Medicare SGR Repealed, Finally

In action that was thought to be highly improbable only a few short weeks ago, the United States Senate last week joined the House in supporting legislation permanently repealing the notorious Sustainable Growth Rate Formula governing physician payments under Medicare.  Passage of the bill then signed by the President averted at the last minute another proposed cut of nearly 23% in Maine and also avoided the need for what would have been the 18th "patch."

Late on the evening of April 14, 2015, the United States Senate voted 92-8 to pass The Medicare Access and CHIP Re-authorization Act (H.R. 2) thus repealing the flawed Sustainable Growth Rate (SGR) Medicare payment formula.  The House had passed the bill on March 26th on a vote of 392 to 87.  President Obama promptly signed the bill, completing the legislative process and freeing physicians and other Medicare providers from a flawed payment formula that had resulted in Medicare payments increasing only 4% since 2001 while the cost of caring for patients increased by 26% during the same period.  MMA is pleased to note that all four of Maine’s Congressional delegation members voted for the bill.  Please take the time to thank our two Senators and two Representatives for this historic vote.

The new law gives physicians the option to stay in Medicare’s traditional fee-for-service system while incentives are offered to move to alternative payment models.  In addition to repealing the SGR formula, the bill:

• Provides all physicians with annual positive 0.5 percent updates for 4 and ½ years (July 1, 2015 through the end of 2019).
• Replaces Medicare’s multiple quality reporting programs with a new single Merit-Based Incentive Payment System (MIPS) that provides positive or negative payment adjustments based on a composite score/performance for providers remaining in the fee-for-service model.  While the MIPS program has similar features of Medicare’s current quality programs, it is intended to be more flexible with new opportunities to earn bonuses.
• Under MIPS, physicians can earn bonuses and face lower penalties.  Maximum MIPS bonuses and penalties would be 4 percent in 2019; 5 percent in 2020, 7 percent in 2021, and 9 percent in 2022 and beyond.  Additional bonuses of up to 10 percent would go for exceptional performance, with $500 million of Medicare funds set aside each year for that purpose.
• Existing programs PQRS, MU, and VBM would officially end in 2019.  The last reporting period would be for 2018.  Physicians would be judged by what is relevant to their practice, and get credit for improvements as well as hitting performance targets.  They would know those targets at the start of each reporting period and receive more timely individual feedback.
• Preserves the 10-day and 90-day global surgical bundled payments by reversing a recently adopted rule by the Centers for Medicare and Medicaid Services (CMS) that would have unbundled these services.
• Sets a goal of achieving interoperability of EHR systems by December 31, 2018.  If not achieved, the Secretary can recommend adjusting MU penalties and/or decertifying EHRs.  A study is required to assist physicians in comparing and selecting among certified EHR products.
• Practices with 15 or fewer professionals would qualify for technical-assistance funding to help improve their performance or transition to alternative payment models.  Priority would be given to practices with low scores and those in rural and underserved areas.
• Liability protections are included if provider standards are followed.

The Maine Medical Association, the American Medical Association, and more than 750 other national and state medical societies and specialty organizations supported the bill.  While certainly not perfect, it does put behind us the flawed formula and gives medicine an opportunity to expand its advocacy agenda which for several years has been negatively impacted by the annual effort to patch the formula.

Let MMA Train Your Staff at Annual HIPAA Update, May 1st

MMA's next First Friday educational presentation is the Annual HIPAA Update which will be presented Friday morning, May 1st from 8:30 am to noon at the MMA offices in Manchester.  The program is also available online through Webex.  An exceptional faculty has been recruited to present at this year's program including attorneys Michael Duddy, Kenneth Lehman, Jennifer Riggle, and Elizabeth Olivier.  MMA attorneys Andrew MacLean and Peter Michaud will also participate.  This once a year program is always the most popular First Friday program of the year.  Register now and learn what is new in the HIPAA privacy world and how to ensure that your practice is in compliance with both state and federal privacy laws.

MMA Nominations Committee Seeking Member Engagement

The Maine Medical Association Nominations Committee will be meeting throughout the Spring and Summer to complete the slate of officers and committee membership for the Association in advance of the Annual Meeting in Bar Harbor from September 11-13, 2015.  The Committee is chaired by Kenneth Christian, M.D. of Holden.  If you are interested in engaging with the Association in any of the following activities, or know of a colleague who is interested, please communicate with Dr. Christian via e-mail to christianken@yahoo.com or to MMA's Executive Vice President Gordon Smith at gsmith@mainemed.com.  Gordon can also be reached on his cell phone at 207-215-7461.

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.

