December 22, 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

Happy Holidays and Best Wishes for the New Year

The officers and staff of the Maine Medical Association wish all our members, their staffs, and our many supporters all the best for the upcoming holidays and the New Year.  Next week we will share our top ten list of our expectations for health care in 2015.  Today we offer some reflections from the Journal of the Maine Medical Association one hundred years ago, in January, 1914.


Weekly Update editors recently had the opportunity to review the January 1914 issue of the Journal of the Maine Medical Association.  Among the more interesting items:

  1. The following announcement:  VACCINATION ONCE MORE VINDICATED.  We wish to call attention, publicly, to the fact that out of twelve patients suffering from a small epidemic of small pox in Portland, in July, 1913, not a single one had ever been vaccinated.
  2. The Journal contained an advertisement for the Medical School of Maine at Bowdoin College, noting that the ninety-fourth year of the school began on Thursday, Oct. 16, 1913.(Editors note:  The medical school closed around 1920).
  3. An advertisement for the Saint Barnabas Hospital on 231 Woodford St., in Portland.  Advertised as "a private institution for the care and treatment of all Surgical Diseases," rates were $2.00 per day and upwards, "depending on size and location of room."
  4. The report of the Cumberland County Medical Society contained the following item:  "Resolved that the Cumberland County Medical Society, with its guests, assembled from all parts of the State, disapprove of any action directed against Dr. Henry Miller, Superintendent of the Insane Asylum at Augusta, as detrimental to the interests of the insane of our State."  Notably, 147 physicians had attended the society's meeting at which the Resolution was passed.  An Editorial Comment elsewhere in the Journal also was critical of state action that was taken to remove the Superintendent of what was later called the Augusta Mental Health Institute (now Riverview) and the role that politics played in the decision, and the decision that led to resignation of another physician from the Board of Trustees.  What follows is the last paragraph of the editorial:  "There are some 1,200 physicians in the State of Maine, serving about 800,000 people, of whom about 190,000 are legalized voters.  A true physician not only seeks to improve the physical and mental welfare of his patients but is a councilor in all matters pertaining to the improvement of general conditions for mankind.  He can be one of the strongest factors for good and make his influence so felt that the petty politician will be relegated to past history. During the past few years a reaction from the domineering form of political activity has swept the country and whether right or wrong, has resulted from such episodes as the one just closed."

If you are interested in reading more items of history from the Journals or the earlier records of MMA (which begin in 1853) in the Weekly Update, please drop me a note at

Gordon Smith


Maine Clinicians Swim With Sharks to Address Costs of Care

Maine clinicians found themselves in the “shark tank” last Wednesday evening in Freeport as speaker Neel Shah, MD, MPP, Executive Director of the Boston-based organization Costs of Care, challenged them to pitch their ideas for eliminating unnecessary tests and procedures in their work place.

The “sharks” judging the proposals included Shah’s co-presenter September Wallingford, RN and the Maine Medical Association’s own Gordon Smith and Andrew MacLean.  A proposal to “unclick” all the automatically pre-ordered tests and labs in the emergency department was selected as the winner due to its simplicity and ease of operationalizing. The pitch was made by MaineGeneral Medical Center Emergency Department Director Tim Pieh, M.D.

Addressing the costs of medical care is even more important than ever as many of the newly insured have plans with very high deductibles.  In Massachusetts, where 98% of the population is now covered, medical debt rates remain unchanged due to high deductibles.

While Shah challenged physicians to expand their notion of professionalism to include active stewardship of medical resources, Wallingford addressed the important of a team-based approach to cost-consciousness, including using nurses for monitoring as appropriate to eliminate redundant tests.

The evening was made possible thanks to the support of a payment reform grant from the Maine Health Access Foundation.

[return to top]

Update on Federal and State Exchanges' Open Enrollment

HHS announced this past week that 2.5 million people have signed up for health insurance through since open enrollment began on Nov. 15th.  The 13 State Exchanges have signed up nearly 740,000 people for health insurance during the same period.  

The open enrollment period closes on Feb. 15, 2015.


[return to top]

Congress Passes Bill to Fund Federal Government Through September

Congress last week passed H.R. 83, the Consolidated and Further Continuing Appropriations Act, which funds most of the federal government through September of next year. (Funding for the Department of Homeland Security will be provided under a continuing resolution that expires Feb. 27.)

