December 7, 2015

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MMA Board Votes to Oppose Health Plan Mergers
At its Board meeting last week, directors voted unanimously to oppose the announced mergers of Anthem and Cigna and Aetna and Humana stating that consolidating four of the five largest health plans in the nation into three companies is not in the best interest of patients or physicians.
Previously, at the MMA's Annual Meeting in September, members had passed a resolution asking the regulatory authorities to apply traditional antitrust laws to the mergers.  AMA data collected each year shows Maine's health plan market to be highly consolidated, although the consolidation has been weakened by the arrival of Community Health Options which was formed as a co-op under the provisions of the Affordable Care Act.

Within the past month, the American Medical Association communicated to the regulatory agencies its opposition to both mergers through a letter from EVP James Madara, M.D. which set forth a detailed analysis of the antitrust implications of the mergers in several areas of the country with highly consolidated market places for health insurance.


MMA Legislative Committee Meets Tonight

The MMA Legislative Committee will hold its first meeting for the new legislative session on tonight at 6 p.m. at the MMA Offices in Manchester. If you can't make it but can call in, the number is 1-302-202-1092, and the PIN is 7297185.

The Committee, chaired by Amy Madden, M.D., will review bills that will be considered in the 2016 session and  discuss other legislative/public policy issues.  Any MMA member is welcome to attend but we appreciate your letting Sarah Lepoff at MMA know by e-mail to  

It is particularly important for specialty society leaders to attend so that MMA and our advocacy team can be aware of any unique issues and interests the specialties may have.

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Opioid/Heroin Task Forces to Meet Thursday, Dec. 17

All three of the Task Forces of the Anti-Opiate/Heroin Initiative have now met at least three times and are scheduled to meet again.   The Prevention/Harm Reduction Task Force will meet again from 1:00pm to 3:00pm on Dec.17 and the Treatment Task Force will meet from 9:00am to 11:00am  the same day.  Both meetings will be held at the Maine Medical Association.  Following those meetings, the Prevention/Harm Reduction Task Force will meet on Thursdays from 1:00 to 3:00pm on Jan. 7, 21 and Feb. 4. These meetings will also be held at the offices of the Maine Medical Association in Manchester, Maine.  

The meetings are all open to the public and the notices, agendas and minutes will be posted on the U.S. Attorney's Website.

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MHMC, MMA and AMA Offer Free Webinar on Dec. 16 (noon) on Physician Satisfaction

The Maine Health Management Coalition and MMA collaborate again in December, along with the AMA, with a free noontime webinar, PROVIDER SATISFACTION;  THE KEY TO ACHIEVING THE QUADRUPLE AIM.   Presenters will be Ellie Rajcevich, MPA, Practice Development Advisor, American Medical Association and Michael Tutty, PhD, MHA, Vice President of Professional Satisfaction and Practice Sustainability, American Medical Association.

Provider satisfaction is a powerful driver of the Triple Aim outcomes - better care, better health and lower cost.  Yet nearly half of all U.S. physicians exhibit at least one sign of burnout, which contributes to professional dissatisfaction and increases the likelihood of mistakes, patient and team dissatisfaction and physician intent to leave the practice.  The Quadruple Aim prioritizes provider satisfaction with the Triple Aim outcomes.  Improvements in clinical workflows, teamwork and communication are among the most potent antidotes to burnout that can enhance professional satisfaction and achieve the Quadruple Aim.  This session will provide an overview of the AMA's work in professional satisfaction and tangible solutions that can be implemented in the practice setting.

There is no cost to join the webinar but you must register at under News and Events.

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File by Dec. 16 to avoid Medicare pay cut of 2-4 percent

From the AMA:

Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don’t take action now.

Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians.

How to avoid the penalty: File an informal review request with CMS before midnight Eastern time Dec. 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request.

Additional information about the process and contact information for questions is available in CMS’ informal review fact sheet.

Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time.

Think it shouldn’t be this way? We agree. That’s why the AMA is pressing CMS to rectify the impossible situation in which it has placed physicians.

A letter (log in) sent Tuesday to CMS calls on the agency to not impose 2016 PQRS penalties or negative value-based payment modifier adjustments on physicians who attempted to comply with PQRS requirements during the 2014 reporting period.
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A No-Cost Resource for Supporting Maine Physician Practices: Introducing the Northern New England Practice Transformation Network

Maine Quality Counts and regional partners have created the Northern New England Practice Transformation Network (NNE-PTN), a federally-funded set of resources and learning available to practices at no cost.  The NNE-PTN is a collaborative effort of trusted organizations that is offering support to primary care, specialist, and behavioral health clinicians to improve the health of patients, improve the health and vitality of clinicians and practice teams, and strengthen the financial health of practices. 