Rural Medical Access Fund Applications Due on May 1st

For more than twenty years, the state's Rural Medical Access Program has made funds available to eligible physicians who practice obstetrics in federally designated Medically Underserved Areas/Populations and Primary Care Health Professional Shortage Areas.  To be considered eligible, physicians must be practicing in Maine, have performed deliveries and/or provided prenatal care, and have malpractice for prenatal care and/or obstetrical services for at least the period of July 1, 2014 through Dec. 31, 2014.

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.

EHR Program Modifications a Mixed Bag for Physicians

The Centers for Medicare & Medicaid Services (CMS) on March 20th released the Stage 3 proposed rule for meaningful use of electronic health records (EHR). The same day, the Office of the National Coordinator for Health IT (ONC) released a proposed rule for the next version of certified EHRs (Version 2015).

The rules represent a mixed bag for physicians, and comments are due for both rules by May 29.  Following is an overview of the rules.

CMS' meaningful use Stage 3 rule:
The AMA continues to harbor a number of concerns with the overarching framework of the meaningful use program, including:

• The general pass/fail construct
• Increased thresholds or other added criteria that do not reflect the existing barriers—making it very challenging to meet certain measures
• The requirement to move to a full-year reporting period

ONC's certified EHR rule:
The ONC was responsive to a number of the concerns the AMA has pressed for repeatedly. These include proposals for:

• Creating greater transparency of certified EHRs
• Giving further clarity on vendor requirements to address privacy and security concerns
• Providing post-market surveillance to address how certified products are performing
• Improving data exchange, including provider directories, patient matching and the API concept to access common clinical data

While a number of the changes proposed by the ONC are promising, the AMA believes further emphasis needs to be placed on testing products during and after the certification process.

CMS' meaningful use years 2015-2017 rule:
In addition,  CMS on April 10 released a separate proposed rule to address years 2015-2017 of the meaningful use program. The AMA is still in the process of reviewing this rule but will provide a summary and ask the Federation for additional feedback in the near future.

EHRs talk to one another without understanding

Physicians' electronic health record (EHR) systems may be able to send and receive information to other EHRs, but the ability for information to be exchanged, incorporated and presented in a contextual manner still is lacking, physicians told the Office of the National Coordinator for Health IT (ONC) earlier this month.

In a letter to National Coordinator Health Information Technology Karen B. DeSalvo, MD, the AMA outlined key facets of achieving true interoperability between EHRs based on the ONC's interoperability roadmap:

• Prioritize cornerstone issues to lay a strong foundation
• Don't use a punitive approach
• Address cost and usability barriers
• Acknowledge the meaningful use program's impact

Read more about these recommendations at AMA Wire®.

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Open Payments Review and Dispute Period Now Underway

Under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services (CMS) is required to publicly report on an annual basis items of value that are given to physicians and teaching hospitals.

Preceding the public data release, physicians are given a brief window of time to review their data and dispute errors.  CMS announced April 6th that physicians could begin registering in the Open Payments System and reviewing their 2014 data.

Disputes that are initiated by May 20th will be flagged in the public data release scheduled to take place June 30th.  Visit the AMA website for step-by-step instructions on how to register and review the Open Payments data.

Physicians can share their registration experience with the AMA by sending an email to OpenPayments@ama-assn.org. Responses will be used in the AMA's ongoing advocacy efforts.  [return to top]

POLITICAL PULSE: Proposal on Independent Prescriptive Authority for CRNAs has Lengthy Hearing before LCRED Committee

MMA AND OTHER PHYSICIAN ORGANIZATIONS OPPOSE LD 970 ON INDEPENDENT PRESCRIPTIVE AUTHORITY FOR CRNAs IN HEARING BEFORE LABOR, COMMERCE, RESEARCH & ECONOMIC DEVELOPMENT COMMITTEE

Last Tuesday afternoon, the LCRED Committee held a public hearing that neared four hours in length on L.D. 970, An Act Regarding Advanced Practice Registered Nurse Requirements.  Katherine Pope, M.D., former MMA Legislative Committee Chair and Board member, former nurse, and current Spectrum Medical Group anesthesiologist presented the MMA's testimony in opposition to the bill.  Organized medicine stood strongly united in opposition to this legislation with physicians and other representatives of the MMA, Maine Osteopathic Association, Maine Academy of Family Physicians, Maine Society of Anesthesiologists, and Spectrum Medical Group testifying against the bill.  The physician organization testimony identified important issues and raised key questions to which the proponent nursing interests could not respond.  A work session on the bill has not yet been scheduled.  An important threshold question is whether the Department of Professional & Financial Regulation (DPFR) will be asked to conduct a so-called "sunrise review," a statutory requirement prior to expansion of the scope of practice of any DPFR licensee.