Key highlights for the physician community include:

  • Ebola: $5.4 billion of emergency funding is included to prepare for and respond to the Ebola outbreak.
  • National Institutes of Health (NIH): The bill provides $30.3 billion for NIH, an increase of $150 million in base funding and $238 million in Ebola-related research.
  • Prescription drug abuse and prevention: To combat prescription drug abuse across the nation, the bill provides $20 million in increased funding for relevant programs within the Centers for Disease Control and Prevention. A $12 million increase will be for state grants within the Substance Abuse and Mental Health Services Administration to expand treatment services for dependence on heroin and other opioids.
  • Recovery Audit Contractors (RAC): The bill includes language recognizing that RAC audits can reduce patient access to care and jeopardize the economic viability of critical health care providers. The bill directs the Centers for Medicare & Medicaid Services (CMS) to educate providers on how to reduce errors. The agency also must develop procedures to reduce the Office of Medicare Hearings and Appeals (OMHA) backlog and establish a process that provides educational feedback from the OMHA to CMS and RACs to reduce the number of appealed claims that are likely to be overturned once elevated to the OMHA.

  [return to top]

Hanley Center for Health Leadership Extends Executive Director Application Deadline until December 31st

The Daniel Hanley Center for Health Leadership (the Center) is now accepting letters of interest and resumes as it seeks an accomplished health/healthcare executive with leadership experience within a non-profit healthcare setting to be Executive Director.  Reporting to the Board of Trustees, the Executive Director is responsible for the overall strategic direction and leadership of the Center.

The Daniel Hanley Center for Health Leadership is a nonprofit, independent, statewide organization dedicated to supporting the transformation of health and healthcare by building a culture of trust and collaboration. The core services provided by the Center are (1) engaging health/healthcare stakeholders to address complex issues that require a collaborative solution; and (2) professional development programs for health/healthcare leaders, including the Health Leadership Development (HLD) course for emerging and evolving leaders throughout Maine and the Physician Executive Leadership Institute (PELI) designed to prepare physicians to lead change in an increasingly complex healthcare environment.

Position Overview:  The Executive Director is responsible for providing leadership, management, and strategic direction in establishing current and long-range plans and policies, and achieving the Center’s primary goals and objectives.  The Executive Director advises guides, directs, and authorizes the implementation of major plans and procedures consistent with established policies and Board approval; and oversees the adequacy and soundness of the organization’s financial structure.  The Executive Director is responsible for meeting financial goals and ensuring the long term sustainability of the Center.

Specific Responsibilities include:

  • Overall Management and Operations of the Center and all of its programs.
  • Strategic Direction including development and implementation of Strategic Plan in close cooperation with the Board of Directors and identification of new opportunities that will meet existing needs and provide the Hanley Center with support needed to insure the long-term sustainability of the organization.
  • Leadership Program and Business Development including supporting the growth, development, and delivery of current Center programs and the development of new programs, initiatives, and partnerships that will support the Hanley Center’s mission and provide additional revenue.
  • Compliance with the Hanley Center’s policies and procedures, federal and state requirements for nonprofit organizations, financial accounting requirements, and other regulatory or Board requirements.

Required Knowledge & Experience:

  • Bachelor’s degree in healthcare administration, public health, business administration, or related fields; Master’s degree preferred.
  • Minimum 10 years of progressively responsible managerial experience.
  • Working knowledge of significant developments and trends in the healthcare environment.
  • Knowledge of Maine’s healthcare environment is a high priority.
  • Experience developing and successfully executing a sound strategic and business plan.
  • Experience working with a volunteer board, including identification and recruitment of members, governance and education.
  • Experience in fundraising and grant development.
  • Demonstrated success building sound and productive relationships in diverse environments key to the organization, including political, business, financial, regulatory, policy, academic, philanthropic, among others.
  • Experience in developing and sustaining strategic partnerships to enable enhanced performance of all organizations involved.

For additional information, please see   and/or contact:

Kathryn Vezina, MSN, RN, JD, Esq.

Associate Executive Director

Daniel Hanley Center for Health Leadership

217 Commercial St., Suite 201

Portland, ME 04101

(o) 207-553-9854

(c) 207-590-1632

  [return to top]

New Medicare Pay Cuts Coming in 2015; Participation Selections Due Dec. 31

Physicians have until Dec. 31 to decide whether they will be participating or nonparticipating physicians in the Medicare program next year.  In addition to the annual threat of a steep payment cut as a result of the sustainable growth rate (SGR) formula, another factor for physicians to consider in making the decision this time around is that 2015 will be the first year that the Centers for Medicare & Medicaid Services (CMS) will impose penalties under the value-based modifier (VBM) program. 

According to CMS, 1,010 groups of 100 or more eligible professionals will see payment adjustments from the VBM in 2015.  More than 300 of these groups will face Medicare payment cuts of 1 percent, while a few others will see cuts of 0.5 percent.  Only 16 groups will receive bonuses of an amount yet unknown.

