POLITICAL PULSE: Legislature Adjourns; Constitutional Question Goes to the Law Court

The session-long tension between Governor LePage and the legislative leadership continued to the very end of the First Regular Session as the two branches of government disagree on the timing of the Governor's opportunity to act upon bills enacted by the legislature and sent to him for signature.  The outcome of some 70 bills depends on whether Executive branch's or Legislative branch's interpretation of the Maine Constitution is correct, an interpretation that is likely to be made by the Maine Supreme Judicial Court which has been asked by the Governor to make the final decision on the matter.  The Legislature did adjourn on July 16th.

The latest controversy arising out of Maine's divided government came to light on or about July 10th when the Legislature's Office of the Revisor of Statutes began "chaptering" or putting in a format to become law without the Governor's signature, some 19 bills held by the Governor's Office beyond the 10 days he had to act upon them.  The Governor's legal counsel issued an opinion that the Governor was entitled to hold on to the bills because the Legislature had finally adjourned.  Attorney General Janet Mills responded to a bipartisan inquiry from the Senate that the bills had become law because the Legislature had not finally adjourned.  Final adjournment of a legislative session traditionally is known as "adjournment sine die," or adjournment with no specified date of return.  When the Legislature left Augusta on June 30th, leaders planned to return on July 16th to finish their business, including further vetoes anticipated from Governor LePage.  The Governor continues to hold another 50 or so bills.   

 Several bills of interest to MMA appear to be caught up in the controversy.  Among those being "chaptered" and becoming law are LDs 1307 (diversion alert), 1145 (involuntary commitment), 1013 (shackling pregnant prisoners), 1108 (protect children from e-cigarette vapor), 1391 (treatment of forensic patients), and 91 (prescribing by dental hygienists).  Among the bills that may be held by the Governor are LDs 140 (access to naloxone), 787 (adult day care/respite care), 831 (targeted prevention services), 905 (Fund for a Healthy Maine study), and 1350 (reimbursement of direct care workers).

In the coming weeks MMA advocacy staff will prepare a summary of all the legislative action impacting physician practices and will make it available to all MMA members.  Advocacy staff members are also available to make grand rounds type presentations on the new laws and regulations impacting on the medical profession.  Medical staffs or practices wishing to have such a presentation should contact MMA EVP Gordon Smith, Esq. at gsmith@mainemed.com or call him at 622-3374 ext. 212.  There is a modest fee for these talks unless the institution is participating in the MMA group membership program or is in the FQHC membership program.

Fed Up With EHRs? Share Concerns During AMA Town Hall Tonight!

Physicians aren’t happy with the way electronic health record (EHR) systems are working, largely due to government regulations that have encroached on time with patients and turned physicians into typists.  If you’re frustrated with your EHR and looming meaningful use regulations, join a special town hall meeting that will be live-streamed online from 7 to 8:30 p.m. Eastern time Monday.

Among the national and local leaders who will be a part of the conversation will be Rep. Tom Price, MD, a Republican from Georgia’s 6th District, and AMA President Steven J. Stack, MD.  This event is hosted by the AMA and the Medical Association of Georgia in Atlanta, and local physicians can attend in person—sign up online. Those who live-stream the town hall can participate on Twitter with #FixEHR.

Government requirements have twisted EHR technology so it interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and creates new costs that divert resources away from patient care improvements.  Meanwhile, the much anticipated benefits of being able to share important patient health care information electronically among providers in different settings have gone unfulfilled.

Physician participation in Stage 2 of meaningful use is less than 10 percent, even though 80 percent of physicians have adopted EHRs. Moving forward with Stage 3 could mean less time with patients, hindrances to practice innovation and costly penalties.  The town hall will include information about the AMA’s push to reframe federal regulations and encourage better EHR design to emphasize high-quality patient care.

Learn more about why the Centers for Medicare & Medicaid Services should postpone Stage 3, and read more meaningful use news at AMA Wire. [return to top]

NEW LAWs: Two New Laws Impact Child Abuse Reporting Process

The Weekly Update begins this week a series of articles on new laws and regulations resulting from the actions of the 127th Legislature.  We begin this week with a new law impacting on the mandatory reporting of child abuse and neglect.  