Interested practices can register for participation in the NNE-PTN online at

For more information, visit the Maine Quality Counts website at, or contact Lesley Myska at tel. 207.620.8526, ext. 1007 or  

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Maine’s “Wrongful birth” Restriction Challenged in Court

The Bangor Daily News reports that a Maine woman has sued a federal health clinic and Merck after giving birth to a healthy baby following a procedure in which a long-term contraceptive device was to be implanted in her arm. Kayla Doherty, who was 21 at the time she gave birth, claims the device was never placed in her arm. When she learned she was pregnant, she returned to the clinic to have the device removed, at which time she was told it could not be located. At Inland Hospital, “The ultrasound tech said it was never inserted, that it had never been placed in me, so it was possible to get pregnant,” she said. The device is 1.6 inches long and is designed to be implanted subcutaneously in the area between the biceps and triceps muscles.

The lawsuit alleges that Merck manufactured a defective product with a history of insertion problems, and she claimed that the clinic physician was negligent in the insertion process and failed to obtain her informed consent. Defense attorneys have responded by saying, in part, that Maine’s “Wrongful Birth” statute (Title 24, Section 2931) does not recognize the birth of a healthy child as an actionable injury. That statute says, in part, “No person may maintain a claim for relief or receive an award for damages based on the claim that the birth and rearing of a healthy child resulted in damages to him.” The law does recognize claims for the birth of “an unhealthy child” or for maternal death or injury resulting from medical negligence.

One unusual aspect of the case is the claim that Doherty’s medical record states that one device, Implanon, was implanted, but the billing records refer to a different device, Nexplanon. Both are manufactured by Merck.

The U.S. District Court is expected to refer to the Maine Supreme Judicial Court the question of whether the statute is constitutional.

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Health Care Spending in the Nation Increased 5.3% in 2014 Reaching $3 Trillion

According to an analysis by CMS published last week in the well-known journal Health Affairs, annual health spending in the U.S. jumped 5.3% to $9,523 per person.  The increases outpaced the country's growth in GDP by 1.2%.  The two major drivers of the increase were expansion of insurance coverage through the ACA and increases in prescription drug spending. Drug spending grew more than 12% to $297.7 billion, representing its largest annual increase in more than a decade.  Hepatitis C drugs alone accounted for about a third of the drug spending increase.

In 2014, 2.2 million people gained private insurance coverage and another 7.7 million enrolled in Medicaid, mostly due to enhanced eligibility provisions in the ACA.  Maine is among a minority of states and the only state in New England which has not accepted the federal funds available under the Medicaid expansion provisions in the ACA.

Overall, government and private health insurance were the source of nearly three quarters of the health spending.   Out-of-pocket spending by consumers on co-payments, deductibles and coinsurance made up 11 percent of health spending.

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CMS Proposes Flexible Collaborative Practice Rule

The Centers for Medicare & Medicaid Services have proposed a rule that includes the second phase of regulations implementing the Affordable Care Act’s patient safety requirements.

According to the ACA, a qualified health plan may contract with a hospital that has over than 50 beds only if that hospital uses a patient safety evaluation system as described in the Patient Safety and Quality Improvement Act of 2005.  “Reasonable exceptions” to the PSES requirement are allowed.

The first phase of implementation for this section of the ACA, effective for plan years beginning on or after January 1, 2015, is based on compliance with the Medicare Hospital Conditions of Participation for quality assessment and performance improvement and discharge planning.  Hospitals must provide qualified health plans with their CMS Certification Numbers to demonstrate that they meet the conditions.

The proposed regulations for phase two, which would apply to plan years beginning on or after January 1, 2017, would require hospitals to continue to demonstrate compliance with the Conditions AND either:

·       Have an agreement with a patient safety organization and a mechanism for comprehensive person-centered hospital discharge; or

·       Implement other evidence-based initiatives to reduce harm and improve quality.

If a hospital chooses to have an agreement with a patient safety organization, the rule would require plan issuers to verify that the hospital uses a patient safety evaluation system as defined in the current regulations.

The plan issuer would also be required to verify that the hospital has a mechanism for comprehensive person-centered hospital discharge to improve care coordination and quality for each patient.

For hospitals choosing not to have such an agreement, CMS would allow them to implement other “evidence-based initiatives to reduce all cause preventable harm, prevent hospital readmission, improve care coordination and improve health care quality through the collection, management and analysis of patient safety events.” 

