January 12, 2015

 
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MMA Presents Legislative Package for 2015

The 127th Maine Legislature reconvened last Wednesday with the events of the day centered on the inauguration for Governor Paul LePage for a second four-year term.  The House and Senate will meet at 10:00 am this week on Tuesday and Wednesday but most legislators will leave Augusta mid-day Wednesday to tour portions of the state on a bus tour organized through the Maine Development Foundation.  The bills prepared by MMA advocacy Staff are listed below.

The Legislature is expected to be in session until late June.  The cloture date for all bills to be pre-filed was last Friday, January 2nd.  MMA filed several bills on behalf of legislators, including those with the following titles:

  • An Act to Improve Childhood Vaccination Rates in Maine (Rep. Linda Sanborn, M.D.)
  • An Act to Ensure Comprehensive Medical, Educational, and Behavioral Assessment of Children Entering State Custody  (Sen. Geoffrey Gratwick, M.D.)
  • An Act to Ensure Appropriate Health Insurance Coverage for Prescription Eye Drops (Rep. Henry Beck)
  • An Act to Clarify the Use of "M.D." to Represent Achievement of a Graduate Degree by an Individual not Licensed to Practice Medicine in Maine (Rep. Patricia Hymanson, M.D.)
  • An Act to Amend the Law Requiring the Reporting of Injuries to Children Under Six Months of Age or Otherwise Nonambulatory (Rep. Dillon Bates)
  • An Act to Eliminate the Dual Licensing of Physician Assistants (concept draft) (Rep. Anne-Marie Mastraccio)
  • An Act to Amend the Health Care Practitioner Transparency Requirements (Sen. Geoffrey Gratwick, M.D.}

 MMA was also involved in the drafting of a concept draft entitled, An Act to Decrease Uncompensated Care, Reduce Medical Debt and Improve Health Outcomes and a concept draft dealing with home births and the potential licensing of certified professional midwives.  Sen. Anne Haskell is sponsoring the first bill and Sen. Amy Volk the second.

 Finally, Sen. Gratwick has resubmitted on behalf of the Maine Chapter of the American Academy of Pediatrics, legislation known as L.D. 272 in the 126th Legislature that would prohibit minors from using indoor tanning facilities. The bill passed last year but was vetoed by Governor LePage.

 Physicians wishing to serve as Doctor of the Day during one of the days the House and Senate is in session should communicate with Ashley Bernier at MMA (abernier@mainemed.com).

Physician's Day at the Legislature will be held on Thursday, March 12th and all medical specialties and any individual physicians are welcome to participate.  For more information, contact Dianna Poulin at dpoulin@mainemed.com or call her at 622-3374, ext. 223.

 
 

MMA Legislative Committee Weekly Conference Call, Tuesday, January 13th, 8 p.m.

The first MMA Legislative Committee weekly conference call for the First Regular Session of the 127th Maine Legislature will take place tomorrow, Tuesday, January 13th at 8:00 p.m.

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session.

Conference call number:  1-619-326-2772

Passcode:  729-7185

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed the previous week, to hear the views of specialty societies on the new bills or their concerns about any current health policy issues, and to discuss the highlights of legislative action of the week.  The calls rarely last longer than an hour.  The MMA staff lists a suggested position for each bill and any medical specialty particularly affected by the bill.  

If you have an opinion about any of these bills, but cannot participate in the call, please contact Andrew MacLean, Deputy EVP & General Counsel at amaclean@mainemed.com or 622-3374, ext. 214.

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first.  This will be important when the list grows in the next few weeks.

LD 5, An Act To Remove the Limit on the Number of Patients a Primary Caregiver May Provide for under the Medical Marijuana Laws (monitor)

LD 7, Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 21: Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder, a Major Substantive Rule of the Department of Health and Human Services(monitor; psychiatrists)

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POLITICAL PULSE: New Legislature Completes First Week; Governor Introduces Biennial Budget

Members of the 127th Maine Legislature returned to the Capitol in Augusta last week to begin the substantive work of their First Regular Session which is expected to last until mid-June.  LDs 1 through 11 were printed last week and the MMA has identified two of these for review during the Legislative Committee conference call tomorrow night (see related article).  In a closely contested Cumberland County Senate seat, Democrat Cathy Breen finally was seated last week.  The new legislature includes the following four physicians:

  • Senator Geoffrey Gratwick, M.D. (D-Penobscot) serving on the Insurance & Financial Services Committee
  • Representative Linda Sanborn, M.D. (D-Gorham) serving on the Appropriations & Financial Affairs Committee
  • Representative Heidi Brooks, M.D. (D-Lewiston) serving on the Insurance & Financial Services Committee
  • Representative Patricia Hymanson, M.D. (D-York) serving on the Health & Human Services Committee

 Much of January will be devoted to organizing and orienting committees.  Legislative sessions are scheduled for Tuesdays and Thursdays through the end of January and will involve mostly referencing of bills to committees.  You can find more information about the legislature on its web site.

