U.S. House Leaders Announce Bipartisan SGR Repeal Bill, H.R. 1470

In unusual bipartisan action, Congressional leaders in the House unveiled legislation that would permanently repeal the sustainable growth rate which is again producing a scheduled 20.1% reduction in physician payment rates under Medicare, effective April 1, 2015.

With only one week left before the next cut hits, efforts to fix the flawed Sustainable Growth Rate (SGR) formula driving Medicare physician fees has accelerated in recent days.  Last week, the U.S. House leadership, in an unusual bipartisan act, unveiled proposed legislation, H.R. 1470 which is an updated version of the legislation crafted a year ago, and which includes the following key provisions:

• Permanently repeals the SGR funding formula
• Adds positive annual payment updates of 0.5% for four years
• Includes a 5% incentive payment for physicians participating in and meeting certain thresholds of alternative payment models
• Replaces current Medicare quality reporting programs with a consolidated merit-based incentive payment system (MIPS)
• Extends the Children's Health Insurance Program (CHIP) for 2 years.

Health Insurance Marketplace Tax Penalty Special Enrollment Period: March 15 through April 30, 2015

The Open Enrollment Period for 2015 Marketplace health coverage is over, but consumers may still be able to get covered and avoid a tax penalty next year. There is a new Special Enrollment Period (SEP) for consumers who find out they must pay a tax penalty because they did not have coverage in 2014.  You are eligible for this SEP if you:

• are not currently enrolled in 2015 Marketplace coverage,
• attest that when you filed your 2014 tax return you paid the fee for not having health coverage in 2014, and
• attest that you first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing your 2014 taxes.

This SEP will begin on March 15th and end on April 30th. Consumers who qualify must complete the entire enrollment process (that is, including selecting a plan) by 11:59 pm E.S.T. on April 30th.

Other life events that may qualify you for a Special Enrollment Period include:

• Getting married
• Having a baby, adopting a child or placing a child for adoption or foster care
• Losing other health coverage
• Permanently moving outside your plan’s coverage area
• Gaining citizenship or lawful presence in the U.S.
• Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder.
• Leaving incarceration
• For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

If you think you my qualify for a Special Enrollment Period, you can apply at healthcare.gov or by calling 1-800-318-2596. For free in-person help with your application go to www.enroll207.com to find an assister near you.  More information about Special Enrollment Periods is available at www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

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Doctors' Day, 2015

This year Doctors' Day will be celebrated one week from today, on Monday, March 30th.  On this day, many patients, facilities, and the Maine Medical Association will pause to thank physicians for the work they do every day for their patients, population health, and public health.  

New AMA, CDC Initiative Aims to “Prevent Diabetes STAT”

Leading voices in health care launch urgent effort to reduce the incidence of type 2 diabetes, one of nation’s most debilitating chronic diseases

With more than 86 million Americans living with prediabetes and nearly 90 percent of them unaware of it, the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) today announced that they have joined forces to take urgent action to Prevent Diabetes STAT and are urging others to join in this critical effort.

Prevent Diabetes STAT: Screen, Test, Act - Today™, is a multi-year initiative that expands on the robust work each organization has already begun to reach more Americans with prediabetes and stop the progression to type 2 diabetes, one of the nation’s most debilitating chronic diseases. Through this initiative, the AMA and CDC are sounding an alarm and shining a light on prediabetes as a critical and serious medical condition. 

“It’s time that the nation comes together to take immediate action to help prevent diabetes before it starts,” said AMA President Robert M. Wah, M.D. “Type 2 diabetes is one of our nation’s leading causes of suffering and death—with one out of three people at risk of developing the disease in their lifetime. To address and reverse this alarming national trend, America needs frontline physicians and other health care professionals as well as key stakeholders such as employers, insurers, and community organizations to mobilize and create stronger linkages between the care delivery system, our communities, and the patients we serve.”