CMS to Make ICD-10 Transition Less Disruptive

The October 1st hard deadline to implement the ICD-10 code set is just around the corner, but many physicians are concerned about potential claims disruptions that could result when implementing the code set into their practices. In response, the AMA worked with the Centers for Medicare & Medicaid Services (CMS) to ease the transition.

The AMA and CMS released a joint statement July 6th announcing a 12-month transition period during which time Medicare claims will not be denied solely based on the specificity of the diagnosis codes, as long as they are from the appropriate ICD-10 code family.

The changes address:

• Claim denials.  For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.
  
  This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding.  In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.
  
  Both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow this policy.


• Quality-reporting penalties.  Similar to claim denials, CMS will not subject physicians to penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.
  
  In addition, penalties will not be applied if CMS experiences difficulties calculating quality scores for these programs as a result of ICD-10 implementation.


• Payment disruptions.  If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.


• Navigating transition problems.  CMS said it will establish a communication center to monitor issues and resolve them as quickly as possible. This will include an “ICD-10 ombudsman” devoted to triaging physician issues.

The AMA will continue to work with CMS as the deadline approaches and following the implementation to address issues as they arise. Get eight must-have ICD-10 resources at AMA Wire®.

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CMS Issues New Medicare Payment Proposals

The Centers for Medicare & Medicaid Services (CMS) recently released the 2016 Medicare physician payment schedule proposed rule as well as a proposal for a new bundled payment program for hip and knee procedures.

In the rule, the agency proposes to adopt Current Procedural Technology (CPT®) codes and recommended values from the AMA/Specialty Society Relative Value Update Committee (RUC) to pay for advance care planning services.  It also seeks comments on potential coverage of collaborative care services and expansion of the Comprehensive Primary Care initiative.  The proposed rule also includes policy changes on misvalued codes, physician self-referral, appropriate use criteria for advanced diagnostic imaging and the value-based payment modifier.

The hip and knee bundled payment proposal would initiate a five-year mandatory test in which fee-for-service claims for inpatient, post-acute care and physician services for joint replacement procedures would continue to be submitted, but the hospitals would be responsible for reducing the total cost of these episodes up until 90 days after discharge, including physician and post-acute services.  The program would be mandatory for hospitals in 75 regions throughout the country.  After a reconciliation process, the hospitals could share in savings for the episodes or, if spending is above the amount set by Medicare, would have to repay the program for a portion of the overage.

The AMA is in the process of reviewing and analyzing both proposals and will submit public comments on them. Watch AMA Wire for more details. [return to top]

127th Legislature Recognizes Connie Adler, M.D.

During the final day of the legislative session, the 127th Maine Legislature recognized Connie Adler, M.D. who is retiring from Franklin Memorial Hospital after more than twenty years of service to the Frankly County community. Together with Tom Weigle, M.D. and Jay Naliboff, M.D., she joined what became Pine Tree Women's Care and subsequently Franklin Health Women's Care, where she has been the lead physician since 1999.  

Make Plans Now to Attend 162nd MMA Annual Meeting, September 11-13, 2015 in Bar Harbor

Registration material for MMA's upcoming Annual Session in Bar Harbor, from September 11-13, 2015 is in the mail to each MMA member this week.  The meeting once again will be at the Harborside Hotel & Marina and opens with a reception on Friday evening, September 11th.  Three hours of category one CME has been applied for and the focus of the meeting will be "Advocating for the Profession."  Please make plans soon to join your professional colleagues to discuss issues of common interest and to conduct the annual business of your association.  Anyone wishing to submit a Resolution for consideration should send it to EVP Gordon Smith via e-mail to gsmith@mainemed.com no later than August 15th.

Medicare to Pay for Counseling on End-of-Life Care, Effective January 1, 2016

On Wednesday, July 8th, the Centers for Medicare and Medicaid Services announced plans to pay physicians to counsel patients about end-of-life care, effective January 1, 2016.  The decision was announced by Patrick Conway, Medicare's chief medical officer who stated, "As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions . . . that are critical to high-quality care.   I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so."

