SGR Repeal Close — Senate to Vote Today or Tomorrow

While a bipartisan bill to eliminate the sustainable growth rate (SGR) is waiting for the U.S. Senate to take action when it returns today from a two-week recess, the current SGR patch ended at midnight on March 31st.  As a result, all physician services provided from that date will be subject to a 21 percent cut unless the Senate enacts the bill and sends it to the President's desk for his signature.  The President has stated that he will sign the legislation if it gets to him.

After the U.S. House of Representatives two weeks ago overwhelmingly approved a bill to eliminate the flawed Medicare sustainable growth rate (SGR) formula, the U.S. Senate delayed giving its final approval to the bill.  Senate leaders said they will vote on the bill promptly after Congress’ two-week April recess.  Both Congresswoman Chellie Pingree and new Congressman Bruce Poliquin voted in favor of the House bill.

The current Medicare payment patch expired at the end of March, which means doctors will receive 21 percent cuts in Medicare reimbursements. Here’s what physicians need to know about these cuts:

• The Centers for Medicare & Medicaid Services (CMS) is instructing its carriers to “hold” claims for 10 business days until legislation can be passed and signed into law that reverses the cut.
• The 10-day hold means that claims will be held through April 14. This is not a departure from standard practice.
• By regulation, CMS may not pay electronic claims prior to 14 days (29 days for paper claims).
• It is possible that the situation will be resolved before any claims are actually processed at the reduced rate.
• The AMA anticipates that when Congress passes a bill, the restored payment rates will be applied retroactively. 

By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount.  For that reason, the AMA is advising against submitting claims with reduced amounts reflecting the 21 percent cut.

The bill, H.R. 2, would set into motion Medicare physician payment reforms that will support physician practices that serve our nation’s seniors and military families enrolled in TRICARE.  President Barack Obama said he would sign the legislation into law, intensifying pressure on the Senate to move the bill forward.  The Senate is expected to vote when it returns on April 13th.  Read about the provisions of the bill at AMA Wire®.

AMA President Robert M. Wah, MD, in a statement said he was “extremely disappointed” that the Senate delayed its vote.

“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Wah said.  “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”

Physicians can contact their senators and urge them to support H.R. 2 when they get back from their vacation in any of the following ways:

• Call senators using the AMA’s toll-free Physicians Grassroots Hotline at 1-800-833-6354.
• Send an urgent email to senators reinforcing the need for SGR repeal now.
• Contact senators directly through their own social media channels.

More Stolen Identities for Tax Filing Purposes; Please Let MMA Know if You are a Victim of this Scam

As the tax filing deadline nears, MMA has heard from some members recently that they have been the victim of the stolen identity scam that involves filing a tax return in the name of a physician using stolen social security numbers and other information.  Many times, the physician does not become aware of the scam until he or she files the tax return, only to receive a message from the IRS that a return had already been filed in the name of the physician.  While the physician (and spouse if a joint return) are ultimately held harmless from the point of view of the tax return, there is considerable inconvenience in dealing with the stolen identity.

Is Your Texting HIPAA-secure? Download DocBookMD Today!

Texting clinical information risks HIPAA violations, but the Maine Medical Association has a solution.  MMA members have free access to DocBookMD, a "physician-centric" smart phone app that enables you and other users to exchange patient information through a HIPAA-secure network.  With DocBookMD, using your desktop or your iPhone, iPad, and Android devices, you can:  send messages that meet HIPAA requirements for encryption and security; share patient information at the point-of-care, and build a "Care Team" in order to communicate with non-physicians at your practice, and at your discretion.  MMA members can download and register now at www.docbookmd.com, or click on the above link from your mobile device and it will take you to the App store or Google play.

From the Archives: Fifty Years ago this Month in the Journal of the Maine Medical Assocation

From the April 1965 County Society Notes in the Journal of the Maine Medical Association.

How to Beat Burnout: 7 Signs Physicians Should Know

From the American Medical Association

If constant stress has you feeling exhausted, detached from patients, or cynical, take notice.  You may be in danger of burnout, which studies show is more prevalent among physicians than other professionals.  But how can you avoid it?  Learn the signs of physician burnout and what you can do to stay motivated on the job.

Mark Linzer, MD, Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis, has studied physician burnout since 1996.  He said he understands why many physicians eventually feel exhausted practicing medicine, but this problem is avoidable. 

“Burnout doesn’t have to be highly expensive to fix,” Dr. Linzer said.  “The problem is that no one is listening. People always want to say that physician wellness and performance measures will cost a lot of money, but preventing burnout can actually save money in the long run on recruiting and training new practice staff.”  

