Jan 13 JAMA Features Community Health Efforts in Franklin County
Congratulations to four longtime MMA members and their co-authors who were featured in last week's Journal of the American Medical Association (JAMA). The physicians co-authored a community health study which demonstrated that in rural Franklin County, sustained, community-wide programs targeting cardiovascular risk factors and behavior changes were associated with reductions in hospitalization and death rates over a 40 year period ending in 2010.
The co-authors, who worked for nearly two years on the study, are MMA members N. Burgess Record, M.D., Roderick Prior, M.D., David Dixon, M.D., and Daniel Onion, M.D., MPH. Additional co-authors included Gerald Cayer, MPH of Franklin Regional Hospital, Sandra Record, R.N. and Fenwick Fowler, B.A.
The comparisons of outcomes were made with the rest of the state, with substantial improvements seen for hypertension and cholesterol control and smoking cessation. The authors studied health outcomes associated with a comprehensive cardiovascular risk reduction program in a low-income rural community. In the late 1960s, local community groups in Franklin County identified CVD prevention as a priority. A new Community Action Agency, a new nonprofit medical group practice (Rural Health Associates) and later Franklin Memorial Hospital initiated and coordinated their efforts. With hospital medical staff sponsorship, RHA established the community-wide Franklin Cardiovascular Health Program (FCHP) in l974.
The programs targeted hypertension, cholesterol, and smoking, as well as diet and physical activity. The current analysis included residents of Franklin County and used the preceding decade as a baseline and compared the county with other Maine counties and state averages.
Local public and nonprofit organizations collaborated on various components of the multi-faceted community effort, including schools, the hospital, law enforcement, Health Community Coalition and Western Maine Community Action, among others. "The big story is about the collaboration to help overcome barriers to care, and the whole idea of 'it takes a village,'" said Sandra Record, R.N. "A few key concepts to the success of this project are: go to where the people are (community, schools, medical practices, and worksites); provide regularly scheduled risk factor clinics; work collaboratively with existing resources; and communicate with patient and provider."
In its first four years, FCHP screened about 50% of county adults. Individuals with hypertension showed significant movement from detection to treatment and blood pressure control; the proportion in control increased from 18;3% to 43% from 1975 to 1978, an absolute increase of 24.7 percent. After introducing cholesterol screening in 1986, FCHP reached 40% of county adults within 5 years, half of whom had elevated cholesterol levels. Similarly, after initiation of multiple community smoking cessation projects, community-wide smoking rates improved significantly from 48.5 percent to 69.5 percent, and became significantly higher than that for the rest of Maine, although these differences after disappeared when Maine's overall quit rate increased.
Franklin County hospitalizations per capita were fewer than expected for the period 1994-2006. The lower overall hospitalization rates were associated with $5,450.362 reductions in total in and out-of-area hospital charges for Franklin County residents per year.
After being at or above overall Maine mortality rates in the 1960s, Franklin County rates decreased below Maine rates for almost the entire period 1970-2010. Cardiovascular-specific mortality rates decreased similarly. The greatest differences coincided with periods of peak efforts to improve health care access, detect and control hypertension and hypercholesterolemia and reduce smoking.
The JAMA article was accompanied by an editorial extolling the attributes of the program.
Doctors’ Lounge Networking Forum, Wednesday, January 28, 5:30-7:00 pm, Ri Ra’s, Portland
Join Specialty Solutions at the Doctors’ Lounge, a monthly networking forum for physicians and advanced practice providers.
Historically, physicians have had more face-to-face interaction, but with time constraints, the loss of funding for hospital-based doctors’ lounges, and the regionalization of physician practices, it has
become extremely challenging for physicians to have informal interactions with their colleagues. Through the Doctors’ Lounge, physicians can connect and develop bonds that will be helpful as care delivery continues to change.
The next Doctors’ Lounge is Wednesday, January 28, 2015 from 5:30 to 7:00 p.m. at Ri Ra’s on Commercial Street in Portland. For more information, please email@example.com.
[return to top]
OCR Director Says Second Round of HIPAA Compliance Audits Will Begin Soon
Speaking with reporters on January 13th, DHHS Office of Civil Rights (OCR) Director Jocelyn Samuels said that the next round of HIPAA compliance audits by her office will begin "expeditiously" and will be accompanied by new audit guidelines that will be posted on the OCR web site. She described the audits as "additional tools" for the OCR to ensure compliance with the HIPAA privacy and security rules. The audits are in addition to investigating complaints of possible violations and continuing education and outreach programs. Samuels said the audits will help covered entities correct compliance issues and will help the government identify systematic HIPAA compliance problems. She described investigations of noncompliance with the HIPAA privacy rule that have "industrywide impact," known to the Office as "high-impact cases." The OCR has entered in to 16 resolution agreements since 2012 that have included monetary settlements and corrective action plans. [return to top]
MMA Legislative Committee Weekly Conference Call, Tuesday, January 20th, 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 20th 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
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 firstname.lastname@example.org 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 20, An Act To Improve Substance Abuse Treatment (monitor; psychiatrists)
LD 21, An Act To Amend the Medical Marijuana Laws (monitor; Public Health Committee)
LD 23, An Act To Remove from the Maine Medical Use of Marijuana Act the Requirement That a Patient's Medical Condition Be Debilitating (monitor or oppose; Public Health Committee)
LD 35, An Act To Allow a Qualifying Patient To Use Medical Marijuana in a Hospital (monitor or oppose; Public Health Committee)
LD 45, An Act To Exempt Certain Capital Expenditures from the Maine Certificate of Need Act of 2002 (monitor or support)
LD 61, An Act To Require Tattoo Practitioners To Be at Least 18 Years of Age (support; Public Health Committee)
LD 62, An Act To Require Notice to Municipal Officers of Violations of Emergency Medical Services Law and Rule (monitor; emergency physicians; Public Health Committee)
[return to top]
CMS Administrator Tavenner Stepping Down at End of February
According to an internal CMS email that circulated last Friday, Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services will leave her position at the end of February. Principal Deputy Administrator Andy Slavitt will become acting Administrator. Tavenner joined CMS in 2010 and served the agency through the difficult years of ACA implementation. [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.