New Online CME: Genetic Testing for Breast Cancer

Breast Cancer Genetic Testing CME courses: Content for MMA Weekly Update

Genetic Testing for Breast Cancer Risk

If you have determined that a patient has an increased risk for hereditary breast cancer, he or she may be a candidate for genetic testing. There are numerous options for breast cancer genetic testing, with different strengths and limitations depending on the patient’s personal and family history. This online education program gives clinicians an opportunity to practice evaluating how well a particular genetic test assesses breast cancer risk and the potential impact of testing on patient outcomes.

In this CME course, clinicians can practice identifying patients for breast cancer genetic testing and selecting the best testing option. Highlights of the program include:

·         Practice identifying candidates for single gene and multi-gene panel testing for hereditary breast cancer.

·         Strategies for efficient and cost-effective genetic testing.

·         Tips for discussing BRCA1 and BRCA2 testing with patients.  

·         Downloadable point-of-care tools that can be used in the clinic.

Visit Genetic Testing for Breast Cancer Risk 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]

Workers' Comp Proposes Medical Fee Schedule Changes

On July 9^th  the MMA staff submitted comments on the Maine Workers’ Compensation Board’s proposed rule changes relating to the medical fee schedule. Among the changes the Association supports are clarifications of the rules regarding patient authorizations (they are not required) and records (they are to be sent with each bill and paid for by the insurer/employer). The MMA also supports the change from a reimbursement formula to a fee schedule for durable medical equipment. We asked for clarification of references to such items as post-surgical care, which has no definition or time frame, whether “any visit” includes diagnostic testing, and whether a diagnostic code reference will be considered a sufficient “description of the injury” on requests for payment for services. The proposed rules also refer to ICD codes without any discussion about how the change from ICD-9 to ICD-10 will be handled by the agency.

Finally, the proposed rules have two fee reduction sections which the MMA opposes. The fee for the first page of copies is reduced from $10 to $5, although the per-page amount is increased from $0.35 to $0.45. More significantly, the facility base rates for ambulatory surgical units are proposed to be reduced over three years from the current $81.32 to $78.53. In comparison, the rates for acute care hospitals will rise from $108.42 to $143.59 and the rates for critical access hospitals will rise from $132.53 to $166.50 during that same time frame. The MMA voiced its strong objection to these changes, particularly since our members are prevented by contract from revealing what they are paid by commercial insurers and the Workers’ Compensation Board does not appear to have asked the insurers for that information before relying on demonstrably poor quality data upon which their consultant based its recommendations. We will continue to monitor and report on these proposed changes.

Job Openings

Family Medicine and Outpatient Internal Medicine Physicians

Waterville Pediatrics - Waterville, ME

Seeking both a Pediatrician and Pediatric Nurse Practitioner to join our expanding practice.  We provide pediatric care to thousands of Maine children of all ages.

Waterville Pediatrics is a well established practice with locations in Waterville and Madison.

Minimal call, competitive salary and benefits.

Please send letter of interest and CV to hsgentile@maine.rr.com

7/27/15

Winthrop Family Medicine Family Practitioner

MaineGeneral Medical Center in Augusta, Maine is seeking a full-time, outpatient BC Family Practitioner to join our nationally recognized Advanced Medical Home practice that delivers care in a team model. Join a collaborative group made up of 11 MDs, DOs, NPs and PAs and practice in an “Open Access” model of scheduling. Provide a full range of care including: OB, newborn and pediatric care, adult medicine, gynecology, geriatric and nursing home care. Technology includes an electronic medical record, online digital radiology program, and online hospital records and ordering. MaineGeneral offers a comprehensive benefits package. The brand new, state-of-the-art, 192-bed MaineGeneral Medical Center at the Alfond Center for Health offers comprehensive inpatient and outpatient services for the surrounding communities. We’re located just an hour north of Portland, Maine’s largest city, and three hours from Boston. Contact Tiffiny Lamarre, Physician Recruiter at tiffiny.lamarre@mainegeneral.org.