“The time to act is now. We need a national, concerted effort to prevent additional cases of type 2 diabetes in our nation – and we need it now,” said Ann Albright, Ph.D., R.D., director of CDC’s Division of Diabetes Translation. “We have the scientific evidence and we’ve built the infrastructure to do something about it, but far too few people know they have prediabetes and that they can take action to prevent or delay developing type 2 diabetes.”

People with prediabetes have higher-than-normal blood glucose levels but not high enough yet to be considered type 2 diabetes. Research shows that 15 percent to 30 percent of overweight people with prediabetes will develop type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity.

As an immediate result of this partnership, the AMA and CDC have co-developed a toolkit to serve as a guide for physicians and other health care providers on the best methods to screen and refer high-risk patients to diabetes prevention programs in their communities. The toolkit along with additional information on how physicians and other key stakeholders can Prevent Diabetes STAT is available online. There is also an online screening tool for patients at www.preventdiabetesstat.org to help them determine their risk for type 2 diabetes.

“This initiative is also about empowering patients to take control of their health,” said Dr. Wah. “It starts with knowing your risk factors.”

Over the past two years, both the CDC and the AMA have been laying the groundwork for this national effort. In 2012, the CDC launched its National Diabetes Prevention Program (National DPP) based on research led by the National Institutes of Health, which showed that high-risk individuals who participated in lifestyle change programs, like those recognized by the CDC, saw a significant reduction in the incidence of type 2 diabetes. Today, there are more than 500 of these programs across the country, including online options.

The AMA launched its Improving Health Outcomes initiative in 2013 aimed at preventing both type 2 diabetes and heart disease. That work includes a partnership with the YMCA of the USA to increase the number of physicians who screen patients for prediabetes and refer them to diabetes prevention programs offered by local YMCAs that are part of the CDC’s recognition program. This joint effort included 11 physician practice pilot sites in four states, where care teams helped to inform the development of the AMA and CDC’s toolkit. In the coming months, the AMA will be identifying states in which to strengthen the linkages between the clinical care setting and communities to reduce the incidence of diabetes

“Our health care system simply cannot sustain the continued increases in the number of people developing diabetes.” said Dr. Albright. “Screening, testing and referring people at risk for type 2 diabetes to evidence-based lifestyle change programs are critical to preventing or delaying new cases of type 2 diabetes.”

“Long-term, we are confident that this important and necessary work will improve health outcomes and reduce the staggering burden associated with the public health epidemic of type 2 diabetes,” said Dr. Wah.

Follow our social movement to Prevent Diabetes STAT on Twitter at #PreventDiabetesSTAT.

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**Editor’s Note:  Below are related links for patients and health care providers

Patient Resources

Physician Practice Resources

Toolkit for health care providers

About the AMA
The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America.

About the CDC

CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency. [return to top]

Healthcare Cost Workgroup (SIM Grant) Considers Infrastructure Reform including State Health Plan

The Healthcare Cost Workgroup, now supported with funding from the Maine State Innovation Model Initiative, met last Thursday, March 17th.  The goal of the meeting was to continue discussion of the state's health care infrastructure, with a focus on strategies for identifying and re-purposing of misaligned infrastructure.  Facilitated by Michael Bailit, attendees expressed opinions regarding the need for a State Health Plan and commented on the existing Certificate of Need law.  Comments included that any new State Health Plan or planning process needs to be distinguished from the poor executed plans of the past.

MMA Legislative Committee Weekly Conference Call, Tuesday, March 24th at 8 p.m.

The next MMA Legislative Committee weekly conference call for the First Regular Session of the 127th Maine Legislature will take place tomorrow, Tuesday, March 24th 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 919, An Act To Provide Access to Opioid Analgesics with Abuse-deterrent Properties (support)*

LD 921, An Act To Strengthen the Right of a Victim of Sexual Assault or Domestic Violence To Take Necessary Leave from Employment (monitor; Public Health Committee)

LD 928,  Resolve, To Enhance Consumer Awareness of Expenditures and Gifts by Manufacturers of Prescribed Products (monitor)*

LD 936,  An Act To Protect Children from Sexual Predators, Sexual Abuse and Sexual Assault (monitor; pediatricians)