If physicians want to keep burnout at bay, Dr. Linzer said there are some serious signs they should never ignore. Here are seven ways to know if your practice is getting the best of you—and when to finally do something about it:  

1.    You have a high tolerance to stress.
Stress consistently ranks as the number one predictor for burnout among physicians, Dr. Linzer said.  “Please don’t ignore the stress, even if you can take it,” he said.  Physicians who consistently operate under high stress are at least 15 times more likely to burn out, according to his research.

2.    Your practice is exceptionally chaotic.
A quick glance around your practice will let you know if you or your colleagues may cave to stress.  “People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer said.  “Caring for patients keeps doctors motivated.  What burns them out is caring for patients in a high-stress environment.  Change the environment and you’ll change the overall quality of care.”

3.    You don’t agree with your boss’ values or leadership.
This one is particularly tricky to identify but “necessary to prevent burnout,” Dr. Linzer said.  Whether at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care.  Otherwise, their motivation can slowly wane. 

4.    You’re the emotional buffer.
Working with patients requires more than medical expertise.  “Often, the doctor acts as an emotional buffer,” Dr. Linzer said.  “We will buffer the patient from our own stressful environment until we can’t take it anymore.”

5.    Your job constantly interferes with family events.
Spending quality time with loved ones helps physicians perform better.  “When they can’t do those things, it’s all they think about during the day and the patient suffers,” Dr. Linzer said, citing work-life interference as one of the most common predictors for burnout among physicians in his studies. 

6.    You lack control over your work schedule and free time.
When work demands increase, but control over your schedule doesn’t, stress can kick in and spark burnout.  That’s why Dr. Linzer often tells practices, “If you standardize, customize”— a medical mantra to suggest that if physicians must work a long standardized set of hours each week, practices should at least customize their schedules to flexibly fit changes or needs in their daily lives.

7.    You don’t take care of yourself.
When was the last time you enjoyed a nice bubble bath or morning run?  If you continually neglect yourself, you may neglect your patients, too.  “As physicians, we want to be altruistic but one of the keys to altruism is self-care,” Dr. Linzer said.

Did you fit most of these signs? If you think you or your fellow physicians are suffering from excessive stress, check out these tips from residents who have conquered burnout.  Find more on maintaining a happy medical family in Physician Family, the AMA Alliance’s magazine.

Alsodownload a copy of Dr. Linzer’s clinical study on burnout for tips and recommendations that may fit your practice.

Preventing physician burnout is a priority for the AMA’s Professional Satisfaction and Practice Sustainability initiative, which partners with physicians, leaders, and policymakers to reduce the complexity and costs of practicing medicine so physicians can continue to put patients first.

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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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POLITICAL PULSE: HHS Committee Faces Large Crowd of Supporters on Bill to Test for Krabbe Disease

HHS COMMITTEE FACES CROWD OF SUPPORTERS ON BILL ON KRABBE DISEASE

This past week saw a huge crowd drawn to the State Office Building for a public hearing on LD 84, which seeks to add Krabbe disease to the list of conditions for which newborn screening is done.  The hearing room was packed with people in orange T-shirts showing support for Jamie Davis, who is the young mother pushing for passage of this bill.  The proponents’ testimony was well orchestrated and featured several family members and one pediatric nurse, but no medical experts.  Dr. Tom Brewster testified on behalf of the MMA, explaining to the Committee that we already have a system in place for adding disorders to the screening list based on scientific evidence.  He pointed out that there is no medically established treatment for this disorder.  Dan Morin also testified against the bill on behalf of MaineHealth.

Also before the Health and Human Services Committee were LD 140 and LD 812 which seek to expand access to naloxone for emergency treatment of opioid overdoses.  The MMA offered testimony in support of these measures.

Work sessions on all three of these bills will be held this week.

In other HHS business last week, the MMA testified in favor of a bill (LD 969) to provide some state General Fund appropriation in support of Maine's federally-qualified health centers (FQHCs) in support of the Maine Primary Care Association.  The MMA testified in opposition to a bill (LD 989) that would single out the opiate drug known by the brand name Zohydro for unique compliance requirements.

APPROPRIATIONS COMMITTEE DEVELOPS "PAIRING" OR "BUDDY" SYSTEM FOR NEXT PHASE OF BIENNIAL BUDGET WORK

As the Appropriations Committee has completed accepting reports back from policy committees, it now enters a phase of work sessions that will take up much of the rest of the session.  In a new approach, the Committee apparently has broken the budget into sections and assigned a pair of legislators, one Democrat and one Republican, to consider that section of the budget and make recommendations to the whole Committee.  You can find all budget documents, including the HHS Committee report, on the Office of Fiscal & Program Review web site here.  The biennial budget negotiations likely will occupy much of the rest of the session, some time in June.  The MMA continues its advocacy on behalf of Maine physicians and patients on various aspects of the budget proposal.