8/3/15

Family Medicine Physician

Oakland Family Medicine, a hospital-employed outpatient Family Medicine practice located in Oakland, Maine, is recruiting for an experienced Family Medicine Physician to join our growing team. Responsible for providing care for pediatric through adult patients while working in collaboration with our practice administrator, providers and senior management team as Oakland continues the transition to Patient Centered Medical Home. Join our team of four family medicine physicians and one physician assistant and collaborate with a unique mix of seasoned physicians who have practiced in the area over 10 years, and new team members who have recently joined our group. Weekly schedule will be 32 hours of patient contact time and up to 8 hours of administrative time. MaineGeneral offers a comprehensive benefits package. We’re located just an hour north of Portland, Maine’s largest city, and three hours from Boston. Contact Tiffiny Lamarre, Physician Recruiter at tiffiny.lamarre@mainegeneral.org.

8/3/15

Family Practice Physician – Bucksport Regional Health Center                                                                

The Bucksport Regional Health Center, a Federally Qualified Health Center, has a unique opportunity for an experienced Family Practice Physician to work at a small, independent, community-based primary care facility that offers great quality indicators, a team atmosphere, and excellent working conditions.  Responsibilities will include the diagnosis, treatment, coordination of care, preventive care and provision of health maintenance services to patients of all life cycles. 

Candidates must have graduated from an accredited medical school and completed a residency in Family Practice or Med/Peds, have a current State of Maine Medical License and D.E.A Certificate, and at least five years of experience in the practice of family or internal medicine. The successful candidate will be offered a generous compensation package, including a competitive salary and excellent benefits. 

The Bucksport Regional Health Center has been offering easy access to quality, affordable care for persons of all ages since 1974.  Interested applicants should apply with a resume and cover letter to Carol Carew, Executive Director, 110 Broadway, Bucksport, ME 04416 or via email at ccarew@brhc.info (or call 207-469-7371).

8/17/15

Physician/Medical Director – Nasson Health Care

Nasson Health Care is seeking a qualified clinical leader to work collaboratively with a team of health and administrative professionals to provide comprehensive primary care to patients while utilizing the Patient-Centered Medical Home model of care delivery.  

The Physician/Medical Director: 

• Provides advice and counsel regarding a broad range of clinical, clinical policy, programmatic and strategic issues required to achieve the short and long-term strategies and objectives of Nasson Health Care; 
• Provides direct clinical services and oversees physicians and advanced practice nurses; works in partnership with members of the practice team to manage the care of patients, assuring a high standard of medical care.

Qualifications include:

• A minimum of three years’ experience as a Medical Director of a primary care medical practice;  A degree from an accredited medical school in the U.S.,
• Board certification in Family or Internal Medicine;  An unrestricted Maine license to practice medicine, as well as a U.S. Drug Enforcement Agency license;
• Working knowledge of the core concepts of evidence-based practice, social and behavioral determinants of health, population-based care, integration of medical, behavioral health and dental care, and Meaningful Use of health information technology.

Sebasticook Valley Hospital (SVH) is a 25-bed modern critical access hospital located in Pittsfield which is 20 minutes north of Waterville, and 40 minutes south of Bangor, Maine’s second largest city. The hospital serves a population of 30,000 in this central Maine area.

An excellent opportunity is available for a full time Emergency Medicine Physician.  The Emergency Medicine Physician is responsible for the evaluation and management of patients who seek emergency care for a broad range of illnesses and injuries. 

This is an experienced ED staff treating approximately 13,000 patients annually. Flexible schedule working 12-14 12-hr shifts. We are seeking either an MD/DO board certified/eligible emergency medicine trained physician, or board certified/eligible FP with ED experience. The hospital has EMR, and is CPOE. The compensation and fringe benefits package is highly competitive.

Sebasticook Valley is an affiliate of Eastern Maine Medical Center, the tertiary care center in Bangor. The hospital has a helipad for transporting trauma cases by Life Flight.  SVH serves has a wide range of outpatient services, including over 20 specialty services.

For more information, please contact Sherry Tardy, PHR, AASPR, at 207-487-4085 or stardy@emh.org.

9/14/15

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Upcoming Events

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

General Information for 2015

When and where held:                           

              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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