Other penalties that will be applied in 2015 based on 2013 performance—including those tied to quality reporting, meaningful use and ePrescribing — will decrease the limiting charge amounts that nonparticipating physicians can bill to patients for unassigned claims.  The VBM penalties and bonuses, however, will not apply to unassigned claims. That means practices facing a VBM penalty next year could avoid the penalty by choosing the nonparticipating physician status option.

As described in the AMA guide to Medicare participation options, the Medicare payment schedule for nonparticipating physicians is set 5 percent below the participating physician payment schedule.  At the same time, nonparticipating physicians can bill patients for 15 percent above that lower payment schedule amount. 

While participating physicians agree to accept assignment for all Medicare claims, nonparticipating physicians can decide whether to accept assignment on a claim-by-claim basis.  This year, 96.6 percent of physicians are participating.  Physicians who want to become nonparticipating in 2015 must send a letter to their Medicare contractor postmarked before Jan. 1 to terminate their participation agreement for the coming year.

[return to top]

Federal Court in Oregon Considers DEA Access to PDMP Data

Two essential elements of medical practice — patient privacy and the patient-physician relationship — are at stake in a case before a federal appeals court that involves a state prescription drug monitoring program (PDMP) and surveillance by the U.S. Drug Enforcement Administration (DEA).

The issue in question is whether the DEA as a law enforcement agency has the right to access sensitive patient data without probable cause.  PDMPs collect patient prescription data to be used by doctors and pharmacists for responsible treatment and prescription practices.  Allowing unfettered access to such information could dramatically affect physicians' ability to prescribe the medications their patients need and limit the role of the PDMP to allow physicians to identify other prescriptions the patient has had which can enable more informed decisions about the patient's medical needs.

In this case, a federal magistrate judge ruled the DEA could enforce a subpoena against the Oregon PDMP that allowed disclosure of protected health information without patients' informed consent. The Litigation Center of the AMA and State Medical Societies and the Oregon Medical Association earlier this month filed an amicus brief in support of the Oregon PDMP and the American Civil Liberties Union of Oregon, which intervened in the case.

"PDMPs were enacted by states nationwide principally to focus on the efficacious provision of health care and public health, not enhancement of federal law enforcement," the brief said.

By asserting a right to PDMP data without probable cause or judicial oversight, the DEA is taking improper advantage of the health care data system and undermining the purpose of the PDMP, the brief said. Allowing the DEA access to the PDMP undermines the integrity and confidentiality of the patient-physician relationship. In addition, physicians' privacy is placed in the balance.

"Physicians who treat individuals or populations with pronounced need for pain medications, for example, may feel compromised in their ability to prescribe for fear of unsupervised law enforcement access to those patient prescription records," the brief said.

Visit the AMA Litigation Center's Web page to learn more about this case and others related to patient privacy. [return to top]

Congress Includes Offsets Contrary to Physician Interests in "ABLE" Act

The U.S. House of Representatives and U.S. Senate have both passed by strong majorities tax policy extension legislation that included the Achieving a Better Life Experience (ABLE) Act.  The bill would allow people with disabilities to create special savings accounts to pay for education, housing and other needs without jeopardizing government benefits under programs like Social Security or Medicaid.

Unfortunately, provisions were added to the ABLE Act two days prior to the House vote that would cut Medicare in order to offset the cost of the disability tax policy.

Section 202 of the bill would move up target dates for Medicare physician fee schedule redistributions that were included in the 17th physician payment patch, known as the Protecting Access to Medicare Act (PAMA), which was signed into law in March.  That bill would have required the Centers for Medicare & Medicaid Services (CMS) to meet annual targets for revising "misvalued" services, amounting to 0.5 percent of total fee schedule spending during the years 2017-2020.  If payment redistribution were to fall short of the 0.5 percent target in any of these four years, CMS was instructed to implement across-the-board cuts equal to the shortfall amount.

The budget offset in the ABLE Act revises the PAMA policy timeframe and imposes a 1.0 percent redistribution target in 2016, followed by 0.5 percent targets in 2017 and 2018. This provision would generate $365 million in savings.

The more aggressive framework in the ABLE Act is particularly problematic in light of new policy changes that CMS announced in the 2015 Medicare fee schedule regulation released Oct. 31.  Because CMS has proposed to eliminate the 10-day and 90-day global service periods in 2017 and 2018, respectively, the agency said it needed to concentrate its resources on this work rather than on misvalued codes.  Consequently, the provision means that physician services would be subject to across-the-board cuts for at least some portion of the 2016-2018 period.

