November 24, 2014

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Get Covered and Stay Covered with an Affordable Health Plan for 2015

 Open Enrollment in the ACA Marketplace began on November 15th and ends on February 15, 2015.  According to navigators and certified application assistors in the state, the website is working far better than last year although not perfectly.  The impact of the pending U.S. Supreme Court decision that could impact the availability of the subsidies would not impact subsidies provided in 2015.  In 2014, more than 90% of the enrollees were entitled to subsidies.

The ACA's Health Insurance Marketplace open enrollment began on November 15th and ends on February 15, 2015.  Your patients may be able to get help paying for insurance premiums and out-of-pocket costs for Marketplace health insurance.  More information, online applications and renewals are available at

  • Patients who already have a 2014 Marketplace plan shouldn't forget to update their account during open enrollment to make sure they are getting the right plan at the right price for 2015. Here are 5 Steps to Staying Covered Through the Marketplace.
  • Consumers can get more information and enrollment help by calling the Marketplace Call Center at 1-800-318-2596 and online at  Free, in-person enrollment help is available in Maine. You can find a local assister at

  • Free brochures and materials from enroll207 to help patients get covered and use their new insurance plan are available for order here.

More information and links to Marketplace resources are available at the Maine Medical Association website.  For more information, resources for your patients, or training for your practice, contact ACA Outreach Coordinator Sue Kring at or 662-2364.



Update on Maine Health Management Coalition's Pathways to Excellence

MMA staff attended last week's meeting of the Pathways to Excellence Physicians Steering Committee which meets every other month at the MMA offices in Manchester.  In addition to reviewing what the group had accomplished in 2014, the discussion focused on plans for 2015 and a report on the governance structure of the PTE Physicians Steering Committee and on the Accountable Care Implementation Measure Alignment Subgroup Measures.  It was a substantive and lively meeting.  The meeting was chaired and directed by Lorrie Marquis, Director of PTE for the Coalition.

Major accomplishments for 2014 included patient experience reporting for primary care practices.  Practices first publicly reported with word ratings in July of 2014, with minimum rating being a "Good" for participating in this effort.  Ratings will transition to "Low," "Good," "Better," and "Best" in July of 2015.  A second major accomplishment was the development of the Total Cost of Care Index and Resource Use Index Measures.  These measures have been endorsed for publication for primary care practices beginning in April, 2015.

Additional accomplishments included the PTE "Effective" Outcomes/Clinical Recognitions on the website, including an overall "Effective" score for new website design in April, 2015.

Other initiatives discussed in 2014 but deferred included the establishment of "Advanced Primary Care" and Claims Based Quality, deferred due to concerns with being able to accurately capture preventative measures (particularly colon cancer).

Looking ahead to 2015, the Committee intends to advance specialty reporting with a goal of reporting some measures by the end of calendar year 2015, begin voluntary reporting of behavioral health metrics and better define the governance structure of the PTE Steering Committee.  Among the questions to be answered are, should the physician and system PTE groups be combined?  How should "system" be defined?  And, Who has voting rights?


The new website design for April, 2015 will drop the heart failure and pneumonia measures and add:

1.  Care Transtion Measure (CTM) data that will be reported as an additional HCAHPS domain, downloaded from the CMS Hospital Compare website. 

2.  Rolled-up Surgical Care Improvement Project (SCIP) measures because the Appropriate Care Measure (ACM) data are no longer available from CMS.  The MHMC is aware of the CMS changes in SCIP data collection effective January 1, 2015.

3.  Stroke measures will also be "rolled up" by the Coalition and then compared to national, state, and top 10 percent benchmarks.

4.  Venous Thromboembolism (VTE) measures to be "rolled up" by the Coalition and then compared to national, state and top 10% benchmarks.

5.  Total Cost of Care (TCC) and Resource Use Index (RUI) at group and practice level (to be sent to practitioners next month)  and publicly reported in April).  The Committee voted not to go forward with beginning work on a Price Index, but later in the day the System Committee voted to go forward with the work.  The Coalition Board will make the final decision on this question.

The next meeting of the PTE Physicians Steering Committee will be February 26, 2015 from 8:30 - 11:30 AM.  


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Could New CBO Estimate Encourage Action on SGR Repeal During Lame Duck Session?