To demonstrate compliance, CMS proposes that a QHP issuer collect information from contracted hospitals, such as a copy of the current agreement to partner with a PSO or QIO.  The documentation would need to reflect the implementation of PSO and discharge planning activities or other patient safety initiatives.

The deadline for comments on the proposed regulations is December 21, 2015.

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Maine DHHS Holds Public Hearing on New Telehealth Rules

On Monday, December 7th, the Maine Department of Health and Human Services held a public hearing to take testimony on the recent proposed rules dealing with telehealth in the MaineCare context. Among other changes, the proposed rules allow use of telehealth for all medically necessary services that can be delivered remotely at comparable quality; provide for an "originating site fee" to be paid to the site where the patient is located, while the remote, or provider, site bills for the services rendered; requires the use of secure, HIPAA compliant equipment; and requires member choice, written informed consent and member education.

 The Maine Medical Association provided testimony to the Department supporting the changes in general and asking for reconsideration of some parts of the rule, including the requirement that a patient have two hospital or ED admissions in order to qualify for use of telehealth, the requirement of patient presence during a consult, and the limitation of reimbursement to only one professional side of the interaction.

 Any member of the public is allowed to comment on the proposed rules, and the deadline for comments is Thursday, December 17th. A summary of the proposed rules is proviced in the Notice of Agency Rule-making Proposal, which can be found at The notice also provides information on the rule-making process, including a description of how to comment on the new rules. [return to top]

Health Insurance Marketplace Update: Open Enrollment for 2016

Health Insurance Marketplace Open Enrollment for 2016 goes through January 31, 2016. 

For coverage to begin on January 1, 2016, the deadline to enroll is December 15, 2015.

Consumers can get more information and apply online at HealthCare.Gov. Patients who currently have a 2015 health insurance plan through the Marketplace should review their plans and either renew coverage or select another plan for 2016 by December 15 to avoid any break in coverage. 5 Steps to Staying Covered Through The Marketplace

For more information or resources for your patients, contact ACA Outreach Coordinator Sue Kring at or 662-2364.  More information and links to Marketplace resources are available at the Maine Medical Association website.

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Job Openings

Family Medicine Physician

Growing Direct Primary Care practice in Rockport, Maine is looking for the right family medicine physician to join our practice. 

Includes pediatric and adult outpatient care without OB, but skills that add value for patients are highly desired, such as: Office orthopedics, procedures, occupational medicine, DOT & USCG exams, ultrasound and buprenorphine waiver, etc.

Emergency room or hospitalist credentials may be helpful during the start up phase. 

For more information, please email Practice Manager, Jennifer Overlock, at answers@megunticookfamilymedicine, or call 207-390-8570.


Family Medicine/ Outpatient Internal Medicine Physician

As a result of our continuous growth, Katahdin Valley Health Center is recruiting a Family Medicine/ Outpatient Internal Medicine Physician that is committed to providing quality health care services to the people in Brownville/Millinocket Maine.   Join our practice in a newly renovated facility.  KVHC is a fully electronic medical record site and offers a four day work week with a competitive salary and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off and $2500 annually toward CME. Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.  

To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at or visit our website at  KVHC is an equal opportunity employer.


Maine Judicial Branch Seeks Civil Involuntary Commitment and Treatment Examination Services

A copy of the RFP can be obtained from the MJB’s RFP Coordinator: Laura O’Hanlon, Esq., Chief of Court Management at:, or mailing address:  Administrative Office of the Courts, P.O. Box 4820, Portland, ME 04112-4820. All communication about the RFP must be in writing.  The MJB encourages all interested vendors to obtain a copy of the RFP and submit a competitive proposal.

Proposals must be submitted to the State of Maine Division of Purchases, located at the Burton M. Cross Office Building, 111 Sewall Street, 4th Floor, 9 State House Station, Augusta, Maine, 04333-0009 by 2:00 pm, local time, on December 28, 2015.

The State of Maine Judicial Branch (MJB) seeks Examiners for mental health services statewide to provide examinations of individuals subject to involuntary commitment and involuntary treatment proceedings under Title 34-B of the Maine Revised Statutes.  In accordance with State procurement practices, the MJB has announced the publication of Request for Proposals (RFP) # 201510191 for the purchase of those services.


Full Circle Family Medicine Seeks Family Practitioner

An opportunity awaits you in the heart of Mid-Coast Maine - you are able to live, play and work in one of Maine’s beautiful coastal villages.  Our Medical Practice is in Damariscotta, just an hour northeast of Portland, Maine’s largest city, and three hours from Boston.

