December 29, 2014

 
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Top Ten Predictions for Health Care in Maine and the Nation in 2015

As the new year quickly approaches, MMA offers its predictions for what will and will not occur in health care in Maine and the Nation in 2015.

  1. Implementation of ICD-10 will not be subject to further delays and will occur, as presently scheduled, on Oct. 1.  As clinicians have had an additional two years to prepare for the change, the transition will not be the disaster some have predicted, nonetheless, the administrative burdens imposed will be significant.
  2. The ACA will not be repealed by the Congress and any attempt to do so will be vetoed by President Obama.  The law will continue to be unpopular with the public at large.
  3. The U.S. Supreme Court, in the infamous King v. Burwell case, will decide that the subsidies offered through the federal exchange are consistent with the underlying law.
  4. The Maine legislature will enact a modest MaineCare expansion, proposed by Governor LePage.  The expansion will assist largely those individuals under 100% of the federal poverty level and will require a CMS waiver.
  5. The consolidation of hospitals in Maine will continue with at least one of the major systems merging into another.
  6. The U.S. Congress will not deal with the proposed SGR Medicare reductions scheduled for April 1, 2015 until mid March.  Shortly before the deadline, they will enact a temporary reprieve, resulting in the 18th patch to the flawed payment system established in the mid 1990s.
  7. Physician reimbursement will continue to be impacted by pressures on health care costs and by new payment models.  More revenue will come from alternative payment systems and less from fee for service.  But the transition away from fee for service will continue to be slow.  Price transparency will continue to be an issue.  More physicians will participate in one or more ACOs.
  8. Ebola will not become an epidemic in the U.S. but will continue to be a serious threat in West Africa.  It will also continue to be a political issue in this country.
  9. Immunization rates will continue to decline in Maine despite significant efforts to educate parents as to the benefits of vaccination.
  10. Opioid use in Maine will decline, led by the 50% reduction seen in MaineCare patients in the past 24 months.  While no research has been done, it is presumed that the decrease in opioid use among MaineCare patients is because of the prior authorization requirements established with the support of the medical community in 2012.

 

 

MMA Announces Hiring of Peter Michaud, Esq., RN

The Maine Medical Association is pleased to announce the hiring of Peter Michaud, Esq., RN, effective Jan. 1, 2015.  Peter will serve as a staff attorney and handle a variety of responsibilities in the areas of public health, legal and regulatory services, and advocacy.

 Peter is a native of Madawaska, Maine and is a graduate of Harvard College, the University of Maine School of Law, and Central Maine Medical Center College of Nursing and Health Professions.  Most recently, Peter worked as a practicing RN at Memorial Hospital in North Conway, New Hampshire.  He is a former Workers' Compensation Commissioner in Maine and for many years chaired many medical malpractice pre-litigation screening panels while practicing law in Portland.

"We are very fortunate to have recruited Peter back to his home state and back to the practice of law and advocacy,"  said Gordon Smith, Esq., Executive Vice President of MMA.  "Peter comes to us with a unique background involving both law and nursing and he will be able to assist us in our work on behalf of Maine's physicians on day one of his employment.  We welcome him to the MMA team."

Peter can be reached at MMA beginning Jan. 5, 2015 at pmichaud@mainemed.com and 207-622-3374, ext. 211.

 

 
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Presiding Officers of 127th Legislature Announce Committee Assignments

Senate President Michael Thibodeau (R) and House Speaker Mark Eves (D) announced committee assignments on Tuesday, Dec. 23rd.  Of particular significance to health care interests, the Appropriations Committee will be chaired by veteran lawmaker Margaret Rotundo (D-Lewiston) on the House side and James Hamper (R-Oxford) on the Senate side.  The Health & Human Services Committee will be chaired by second term House member Drew Gattine (D-Westbrook) and freshman Senator Erik Brakey (R-Auburn).

The physician members of the Legislature generally drew assignments of interest to each.  Veteran house member Linda Sanborn, M.D. will be back on the Appropriations Committee.  Second term Senator Geoffrey Gratwick, M.D. will be back on the Insurance & Financial Services Committee.  First term house members Patty Hymanson, M.D. will be on the Health & Human Services Committee and Heidi Brooks, M.D. will be on the Insurance & Financial Services Committee.  You can find the list of committee assignments here.

Governor LePage will present his two-year budget on Jan. 9th following an inaugural event on Jan. 7th.  

MMA will resume its weekly Legislative Committee conference calls on Tuesday evening, Jan. 13th, at 8:00 pm.  The Committee is again chaired by Amy Madden, M.D., a family physician practicing at the Belgrade Health Center.  Any MMA member is welcome to participate in these calls.  The conference call number and the legislative proposals to be discussed will be included in the Weekly Update each Monday.