The AMA, along with state medical societies and national specialty organizations, is pressing Congress for a "permanent fix" to the Medicare SGR payment problem during the lame duck session taking place now.  The most recent patch expires on March 31, 2015.  The next scheduled cut would be 21%.  AMA President Robert Wah, M.D. said in a blog post on November 10th that the lame duck session "is a perfect opportunity to end the broken cycle of temporary patches" to the SGR problem.  "If Congress does not seize the moment to act now during the lame duck session all of the hard bipartisan, bicameral work that went into building that framework will be for naught, and the process of negotiating a solution will start all over again," said Wah.  The good news is that SGR repeal has gained some recent traction, showing that there is interest in Congress working together on this issue.  For example, the Republican Doctors Caucus on November 3rd sent a letter to Republican leaders urging them to pass the SGR Repeal and Medicare Provider Payment Modernization Act.  Also, more than 110 lawmakers signed on to a separate letter led by Reps. Kurt Schrader, D-OR, and Reid Ribble, R-WI, asking them to move forward with an SGR repeal.  You can find more information about the SGR issue, including the specific impact on Maine, here.

The Congressional Budget Office has released an updated estimate of the cost to repeal the SGR that is now $5 billion lower than previously assessed.  The CBO estimates the cost now would be just under $119 billion, far less than the cost numbers floated in previous years.

Regardless of the cost, a growing number of members of Congress have expressed willingness to consider repeal without a full pay-for.  "It's really a bogus number to begin with," said Philip Roe, MD, (R-Tenn), co-chair of the Doctors Caucus.  "So the answer is yes, I'll vote for it with no offsets."   Two other Republicans, Rep. Joe Heck, MD (R-Nev) and Rep. Charles Boustany, Jr. (R-La) also expressed similar sentiments. 

MMA staff will be speaking with staffers for the Maine Congressional delegation this coming week to encourage action on the SGR repeal during the current lame duck session.


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CME Presentations on Prescribing for Pain and the PMP Now Available for 2015 through MMA

MMA has been notified by the state Office of Substance Abuse and Adult Mental Health Services that a $15,000 grant from federal funds has been approved for the purpose of educating Maine prescribers on the current clinical standards and regulatory requirements associated with prescribing for chronic pain and the appropriate use of the Prescription Monitoring Program.  The grant will fund at least ten programs over the next 16 months, beginning on December 1, 2014.  If your practice, medical staff, or specialty society would like to host such a session, please contact Gail Begin at MMA at  Because of the grant, there is no cost to host a session for the site or the attendees.

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MaineCare Seeks Provider Advisory Committee Members

MaineCare has restructured and empowered its Provider Advisory Committee.  This is a group of providers who meet quarterly with the MaineCare Medical Director, Kevin Flanigan, M.D., M.B.A. to review MaineCare changes/proposed changes and provide insight into the impact at the patient level.  This group also brings forward suggestions for future changes/improvements for MaineCare to consider.  The meetings are for two hours here in Augusta and can be attended by phone when necessary.  The commitment is for a three year term with the potential for a two additional three year terms. 

Presently there will be two members completing their terms this December.  The specific seats they occupy will need to be filled and the Program is hoping to maintain the same demographic make-up with their replacements.  The seats that need to be filled are assigned to a Surgeon and a Family Practice/General Practice physician.  In this case, both are male but their replacements do not need to be.  One is from a rural area and the other is from a central urban area and the Program would like to maintain those characteristics. 

Finally, members of this committee must be actively seeing MaineCare members and their practice must be open to accepting new members from MaineCare.

If you are interested in joining this Committee, please contact Gordon Smith, EVP at or 622-3374, ext. 212.

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MMA's October 2014 Member Survey Results

The MMA aims to survey the membership quarterly using the SurveyMonkey tool to determine physicians' opinions on a variety of current topics in medicine, law, policy, and politics.  The following are the three questions asked in October and the results.

 Question 1:  Do you think the Maine Legislature should enact legislation requiring pseudoephedrine to be sold by prescription?  (182 individuals responded; 3 did not)

 Answer:  Yes (57 or 31.32%); No (125 or 68.68%)


Question 2:  Do you think the Maine Workers' Compensation Board should impose limits on opiate-based medication similar to those adopted by MaineCare?  (180 individuals responded; 5 did not)

 Answer:  Yes (103 or 57.22%); No (77 or 42.78%)


Question 3:  Do you support having a separate licensing board for Physician Assistants, who are now licensed through either the Board of Licensure in Medicine or the Board of Osteopathic Licensure, or both, depending on the supervising physician?  (177 individuals responded; 8 did not)

Answer:  Yes (63 or 35.59%); No (114 or 64.41%)

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Value-Based Care Workshop for Clinicians, Dec. 17, Hilton Garden Inn, Freeport

With funding provided by the Maine Health Access Foundation (MeHAF), the MMA is pleased to present this workshop on value-based care at the Hilton Garden Inn in Freeport.

5:30 Reception

6:00 Dinner

6:30 Workshop

8:30 Adjournment


Clinicians are being held more and more accountable for performance. While most agree there is room for improvement, the best manner for clinicians to assume responsibility is yet to be determined. This interactive workshop will cover best practices for combining leadership directives and clinical insights to create homegrown value improvement initiatives that lead to better care at lower costs.  