Last Friday, Governor LePage released his proposed biennial budget for SFY 2016-2017, the $6.3 billion budget for the two state fiscal years beginning July 1, 2015. MMA still is analyzing the proposal, but we are very pleased to see the Governor's commitment to continuing the ACA primary care fee increase and payments for MaineCare health homes and we are concerned about the proposals to permit municipalities to tax non-profit organizations, to reduce reimbursement for services in emergency departments, and to cut "provider-based" reimbursement.  You can find the documents on the Governor's proposed biennial budget on the Bureau of the Budget web site.

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Payment Reform Policy Brief Series: Shared Savings Programs

Each week over the next month, the Weekly Update will feature one from a series of policy briefs featuring content covered in the document Payment Reform Update: Current Context and Emerging Issues, prepared by health care attorney Ben Townsend for the Maine Medical Association. This week's topic is:

Shared Savings Programs

A complete set of the payment reform policy briefs can be accessed on the Payment Reform Resources webpage

Come and learn more about shared savings programs and related topics when Ben Townsend, Kozak & Gayer, speaks at the February 6 First Friday program on "Current Issues in Payment Reform" along with Frank Johnson, Director of System and Payment Reform, Maine Health Management Coalition and Lisa Letourneau, MD, MPH, Executive Director, Quality Counts. To register, email Lisa Martin at lmartin@mainemed.com or complete this form. [return to top]

One Month until Open Enrollment Ends for Health Insurance Marketplace

The Open Enrollment period to get health insurance for 2015 through the Marketplace ends on February 15, 2015. Patients may be able to get help paying for insurance premiums and out-of-pocket costs for Marketplace health insurance.  

  • Consumers can apply online and get more information at www.healthcare.gov, and can ask questions and get enrollment help by calling the Marketplace Call Center at 1-800-318-2596.
  • Free in-person enrollment help is available in Maine.  Search for local assistance at www.enroll207.com.
  • Free brochures are available at enroll207.  Go to www.enroll207.com/material-order-form/ for free materials to help patients get covered and use their new insurance plan.

More information and links to Marketplace resources, including upcoming Health Insurance Marketplace 101 webinars, are available at the Maine Medical Association website.  For additional resources for your patients and updates or training for your practice, contact ACA Outreach Coordinator Sue Kring at skring@mainemed.com or 662-2364.

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First Friday's Educational Programming Resumes on Feb. 6 with Physician Payment Reform

MMA resumes its educational programming on Friday, Feb. 6 with a presentation on physician payment reform.  Faculty includes attorney Benjamin Townsend of Kozak & Gayer, Frank Johnson of the Maine Health Management Coalition, and Lisa Letourneau, M.D., M.P.H., Executive Director of Quality Counts.  Attorney Townsend will review the toolkit on payment reform he prepared for MMA and Mr. Johnson and Dr. Letourneau will review the various initiatives of their organizations, many of them supported by the state's SIM (State Innovation Model) grant.  The program will be held from 9:00 am to noon at MMA's offices in Manchester but is also available for remote participation.  Category one CME has been applied for and there is a $70 fee.  Registration is available on the MMA website or by calling Lisa Martin at 622-3374, ext. 221.

MMA will present seven First Friday presentations in 2015.  The Annual Coding Seminar will be held on Friday, April 3 and the Annual HIPAA Training will be on Friday, May 1.  

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State Laws Taking Effect January 1, 2015

A small number of laws enacted by the 126th Legislature took effect on January 1, 2015.  As most state laws take effect 90 days after adjournment of the legislative session,  a new year usually brings forth only a handful of new laws which specifically included an effective date of January 1st. Of particular interest this year are the following:

  1. A law requiring health plans to cover cancer medication taken orally if the plan covers the equivalent medication administered intravenously.  Supported by the American Cancer Society, MMA, and other health organizations, the legislation is vitally important for those patients for whom an oral medication was appropriate but their health plan included the oral version of the medication in their pharmacy plan, subjecting it to high co-payments that could reach thousands of dollars.  The MMA extends a special "thank you" to New England Cancer Specialists for its critical work on this bill.
  2. A second new law effective January 1st increases the age for mandated health plan coverage of assessment and treatment of autism spectrum disorders.  The previous law covered children ages 5 and under the and new law covers children up to 10 years of age.  The legislation originally presented would have covered children up to the age of majority but in a legislative compromise between supporters and opponents of the bill, the age of 10 was arrived at. This bill was an important initiative of the Autism Society of Maine.  It was also supported by MMA and the Maine Association of Psychiatric Physicians.
  3. A third bill requires health insurers to cover up to $150 of a laboratory fee to test an individual for the human leukocyte antigen to determine whether the person would be a suitable bone marrow donor.
 
 
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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]

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

Now that the new year is upon us, MMA staff 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. And some significant parts of the law will be repealed, including the tax on medical devices and the Independent Payment Advisory Board (already defunded).
  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.