LD 940,  Resolve, To Require Hospitals To Provide Information to Parents of Infants Regarding Testing for Krabbe Disease (support; pediatricians)*

LD 943,  An Act To Provide Access to Infertility Treatment (monitor; OB/GYNs)

LD 948,  An Act To Harmonize Maine's Laws Governing Toxic Chemicals in Children's Products with Those of Other States (monitor; Public Health Committee)

LD 950, An Act To Prohibit Discrimination against a Person Who Is Not Vaccinated (oppose; pediatricians; Public Health Committee)*

LD 960, An Act To Support Family Caregivers in the Workforce (monitor)

LD 966, An Act To Assist Patients in Need of Psychiatric Services (monitor; psychiatrists)

LD 969, An Act To Preserve Jobs and Primary Care Services in Rural and Underserved Areas of Maine (monitor)

LD 970,  An Act Regarding Advanced Practice Registered Nurse Requirements (oppose; anesthesiologists)*

LD 971, An Act To Reinstate the State Fire Marshal's Authority To Inspect Amusement Rides (monitor; pediatricians, Public Health Committee)

LD 973, An Act To Ensure That Nicotine Products Are Taxed Equally (support; Public Health Committee)

LD 978,  An Act To Promote Patient Choice and Access to Health Care (monitor)

LD 984,  An Act To Authorize the Dispensing of Eyeglasses with an Expired Prescription (monitor; ophthalmologists)

LD 989, An Act To Limit the Use of Extended-release Hydrocodone Bitartrate (monitor)

LD 991, An Act To Amend Maine's Genetically Modified Food Products Labeling Law (monitor; Public Health Committee)

LD 1000,  An Act To Define Prosthetic and Orthotic Devices for Purposes of the Sales Tax Law (monitor)

LD 1003, An Act To Prohibit Discrimination by Employers and Protect the Privacy of an Applicant for Employment, an Employee or an Employee's Dependents Regarding Reproductive Health Decisions (monitor)

LD 1005,  An Act To Amend the Law Regarding Medical Examiners (oppose)*

LD 1009, An Act To Benefit the Education of Denturism Students (monitor)

LD 1011, An Act To Address Drug Testing in the Workplace and the Effect of Approved Substances on Current Drug Policy (monitor)

LD 1013,  An Act To Prevent the Shackling of Pregnant Prisoners (monitor or support; OB/GYNs)*

LD 1018,  An Act To Make Certain Necessary Appropriations and Allocations (monitor)*

LD 1019, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2016 and June 30, 2017 (monitor)*

LD 1020,  An Act To Make Certain Necessary Supplemental Appropriations and Allocations (monitor)* [return to top]

Five Things Physicians Say About the Evolution of Payment Models

Physicians are trying to move to new payment models, but need help successfully managing and responding to the many quality programs and metrics from payers, according to a new joint study by the RAND Corporation and the AMA.

Researchers conducted case studies of 34 physician practices in six diverse geographic markets to determine the effects that alternative health care payment models are having on physicians and practices. The models under investigation included episode-based and bundled payments, shared savings, pay-for-performance, capitation and retainer-based practices. Two other organizational models, accountable care organizations and medical homes, also were examined.

Here are the five things physicians should know about the report:

• The effect that alternative payment models have on practice stability, including the overall financial impact, ranged from neutral to positive. Among practices surveyed, none experienced financial hardship as the result of involvement in new payment models.
  
  
• Physicians generally agreed that the transition to alternative payment models has encouraged the development of collaborative team-based care to prevent the progression of disease.
  
  
• Most physician leaders were optimistic about alternative payment models, while physicians not in leadership roles expressed some apprehension, particularly about certain new documentation requirements. For example, physicians were supportive of new patient registries that list patients with certain health conditions as a way to improve care, but had concerns about documentation requirements where the link to better care was less clear.
  
  
• The operational details of alternative payment models can either help or hinder practices' efforts to improve their own processes. For example, practices are investing in information systems to analyze large amounts of data about practice patterns. But when crucial data—like quality performance feedback—are missing or inaccurate, it is difficult for practices to use data analysis to improve care and reduce spending.
  