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200 years ago in Maine Medicine

While we had intended to review MMA materials from l864-65 to provide a perspective from 150 years ago (which we will do next week), in searching through the archives we found a story from 1814 that we thought readers would enjoy.  The story involves a former MMA President, Hosea Rich, M.D. of Bangor (1780-1865) who practiced actively in Bangor for more than 60 years.

Born in Charlton, MA, October 1, 1780, Hosea studied medicine for five years with intervals of school teaching with Dr. Eaton of Dudley and Dr. Thomas Babbitt of Stourbridge, both of Massachusetts.  Failing, in spite of a well founded education, to obtain a paying practice either in Rhode Island or in New Jersey, he went on a voyage as Ship's Surgeon to Port Au Prince in the West Indies.  Coming home after a year and finding that a sister had married and gone to Bangor to live, he followed her example.  Arriving in Bangor on July 4, 1805, he remained there the rest of his life.

When the British forces attacked Hampden on the Penobscot River in 1814, Dr. Rich, who was surgeon to an Infantry Regiment, took charge of the few wounded in an improvised hospital, in which he had just extracted a bullet from a wounded man, when the enemy rushed in and separated patient and surgeon.  When they met again, years afterward, Dr. Rich approached his patient with a smile, and asking him to call at his office, he there presented him with the bullet which he had so well got rid of so long before.

"It is quite a while since we met, Doctor, isn't it?" 

"Yes," replied Dr. Rich, "that bullet blew us pretty far apart."

Dr. Rich's bill for his services rendered at the Battle of Hampden, read this way:

    Sept. 16, 1814.  The State of Massachusetts Debtor to Visit and dressed 5 persons wounded, being of those wounded at Hampden on the 3d Inst.   $5.

(From the book, Maine Physicians of 1820, by James A. Spalding, M.D., Litt. D., Dart.)

The referenced publication is a splendid record of the Members of the Massachusetts Medical Society practicing in the District of Maine at the time the District separated in 1820.  It was published in Portland more than one hundred years after the separation, in 1928.  The volume also contains a brief history of the origins of the Maine Medical Society in 1820.  The Society was dissolved in 1845, eight years prior to the first meeting of the Maine Medical Association in 1853 in Brunswick.

 


 
 
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Federal Marketplace Open Enrollment Enrolls 6.4 Million to Date

Approximately 6.4 million people have selected a health plan through the federal marketplace exchange or were automatically renewed during the first month of the ACA open enrollment period which began on Nov. 15th.  The latest figures were announced by HHS Secretary Sylvia Matthews Burwell.

The 6.4 million number includes about 1.9 million new consumers buying coverage through the federal exchange. These figures do not include individuals who selected plans through state-based exchanges.  Maine uses the federal marketplace exchange.

Of the 4.5 million people re-enrolled, approximately 30% returned to the marketplace to re-enroll, while the remainder were re-enrolled automatically.

The open enrollment period runs through Feb. 15, 2015.  

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AMA Letter Tells CMS that Payment Recovery Audit Program Needs Overhaul

A "bounty-hunter" Medicare program that takes back payments from physicians must be overhauled, physicians told the Centers for Medicare & Medicaid Services (CMS) in a letter earlier this month, pointing to a two-year backlog of appeals and prohibitive expenses that result from excessive audits.

The AMA letter points out that CMS' own reports have shown that appeals have skyrocketed as a result of the recovery audit contractor (RAC) program.  When appeals from the RAC program entered the Office of Medicare Hearings and Appeals' (OMHA) workload in 2012, the department saw a 42 percent increase in the total number of claims appealed.  That number then increased 506 percent between 2012 and 2013.

And while OMHA can't keep up with appeals, more than 60 percent of RAC determinations that physicians and other Medicare Part B providers appeal are overturned once reviewed.

The AMA is calling on CMS to make five strategic changes to fix the RAC program:

  • Contractors should be subject to financial penalties for inaccurate audit findings.
  • RAC audits of physicians should be performed by a physician of the same specialty or subspecialty and should be licensed in the same jurisdiction.
  • Physicians should be able to rebill for recouped claims for a full year following recoupment.
  • CMS should provide an optional appeals settlement to physicians, similar to that provided to hospitals for short-term care.
  • CMS should retain the current medical record request limits and allow medical record reimbursement for physicians.

Also this month, the AMA provided feedback to the OMHA on innovative ways to help mitigate the appeals backlog.  Visit the AMA's recovery audit Web page to learn more about recent advocacy efforts on this issue.

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Congress Passes Bill to Fund Federal Government Through September

Congress prior to the holidays 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.

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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.
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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]

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.

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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 john.poulin@va.gov.

1/5/15

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.

2/9/15

 

 

 

 

 

 

 

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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 www.mainepa.com/conference for more information or contact Diane McMahon at dmcmahon@mainemed.com or 207-622-3374 ext. 216.

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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

 

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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:  http://www.maineafp.org/cme/mafp-cme-meeting

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

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