Full Circle Family Medicine, is in search of a Family Practitioner to wanting join our NCQA recognized Patient Centered Medical Home practice.  We are proud to be a physician owned, independent practice which includes three MDs and three PA’s.

Job Details and Requirements:

  • Provide a full range of care including: newborn and pediatric care, adult medicine, gynecology, geriatric and nursing home care
  • Telephone Call Coverage
  • Electronic Medical Records

Benefits of practicing at Full Circle Family Medicine include:

  • Competitive salary
  • Generous earned time program
  • Health Benefits
  • CME time and dollars
  • Retirement plans with employer match
  • Malpractice Coverage

For more information contact Wendy Williams, Practice Manager at or (207) 563-6623 option 7.  


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 (or call 207-469-7371).



Inland Hospital Family Practice is seeking a full time Family Medicine Physician without OB to join the employed practice in Oakland.

The practice has been serving the greater Waterville/Oakland area for many years. The practice provides care for infants, pediatrics through geriatric care. A competitive salary with incentives, plus full benefits is offered along with assistance with medical education debt, paid time off, paid CME, and relocation allowance. Qualifications: Board Certified/Eligible in Family Practice. This site is not eligible to sponsor a J-1 waiver.

Inland Hospital is a dynamic healthcare organization that believes in putting the patient first in every way. We are a 48-bed community hospital in Waterville; Lakewood, a 105-bed continuing care center on the hospital campus; 18 primary and specialty care physician offices in Waterville and five surrounding communities. Inland has been a proud member of EMHS since 1998. Inland patients have seamless access to a higher level of care when needed.

For further information, please contact:

Sherry Tardy, Director Business Development/Provider Recruitment, Inland Hospital by email at: or by phone at: 207-487-4085.


Department of Psychiatry Faculty Position

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, in a productive collaboration with the State of Maine, is seeking psychiatrists to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

Riverview Psychiatric Center is a 92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient treatment center for Maine’s public mental health system.  Psychiatrists with expertise in general inpatient psychiatry or forensic psychiatry are encouraged to apply.

Academic duties can include teaching and supervision of medical students and residents. Research opportunities available and encouraged.

Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to  Please reference search number PS0314D.

Dartmouth College/Dartmouth Hitchcock Clinic/Geisel School of Medicine is an equal opportunity/ affirmative action employer with a strong commitment to diversity. In that spirit, we are particularly interested in receiving applications from a broad spectrum of people, including women, persons of color, persons with disabilities, veterans or any other legally protected group.



As a General Surgeon in the Air Guard, you’ll adapt the skills and knowledge you’ve gained in your civilian career to the military environment.  You’ll provide urgent treatment to Air Guard personnel sick or wounded during duty, and regular healthcare to personnel training in your unit.


The Air Guard gives you the opportunity to serve your community and country with pride, and help people in a whole new way. If you still have student loans, you may be eligible for the Student Loan Repayment Program, or you can potentially get money for college that transfers to your dependents through the Montgomery G.I. Bill.

Besides a monthly paycheck, as a member of the Air Guard you’ll receive low-cost life insurance, a military retirement plan, and eligibility for VA home loans. With more than 140 Air Guard bases in the United States, Puerto Rico, Guam, and the U.S. Virgin Islands you’ll be able to serve where you live, without interrupting your civilian medical practice. And as an Air Guard member you’ll have access to Base Exchange and Commissary shopping as well as free available air travel.

Learn More Today

Go to or call 1-800-To-Go-ANG to find out how you can become an important member of America’s homeland defense in the Air Guard.


Orthopedic Surgeon

The Air Guard Orthopedic Surgeon examines, diagnoses, and treats diseases and injuries of musculoskeletal system by surgical and conservative means. In this role, you’ll manage orthopedic surgery services as well as oversee the administration of anesthetics and provide diet recommendations in addition to performing surgical procedures.


The Air Guard gives you the opportunity to serve your community and country with pride, and help people in a whole new way. If you still have student loans, you may be eligible for the Student Loan Repayment Program, or you can potentially get money for college that transfers to your dependents through the Montgomery G.I. Bill.

 Besides a monthly paycheck, as a member of the Air Guard you’ll receive low-cost life insurance, a military retirement plan, and eligibility for VA home loans. With more than 140 Air Guard bases in the United States, Puerto Rico, Guam, and the U.S. Virgin Islands you’ll be able to serve where you live, without interrupting your civilian medical practice. And as an Air Guard member you’ll have access to Base Exchange and Commissary shopping as well as free available air travel.

Learn More Today

Go to or call 1-800-To-Go-ANG to find out how you can become an important member of America’s homeland defense in the Air Guard.




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