A one-page overview of the workshop is available for downloading here.


Neel Shah, MD, MPP, is the Executive Director of Costs of Care, an Assistant Professor at Harvard Medical School, and a practicing obstetrician/gynecologist at Beth Israel Deaconess Medical Center. He has been named one of the “40 smartest people in healthcare” by Becker’s Hospital Review for his efforts to support clinicians in delivering value-based care, and senior author of the textbook Understanding Value-Based Care (McGraw-Hill).

September Wallingford, RN, is Director of Nursing Initiatives at Costs of Care and a practicing registered nurse at Brigham & Women’s Hospital.


Register by Dec. 12 please by emailing There is no fee to attend thanks to an educational grant from the Maine Health Access Foundation to engage physicians in payment reform. An application for 2 hours category 1 AMA CME credit is pending.



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MMAs December 5th First Fridays Program: Annual Compliance Seminar

MMA Annual Compliance Seminar

AGENDA (Registration Form) 8:30 AM Registration

9:00 Introductions and HIPAA Update, Gordon Smith, Esq.

9:30 OSHA, including Bloodborne Pathogen Rule, Stacy Doten, RN

10:00 Employment Law Update, Michael Burian, Esq.

10:30 Break

10:45 Fraud and Abuse Update, Andrew MacLean, Esq.

11:30 Q & A

12:00 Adjourn


1.    To inform attendees of the new laws and regulations impacting on the operation of a medical practice.

2.    To specifically deal with laws and regulations regarding OSHA, Employment, Fraud and Abuse (ACA enhanced) and HIPAA.

3.    To demonstrate how risk of non-compliance can be reduced.


Michael Burian, Esq. joined Kozak & Gayer as an associate in 2010, and he maintains a general health care law practice assisting various types of health care entities. While in law school, Mike was an editor of the Maine Law Review and practiced as a student attorney for the Cumberland Legal Aid Clinic and the Maine Disability Rights Center. He also completed internships at the Maine Office of the Attorney General and the U.S. Attorney’s Office in Portland. Prior to law school, Mike was an AmeriCorps VISTA working for Wyoming Legal Services in Lander, Wyoming.

Stacey P. Doten, RN, CPHQ, HACP is a Senior Risk Manager with Medical Mutual Insurance Company of Maine. She has Associate Degrees in both Laboratory Science from the University of Maine at Augusta and Nursing from Northern Maine Community College. She has more than 20 years of healthcare experience, including healthcare quality and risk management. She is a Certified Professional in Healthcare Quality (CPHQ) and a Certified Professional in Healthcare Accreditation (HACP). She is a member of the Northern New England Society for Healthcare Risk Management (NNESHRM), National Association of Healthcare Quality (NAHQ), and the Maine Medical Group Management Association (MEMGMA).

Gordon H. Smith, Esq. is the Executive Vice President of the Maine Medical Association and has served Maine’s physicians since 1979. He is a native of Winthrop, Maine and a graduate of the University of Maine and Boston College Law School.

Andrew B. MacLean, Esq. is the Deputy Executive Vice President & General Counsel of the Maine Medical Association.  He provides health law and general legal advice to the Association. Mr. MacLean is an experienced health care attorney and lobbyist. He served six years as Mayor of the City of Gardiner and four years on active duty as a U.S. Marine Corps officer.  He is a graduate of Duke University and the University of Maine School of Law.  Disclosure: No significant or relevant financial disclosures.

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10 Medicare Payment Policy Revisions You Need to Know

Chances are you haven't been able to read through the nearly 1,200 pages that constitute the 2015 Medicare Physician Fee Schedule final rule released Oct. 31 and published recently in the Federal Register.  The AMA has pulled out the 10 top payment policy changes discussed in this mammoth document that you need to know about.

Among the policy changes discussed in the top 10 list are:

  • The sustainable growth rate formula calls for a 21.2 percent cut to physician payments, effective April 1.
  • Continuing medical education will not be reported under the Physician Payments Sunshine Act.
  • Proposed penalties under the value-based payment modifier will be scaled back.
  • The timeline for submitting new codes and revaluations of services will shift.

Read the full list and get additional details about each policy change at AMA Wire®.

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Physicians Outline 6 Key Provisions for Network Adequacy

The AMA, the Children's Hospital Association, and more than 100 other organizations urged the National Association of Insurance Commissioners (NAIC) in a letter sent Monday to adopt model legislation that would give patients access to the care and physicians they need. 

The letter includes six key provisions that would serve as a template for many state policymakers considering revision of their network adequacy standards. It was sent to Kansas Insurance Commissioner Sandy Praeger and Wisconsin Commissioner Ted Nickel, who chair key committees at the NAIC.

"By adopting provisions consistent with the principles outlined in this letter, we believe lawmakers and regulators can adapt the model act to establish reasonable, meaningful standards, while still allowing for market flexibility and choice," the letter said.