[return to top]
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 email@example.com or 662-2364.
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.
[return to top]
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.
Payment Reform Policy Brief Series: Direct Primary Care Practice
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:
Direct Primary Care Practice
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 firstname.lastname@example.org or complete this form. [return to top]
MMA Presents Legislative Package for 2015
The Legislature is expected to be in session until late June. The cloture date for all bills to be pre-filed was 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.}
[return to top]
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 (email@example.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 firstname.lastname@example.org or call her at 622-3374, ext. 223.
POLITICAL PULSE: A Closer Look at the Provider Reimbursement Part of the 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. 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.
On Friday, January 9th, 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. You can find the documents on the Governor's proposed biennial budget on the Bureau of the Budget web site.
The following are high points from the “Medical Care - Payments
to Providers” or “MAP” account, the primary account dealing with physician & hospital reimbursement:
- Provider-base reimbursement, p. A-336. Total cut in each year is $7.3 M state & federal. Description says, “Reduces funding by eliminating the separate facility fee payments that are billed on a UB-04 claim form and paid to hospitals for the services of hospital-compensated physicians, and provides funding to equalize reimbursement rates
of hospital-compensated physicians and non-hospital-compensated physicians and eliminates the cost settlement component of hospital-compensated physician reimbursement. This would eliminate the two separate fee schedules of reimbursement and ensure all physicians
billing under Section 90 of the MaineCare Benefits Manual would be reimbursed on the non-facility fee schedule.” There is no separate language in Part C, the language section of the budget.
- Health Homes, p. A-336. Replaces lost federal funding, so GF amount is $5.6 M/$7.8 M in the first & second years of biennium respectively. Description says, “Provides funding for Health Homes for adults
with serious and persistent mental illness and children with serious emotional disturbance (Stage B) and Health Homes for individuals with one or more chronic conditions (Stage A) due to the elimination of the enhanced federal match of 90/10 under the ACA.”
- Primary care fee increase, p. A-336. The amount is $7.4 M GF, $12.5 state & federal funds in each year
of biennium. Description says, “Provides funding for the reimbursement of primary care physicians at an enhanced rate which replaces expiring funds provided through the ACA.”
- Community-based behavioral health services provided by hospital-affiliated entities, p. A-337. Reduces
funding by $1.3 M in each year of biennium. Description says, “Reduces funding by requiring all community-based behavioral health services, including those that are operating as part of a hospital or in an administrative unit of a hospitality to bill and receive
rates of reimbursement under Section 65 of the MaineCare Benefits Manual.”
- Critical Access Hospital (CAH) reimbursement, p. A-337. Saves $4.2 M in each year of biennium by reducing reimbursement from 109% to 101% of costs.
- Methadone treatment coverage eliminated, p. A-339. Savings is $1.2 M/$1.5 M state & federal.
- ER rates, p. A-339. Savings is $1.9 M/$2.6 M state & federal. Description says, “Reduces by changing reimbursement on non-emergent use of emergency services to be paid at an office visit rate.”
- Medicare Shared Savings Program cuts, p. A-339. Savings is $29 M/$34 M state & federal. Description says, “Reduces funding by reducing the Federal Poverty Level (FPL) in the Medicare Savings Program (MSP) to the federal minimum.”
- Section 65 BH services 10% reimbursement cut, p. A-337. Savings in this line is $10.4 M in each year of biennium state & federal. There's also at least one line on this cut in the BDS part of the DHHS budget. FYI, despite the merger
in the Baldacci years, the BOB still breaks the DHHS budget down into 2 parts, “DHHS, formerly BDS” (behavioral & developmental services) & “DHHS, formerly DHS” (human services).
[return to top]
MMA First Friday Forum
February 6, 2015 "Current Issues in Payment Reform"
8:30am Registration, 9am-12pm Program
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
Available on the MMA website or by calling Lisa Martin at 622-3374 ext. 221.
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 email@example.com or 207-622-3374 ext. 216.
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
Maine Concussion Management Initiative Training Programs – Level 1 and Level
General Information for 2015
When and where
March 13, 2015 in Bangor at
St. Joseph’s Hospital
May 1, 2015 in Machias at DownEast
June 12, 2015 in Waterville at Colby
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)
– 8:15 Registration and Continental
1 and Level 2 are run simultaneously)
1 – An Introduction to Concussions and Concussion Management
○ The Diagnostic and Return to Play
○ 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
2 – Interpreting Neurocognitive Testing
○ Using ImPACT Testing in Concussion
○ Interpreting ImPACT Test Results
○ Case Reviews
○ Review and Wrap-up
for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, ATC, RN, PT,
for school personnel and all other attendees
nurses, coaches, school athletic directors, administrators, parents, etc.)
for students – currently enrolled in a college program
Continental Breakfast and mid-morning break
CEU/CME credits for Health Care Professionals
Confirmation will be sent by email and will include:
Directions to training location.
Salis, PT, ATC
Membership Committee Chair
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]
Job in Central Maine
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
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
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.
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 firstname.lastname@example.org. 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]