MMA Legislative Committee Weekly Conference Call, Tuesday, April 14th 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, April 14th 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. 

LD 1224, An Act To Amend the Child Protective Services Laws (monitor; pediatricians)

LD 1229,  Resolve, To Create a Pilot Program To Conduct Screenings for Scotopic Sensitivity Syndrome (monitor; pediatricians)*

LD 1236, An Act To Change the Type of Rulemaking Required Regarding Persons with Intellectual Disabilities or Autism (monitor; pediatricians, psychiatrists)

LD 1238,  An Act To Allow the Release of Child Protective Records to Certain Providers of Child and Adult Services (monitor; pediatricians)

LD 1242,  An Act To Protect Maine Consumers from Medical Identity Theft (monitor)

LD 1246,  An Act To Strengthen Laws Regarding the Manufacture and Sale of Methamphetamine and Other Drugs (monitor)

LD 1258,  An Act To Amend the Maine Medical Use of Marijuana Act with Regard to Good Business Practices (monitor)

LD 1264,  An Act To Transfer Oversight of the Maine Quality Forum to the Maine Health Data Organization (support)*

LD 1265,  An Act To Implement the Recommendations of the Maine Health Exchange Advisory Committee (monitor)

LD 1270,  An Act Regarding Patient-directed Care at the End of Life (oppose)*

LD 1271,  An Act To Protect Patients Who Need Eye Care (support; ophthalmologists)

LD 1282,  An Act To Support Conservation and the Health and Wellness of Maine Youth through Physically Active Residential Environmental Education Programs (monitor; pediatricians)

LD 1285,  An Act To Support School Nutrition (monitor; pediatricians)

LD 1294,  An Act To Improve the Health of Maine Residents through Education and Health Care (monitor)

LD 1301,  An Act To Improve the Safety of Vulnerable Users in Traffic and To Clarify the Responsibilities of Bicyclists and Pedestrians (monitor or support; pediatricians)

LD 1305, An Act To Encourage Health Insurance Consumers To Comparison Shop for Health Care Procedures and Treatment (monitor)*

LD 1307, An Act To Fund the Maine Diversion Alert Program (support)*

LD 1311,  An Act To Establish the Patient Compensation System Act (oppose)*

LD 1312,  An Act To License Outpatient Surgical Abortion Facilities (oppose; OB/GYNs)*

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New Online CME: Preparing Patients for Cancer Genetic Testing

The Jackson Laboratory is pleased to announce a new web based CME series on cancer genetic testing. The first module, now available, focuses on preparing patients for cancer genetic testing.

For patients at high risk for having a hereditary cancer syndrome, genetic testing may be appropriate. This online CME focuses on the benefits and limitations of testing and provides the opportunity to practice deciding whether testing is the best choice for a specific patient.

Highlights of the program include:

• Practice identifying the risks, benefits and limitations of genetic testing by working through cases.
• Watch a real patient and provider discuss important issues to consider in shared decision-making around genetic testing.
• Learn through 15-minute interactive Web cases and downloadable point-of-care tools that can be used in the clinic.
• Free CME.

Visit Pre-Test Decisions & Considerations to explore the program and access point-of-care tools to use in your clinic!

The University of Connecticut School of Medicine designates this enduring material for a maximum of .25 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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MMA's ICD-10 Training Sessions Scheduled for May 8th and 9th; Physician Organizations Continue to Press CMS on Transition Plans

Anticipating the October 1, 2015 deadline, physicians are concerned with preparations for transitioning to the ICD-10 diagnosis code set, 100 state medical societies and national specialty organizations, including the AMA, recently told the Centers for Medicare & Medicaid Services (CMS). 

A letter from the physician groups to CMS underscores the significant challenges of implementing ICD-10 and the need to have sound contingency plans in place to minimize claims and payment disruption for physicians. It presses CMS to release the detailed findings of the end-to-end testing conducted in January as soon as possible. 

The AMA will continue urging CMS to address the concerns outlined in the letter and to sensitize the administration to the challenges of moving to the new code set. Read more about the concerns physicians outlined in the letter at AMA Wire®.

While the AMA continues its push to reform the Centers for Medicare & Medicaid Services (CMS) ICD-10 implementation plans, physicians are reminded to stay abreast of Medicare coverage policies that are being updated by CMS on a rolling basis.

The most recently changed coverage policies can be accessed through the AMA's ICD-10 Web page under "Medicare Testing and Payment." Physicians are urged to review any policies that may impact them.

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:

                           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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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

For assistance, please contact: Dawn Lovelace at 207-221-4561 or dlovelace1@une.edu or Dora Anne Mills at dmills2@une.edu or 207-221-4621

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.

4/20/15

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