In addition, section 203 of the bill would prohibit Medicare from covering vacuum erection systems until erectile dysfunction drugs are covered under Medicare Part D.  This provision, which contradicts recently adopted AMA policy, reduced spending by $444 million.

The AMA and other national physician specialty organizations have been expressing their objections to including these budgetary offsets in the ABLE Act and will work in the 114th Congress to reverse these policies. [return to top]

Reminder: Physicians Must Review 2013 Sunshine Act Data by Dec. 31

It's not too late for physicians to initiate disputes of their 2013 data under the Physician Payments Sunshine Act (also known as the "Open Payments" program).  Even though the Centers for Medicare & Medicaid Services (CMS) publicly released most of the 2013 data Sept. 30, corrections can be made for the next data release. Physicians have until Dec. 31 to file disputes regarding their 2013 data. 

Visit the CMS website to access an Open Payments "search by name" tool.  This tool lets individual physicians see whether they received any reportable payments in 2013 prior to going through the cumbersome Open Payments registration process.

View instructions for registering in the Open Payments system on the AMA's Sunshine Act Web page.
[return to top]

Health Insurance Marketplace 101 Webinars

The Denver Regional Office of the Centers for Medicare & Medicaid Services is offering Health Insurance Marketplace 101 webinars every Tuesday afternoon at 3 pm EST now through the end of Open Enrollment on February 15, 2015.  Registration is not required.  Information about the webinar including dates, topics to be covered, and how to view the webinar is available here [return to top]

Upcoming Events


February 6, 2015 - DOT Physical Exam Certification Training for Health Professsionals: MD, DO, PA, NP & Chiropractors available at the Maine Association of Physician Assistants 25th Annual Winter CME Conference at Sunday River Resort

WHY WAIT WHEN YOU CAN SKI & LEARN??   Your Department of Transportation (DOT) Physical Exam Certification program is just around the corner!  Join us for comfortable, affordable, live, DOT physical exam training event in February of 2015, at the Grand Summit Hotel & Conference Center.   National guidelines now require all providers of DOT Exams to be certified, and we are here to assist.  Our program combines years of occupational DOT experience with the current National Guidelines for Certification in an enjoyable, interactive educational setting.  Our providers, Howard Jones, MD and Lisa Gordon, PA-C facilitate an excellently received day of learning for all providers able to perform DOT Physicals under  the National Regulations, including Medical Doctors (MD), Doctors of Osteopathy (DO), Physician Assistants (PA) , Nurse Practitioners (NP) and Chiropractors.  They are also available as a continued resource for those who need information on sleep study facilities and much more.    

This enjoyable day of learning is slated for Friday, February 6, 2015 at the Sunday River Resort, Newry, Maine. Wonderful skiing, local eateries and entertainment abound.  BRING YOUR FAMILY and BRING YOUR FRIENDS!   We are happy to be able to include additional CME offerings at the time of this event.   

A certificate of completion is provided at the end of the day, which will allow attendees to sit for the exam.  Details of this process will be discussed and reviewed at the time of the education. Visit for more information or contact Diane McMahon at or 207-622-3374 ext. 216.


Dementia Care in Primary Care

Friday, March 13, 2014

Join us to learn about, and work with colleagues, on the implementation of best practices for Dementia Care in Primary Care.  This symposium will be offered on Friday, March 13.  The focus of this symposium is on implementation of a standardized approach to memory related problems in Primary Care.  The symposium will be useful to all providers working in Primary Care.  It will be an all-day event, offering CME as well as an opportunity to engage in an office based Quality Improvement process.

The symposium is sponsored by the Office of Aging and Disability Services and is free to participants.  We encourage bringing a member of your support staff who might be integral to implementation of process improvement.

 The primary site will be at MaineGeneral in Augusta, but work is in progress to transmit to both EMMC in Bangor and MMC in Portland.

Cliff Singer, MD                                                                           Roger Renfrew, MD, FACP

Geriatric Mental Health and Neuropsychiatry                     Facilitator Clinical Geriatrics

Acadia Hospital and EMMC                                                   MaineGeneral Medical Center

207-973-7026                                                                         207-621-3699



SAVE THE DATE:  Maine Academy of Family Physicians Spring Events

23rd Annual MAFP Family Medicine Update – April 8-10, 2015, at the Atlantic Oceanside in Bar Harbor

April 11th (tentative) Certified Medical Examiner Training (for DOT Exams) – dependent on registration minimum met

For more information check our website:

Complete schedule and registration available after January 15th. [return to top]

Job Openings

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


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.









   [return to top]

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