The letter aligns with policy adopted at the 2014 AMA Interim Meeting, which calls for health insurers to make any changes to their provider networks before the open enrollment period gets underway each year. Implementing changes to provider networks at this time will help prevent patients from being stuck with plans that drop their physicians after they already have enrolled.

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Updated AMA Resource Helps Practices Manage Overpayment Recovery Process

Attempting to determine the validity of alleged overpayment recovery requests from health plans can divert significant time from direct patient care, which results in lost practice revenue. Overpayment recovery requests often are made in very general terms and can be intimidating to practices. 

The AMA has updated its overpayment recovery toolkit to help practices recognize and interpret overpayment recovery requests, address and resolve these requests, automate the process, and know their overpayment recovery rights. The toolkit also includes a new webinar that provides an introduction to this challenging topic.

Visit the overpayment Web page to access this newly updated resource and learn more about automating and improving the overpayment recovery process.
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Job Openings

Family Nurse Practitioner

Sacopee Valley Health Center is recruiting a Family Nurse Practitioner to provide walk-in care on Fridays, Saturdays and Sundays.  This 30 hour per week position involves no after-hours call with an excellent benefit package including health, disability and life insurance, 401k retirement plan, and a generous paid time off plan. Applicants must be a graduate of a Family Nurse Practitioner Program with current Maine licensure. Please submit resume to or mail to:  Human Resources Coordinator, Sacopee Valley Health Center, 70 Main Street, Porter, Maine 04068. Sacopee Valley Health Center is an Equal Opportunity Provider and Employer.


Seeking Physicians (Non Behavioral Health) to Participate in Ongoing Committees with MCHO

Maine Community Health Options (MCHO) is seeking physicians (Non Behavioral Health) to participate in ongoing committees with MCHO. 

Available committee roles are:

  1. Credentialing Committee
    • One specialty
    • One primary care physician (MD/DO)
Credentialing files are sent electronically for review prior to the meeting and participation can be in person or remotely. Meets once a month and the stipend is $250 for each meeting.
  1. Medical Management Committee
  • Two specialty physicians (MD/DO)
Agenda items are sent electronically for review.  Meets quarterly and can be attended remotely or in person.  Stipend is $250 for each meeting.
  1. Quality Assurance Committee
    • Two specialty physicians (MD/DO)
Agenda items are sent electronically for review.  Meets quarterly and can be attended remotely or in person.  Stipend is $250 for each meeting.
The physician committee members must hold an active, unrestricted license to practice medicine and be board certified (if applicable) by:
  • A specialty board approved by the American Board of Medical Specialties (doctors of medicine); or
  • The Advisory Board of Osteopathic Specialist from the major areas of clinical services (doctors of osteopathic medicine)

Please contact John Yindra or 207-402-3327 for more information.


Family Practice Physicians

Katahdin Valley Health Center is recruiting dedicated Family Practice Physicians that are committed to providing quality health care services to the people in Central/Northern Maine.  Join our practice in one of the newly expanded facilities.  We are seeking physicians for our Millinocket, Ashland and Houlton locations.  KVHC is a fully electronic medical record site and offers a competitive salary ($170,000 to $190,000 annual) and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off, $2500 annually toward CME as well as a completely outpatient site.  The call schedule is 1 in 8 with additional coverage from the Open Access Clinic.  Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.

To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at or visit our website at  KVHC is an equal opportunity employer.


Chief Dermatologist Job in Central Maine

Challenging, Lucrative, Chief Dermatologist job in central Maine - honoring and serving Veterans.  An experienced Dermatologist is needed in Augusta, Maine.  Must have an unrestricted medical license (from any U.S. state), and current BLS 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 Dermatology by the appropriate accrediting agencies.

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.

Contact John Poulin at 207-621-6913 or


Physician Sought

DFD Russell Medical Centers (DFDRMC) operates three community health centers in beautiful Central Maine. We are seeking a full time physician for immediate placement.  A current unencumbered Maine license and proficiency with electronic medical records are required.

Our three health centers serve a multicultural, rural population of about 10,000 patients and have a family practice focus serving pediatrics to geriatrics.  We have integrated behavioral health, care managers, a patient assistance coordinator and an excellent clinical support staff to support the candidate in delivering excellent clinical care.

Excellent benefits, including medical, dental, life insurance, 401K retirement plan, flexible spending accounts, generous paid time off and an incentive plan.  Salary is commensurate with experience.

We are an equal opportunity employer committed to diversity in the workplace.  If you want additional information about this position, which combines making a difference in patients’ lives with a family-friendly work life, please fax or e-mail your resume as soon as possible to Laurie Kane-Lewis, CEO.

Fax: 207-524-2459 and Email: 


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.









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