 

 

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MMA Advocacy on ACA Primary Care Increase for MaineCare

MMA has been working for several months to advocate for continuation of the MaineCare primary care fee increase funded in 2013 and 2014 by the federal government through the ACA.  The 100% federal funding ended on December 31st and many states have reverted back to previous fee schedules.  But, MaineCare continues to pay for the select set of primary care services at Medicare rates and MMA is advocating for continuation of the increase at the State House.  Approximately $1.5 million dollars is needed in the current fiscal year to continue the payment and $3 million will be needed for the fiscal year beginning July 1, 2015.  There is every indication that the LePage administration is supportive of primary care and understands the significance of the enhanced payments to the independent primary care practices which completed the process to be eligible to receive the higher payments.

Watch the Weekly Update for regular reports on what is happening on this issue.  MMA is still encouraging the private practices to complete a brief survey indicating the impact of the enhanced payment on their practices.  To receive the link to the survey, contact Dee deHaas at ddehaas@mainemed.com.

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Job Openings

Gastroenterologist Job in Central Maine

Challenging, Lucrative, Gastroenterologist job in central Maine - honoring and serving Veterans.  An experienced Gastroenterologist is needed in Augusta.  Develop your skills of diagnosing, treating, and managing patients, while living in an all-season recreational getaway!

Must-haves: Fellowship-trained and B/C specializing in Gastroenterology, fellowship-trained in Transplant Hepatology, and fellowship-trained in Advanced Endoscopy; experience in Upper Endoscopy (including EGD, Barrett's Esophagus diagnosis and treatment, vatical bleeding, bleeding ulcers, dilation, stent placement for esophageal strictures, and treating food impactions); experience in  Colonoscopy (diagnostic and therapeutic), ERCP, EUS with FNA (for both solid and cystic lesions), Push enteroscopy, Deep small bowel enteroscopy, Capsule endoscopy, and Combined Interventional and Endoscopic interventions (Rendezvous procedures); experience in hepatology and liver diseases; lastly, an unrestricted medical license and current BLS certification.

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.

Salary will be commensurate experience, using VA’s market-based physician pay system. 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.  Relocation expenses are not authorized.  Equal Opportunity Employer.  Disabled persons and/or veterans are encouraged to apply.

For more information contact John Poulin: john.poulin@va.gov

2/9/15

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

MMA First Friday Forum

 February 6, 2015  "Current Issues in Payment Reform" 

8:30am Registration, 9am-12pm Program

 

FACULTY: 

 Benjamin Townsend, JD, Kozak & Gayer

Frank Johnson, Director of System and Payment Reform, Maine Health Management Coalition  

Lisa Letourneau, MD, MPH, Executive Director, Quality Counts  


REGISTRATION: 

Available on the MMA website or by calling Lisa Martin at 622-3374 ext. 221. 

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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, 2015 

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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Maine Concussion Management Initiative Training Programs – Level 1 and Level 2

General Information for 2015

When and where held:

              March 13, 2015 in Bangor at St. Joseph’s Hospital  

              May 1, 2015 in Machias at DownEast Community Hospital                       

              June 12, 2015 in Waterville at Colby College

              October 20, 2015 in Portland in conjunction with the Maine Brain Injury Conference

                             (Registration and fees will be through the Maine Brain Injury Conference for October 20)

                            

Training Program: Training programs in 2015 will be updated.

              Level 1 - An Introduction to Concussions and Concussion Management

              Level 2 – Interpreting Neurocognitive Testing (Level 1 is a prerequisite for taking Level 2)

              8:00am – 8:15   Registration and Continental Breakfast (Level 1 and Level 2 are run simultaneously)

              8:15am-12:00pm            Level 1 – An Introduction to Concussions and Concussion Management

                                                          ○            The Diagnostic and Return to Play Dilemma

                                                          ○            Sport Related Concussion: Short and Long Term Sequelae

                                                          ○            Concussion Sideline Assessment

                                                          ○            Concussion Risk Factors, Treatment and Return to Function

                                                          ○            Tools in Concussion Management

                                                          ○            Concussion Case Studies

                                                          ○            Review and Wrap-up

              8:15am-12:00pm            Level 2 – Interpreting Neurocognitive Testing             

                                                          ○            Using ImPACT Testing in Concussion Management

                                                          ○            Interpreting ImPACT Test Results

                                                          ○            Case Reviews

                                                          ○            Review and Wrap-up

              Registration Fee:

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, ATC, RN, PT, OT, SLP)

                                          

              $40 for school personnel and all other attendees

                             (School nurses, coaches, school athletic directors, administrators, parents, etc.)

              $20 for students – currently enrolled in a college program

Registration Fee Includes:

              1. Handouts

              2. Continental Breakfast and mid-morning break

              3. CEU/CME credits for Health Care Professionals

Registration Confirmation will be sent by email and will include:

              1. Directions to training location.            

              2. Training agenda.

For more information contact:

              Jan Salis, PT, ATC

              MCMI - Membership Committee Chair

              jsalis@aol.com

              (207) 577-2018

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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