  
• Most medical practices have shielded individual physicians from direct exposure to new financial incentives created by payers. While practices are paid more for improved performance, they generally use nonmonetary incentives to encourage physicians, including providing performance feedback.

The report's findings will guide the AMA's work in improving alternative payment models and helping physician practices successfully adapt to changes in the health care environment. The findings also point to the need for payers to make similar investments in managing the information that physicians collect.

Read more about the findings at AMA Wire.

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Physician Leadership Changes at the Maine CDC

Sheila Pinette, D.O. last week resigned from her position as Chief Health Officer.  Her last day with the Maine CDC is this coming Friday, March 27th.  Dr. Pinette has served in the CDC or HHS for the past four years. The Maine Medical Association wishes her all the best as she continues her medical career.  

Kenneth J. Albert RN, Esq., Director and Chief Operating Officer of the Maine Center for Disease Control and Prevention has announced that Christopher Pezzullo, D.O. will serve as Acting Chief Health Officer.  He will continue to cover, along with contracted physicians, the responsibilities of the State Epidemiologist while the Maine CDC continues to recruit for that position.

Dr. Pezzullo joined the Maine CDC in 2012 as the Medical Director of the Division of Population Health.  Prior to joining state government, he was the Medical Director of University Health Care at the University of New England and Acting Chief of the Department of Pediatrics at UNECOM.  Dr. Pezzullo earned his Doctor of Osteopathic Medicine at UNECOM in 1993 and completed his Pediatric Residency at Maine Medical Center in 1996.   ‎

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ICD-10 Not Likely to be Delayed; MMA Announces Training Sessions May 8th and 9th

At a Congressional hearing earlier this month, it was once again emphasized by CMS that no future delays are contemplated for the effective date of implementation of ICD-10.  It has already been delayed for two years at the request of the AMA and other physician organizations.  At this point, the October 1, 2015 implementation date is supported strongly by the health plans and CMS and Congress is unlikely to delay further the implementation date.

POLITICAL PULSE: HHS Committee Hopes to Finish Biennial Budget Work Sessions This Week

HHS COMMITTEE CONTINUES BIENNIAL BUDGET WORK SESSIONS THIS WEEK; APPROPRIATIONS COMMITTEE CONTINUES WORK ON DHHS SUPPLEMENTAL BUDGET BILL (L.D. 236)

Members of the HHS Committee begin a third week of work sessions on the DHHS portions of the Governor's FY 2016-2017 biennial budget proposal.  For several weeks now, Republicans and Democrats on the Appropriations Committee have been unable to reach consensus on the DHHS supplemental budget bill, L.D. 236.  The sticking point is the Governor's proposal to divert money in the Fund for a Healthy Maine designated for the Low-Cost Drugs for the Elderly Program to the Medical Care - Payments to Providers account. 

Job Openings: Note Posting of State Epidemiologist Position

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.

3/16/15

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Upcoming Events

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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

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

April 11^th (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.

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Please join us for the Northern Maine Interprofessional Collaborative Practice (IPCP) Summit

The University of New England (UNE) invites you to participate in the Interprofessional Collaborative Practice Summit, taking place on April 14, 2015 on the campus of Northern Maine Community College in Presque Isle.

Funded by UNE’s Maine AHEC Network (Area Health Education Center) and the Josiah Macy, Jr. Foundation, the Summit will host national and local experts to address the relationship between health professions education, clinical practice, and national healthcare reform.

During the course of the day healthcare providers will have an opportunity to learn more about:

• Trends in and principles of interprofessional team-based practice 

• Tools to implement interprofessional practice

• How to develop interprofessional student clinical experiences that prepare the future workforce and help address healthcare shortages 

We encourage you to attend as individuals or as interprofessional teams!

THERE IS NO COST TO ATTEND THOUGH AN RSVP IS REQUIRED OF ALL ATTENDEES

Register online: https://www.surveymonkey.com/r/CYLZD32 and/or visit www.une.edu/ahec for more information

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