LCRED COMMITTEE ALSO ADDRESSING BILLS ON PA LICENSURE, USE OF THE "M.D." DEGREE AS A TITLE, AND TREATMENT OF LYME DISEASE

The LCRED Committee has been busy with some difficult pieces of medical legislation.  Last week, the Committee held an initial work session on two bills drafted by MMA staff.  One bill (LD 830) addresses the issues with physician assistants having to "serve two masters" by being licensed and regulated by both the Board of Licensure in Medicine and the Board of Osteopathic Licensure if they are supervised by allopathic and osteopathic physicians in different work settings.  The BOLIM has raised a number of technical issues with resolving this problem.  The Committee has asked DPFR Commissioner Ann Head to convene a meeting of stakeholders to discuss potential approaches to regulatory relief and to report back in a week.  The Committee voted 12-1 in favor of an amended version of MMA's bill (LD 834) that would clarify the right of a physician who does not hold a current valid physician license to use the designation, "M.D." after his or her name to recognize the earning of that degree.  The problem is that the current statute states that use of the designation, "M.D." is prima facie evidence that one is holding him or herself out to the public as practicing medicine.  Under the amended version of the bill, a licensee who had his or her license permanently revoked still would not be able to use the designation.

Finally, last Thursday, the Committee held its second work session on the bill (LD 422) to protect practitioners who prescribe long-term antibiotic treatment for Lyme disease from disciplinary action by licensing authorities.  Most of the first two work sessions involved lengthy committee caucuses outside of public view as members discuss the nature of the problem and various approaches to amending the bill.  The Committee has struggled to achieve consensus.  Bea Szantyr, M.D. has been very much engaged in the work on this bill and Robert Pinsky, M.D. participated in last week's work session on behalf of the infectious disease community.  The bill is scheduled for yet another work session this Thursday afternoon at 1 p.m.  While the outcome is far from clear, it appears that the best chance of consensus among the various points of view on the Committee may be a "Resolve" that might give some peace of mind to those practitioners who believe that long-term antibiotic treatment for Lyme disease without making any permanent changes to the licensing boards' disciplinary authority.

HEALTH COMMITTEE CONTINUES MARATHON PUBLIC HEARING AND WORK SESSION SCHEDULES

The MMA and/or physician specialty organizations such as the Maine Chapter of the American Academy of Pediatrics (MAAP) and the Maine Association of Psychiatric Physicians (MAPP) have been involved in a number of the many bills being heard or worked by the Health & Human Services Committee during the past two weeks since that Committee completed its work on the biennial budget.  A number of them have not been finally resolved.  These bills deal with issues as varied as tobacco specialty stores (LD 821), blood lead exposure levels (LD 1115), prescription drug marketing to physicians (LD 928), access to naloxone (LDs 140 and 812), state funding for rural health centers (LD 969), testing for Krabbe disease (LD 84), and specific requirements for prescribing the drug, Zohydro (LD 989).

MMA JOINS MHA AND MAINEHEALTH IN OPPOSING BILL SUGGESTING SUBSTANTIAL FINES FOR FAILURE TO COMPLY WITH PRICE TRANSPARENCY LAWS BEFORE INSURANCE COMMITTEE

Last Thursday afternoon, the Insurance & Financial Services Committee held a public hearing on LD 813, An Act To Ensure That Hospitals Comply with the Laws Governing Transparency of Medical Billing, a bill that would provide for a patient's private right of action and substantial penalties for a hospital, ambulatory surgical facility, or potentially a medical practice that fails to comply with price transparency legislation enacted by the previous legislature.  Proponents of the bill were a nursing professor and student from Husson University.  Opponents were the MHA, MMA, and MaineHealth.  A work session is scheduled for this week.

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 21st 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 21st 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 1316, An Act Regarding the Employment of Certified Nursing Assistants and Direct Care Workers (monitor; geriatricians)

LD 1337,  An Act To Fully Fund the Family Caregiver Respite Program (monitor; psychiatrists)

LD 1340,  An Act To Enact the Preservation of Religious Freedom Act (oppose; sponsor has said he will not pursue this bill)*

LD 1344,  An Act To Protect Maine Consumers in the Individual Health Insurance Market and Support Maine's Economy (support)*

LD 1349,  An Act To Establish the Office of the Inspector General in the Department of Health and Human Services (monitor)

We also will revisit LD 1305,  An Act To Encourage Health Insurance Consumers To Comparison Shop for Health Care Procedures and Treatment (oppose)

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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.

For more information, contact Emily Edelman: emily.edelman@jax.org [return to top]

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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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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