:

  • L.D. 1642 and L.D. 1760 advancing health care pricing transparency; and
  • L.D. 388 and 1840 streamlining enrollment for the Prescription Monitoring Program.

Information on all the newly enacted laws can be found on the legislative and regulatory section of the MMA web site.



[return to top]

CMS Announces Award of Medicare Quality Improvement Network to Healthcentric Advisors

On Friday, July 18th, CMS announced that it had awarded the new five-year contract (11th scope of work) for Medicare quality review beginning August 1, 2014 to HealthCentric Advisors of Rhode Island.  The contract was awarded for all six New England states, thus removing Maine, New Hampshire, and Vermont from the previous contractor, Northeast Healthcare Quality Foundation, the current QIO which has held the Medicare contract for several years.

Healthcentric Advisors, formerly known as Quality Partners of Rhode Island, was previously the Medicare QIO for the state of Rhode Island.  The organization is a nationally recognized healthcare quality improvement and patient safety advisory organization providing its clients with effective education, consulting, research, analytical, and project management services.

The Rhode Island organization is the same organization that partnered with Maine Quality Counts to put together a proposal to provide QIO services in Maine.  While that effort was ultimately unsuccessful, MMA is encouraged with this awarding of the contract to the Rhode Island group given that it has committed in its application to have more of a local presence than the previous contractor and to collaborate with local QI initiatives, such as the projects currently led by Quality Counts.

The award of the contract is subject to appeal and it is possible that the Northeast Healthcare Quality Foundation will contest the award.

The grouping of the six New England states is consistent with the announced intention of CMS to have fewer contractors doing the quality review work across the country.

[return to top]

Upcoming Events

5th Annual Patient Safety Academy

Friday, September 5, 2014

 9 am – 4 pm

University of Southern Maine, Portland campus, Abromson Center

Cost: $50, with a discounted rate of $25 for students

Registration is now open. To register, click here or visit the Patient Safety Academy webpage atusm.maine.edu/muskie/psa



Direct Primary Care (DPC) Workshop

with Dr. Brian Forest, Founder, Access Healthcare Direct & AAFP DPC Workgroup Leader

& Maine physicians developing an integrated Maine Direct Care Network for existing practices

 Calling Doctors & Consumers: Come explore the options.

September 26, 1-5pm and September 27, 8:30-12:30pm,  2014

Maine Medical Association, Manchester

For further information email MaineDPCProject@yahoo.com.


The Maine Public Health Association’s (MPHA) 

30th Annual Fall Conference

October 7, 2014

Augusta Civic Center

Keynote speakers include: Erik N. Steele, D.O., FAAFP, Senior Vice President, Chief Medical Officer, Summa Health System and Paul Kuehnert, DNP, RN Team Director for the Bridging Health and Health Care Portfolio, Robert Wood Johnson Foundation

For more information or to register, click here.


Maine Concussion Management Initiative Training

October 21, 2014 in Portland in conjunction with the Maine Brain Injury Conference

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

  [return to top]

Job Openings


A progressive 25-bed critical access hospital in central Maine is seeking a FP to join their employed primary care group.  This is a full time opportunity which consists of 32 patient contact hours per week, allowing time to enjoy what this region of Maine has to offer! 

Sebasticook Valley Health (SVH) in Pittsfield, Maine is an integral member of the communities it serves. SVH takes a proactive approach in helping people in the Sebasticook Valley improve the quality of their lives.  SVH serves an area of approximately 30,000 people and has a wide range of outpatient services, including over 20 specialty services.  SVH is a proud member of the Eastern Maine Healthcare Systems which ensures access to high quality care to Maine residents and visitors.

For Further Information, please contact:

Sherry Tardy, Director Business Development/Provider Recruitment
Sebasticook Valley Hospital
447 North Main Street
Pittsfield, ME  04967

By email at: stardy@emh.org or by phone at: 207-487-4085


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 psychiatry.jobs@dartmouth.edu.  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.


   [return to top]

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