Maine Enrollment of 84,000 in ACA Marketplace Exchange Continues to Beat Expectations

As of the last day of open enrollment on Sunday, January 31st, more than 84,000 Mainers had enrolled in health plans through the marketplace exchange, representing a 27% increase over 2015.  More than 15,000 of the enrollees are new this year, the remainder representing renewals.  

In 2015, 66,118 people enrolled and in 2014, approximately 45,000 people signed up.  Emily Brostek, Executive Director of Consumers for Affordable Care (CAHC), noted that Maine continued to see high enrollment, exceeding expectations.  "Again, Maine has seen high and rising enrollment numbers, which shows that people continue to welcome affordable plans they can get through the marketplace.  We've seen the numbers go up and up every year," Brostek noted.

Next MMA Weekly Legislative Committee Conference Call is Tuesday, February 9th at 8 p.m.

MMA Legislative Committee Chair Amy Madden, M.D. welcomes you to participate in the weekly conference calls of the MMA Legislative Committee.

The next MMA Legislative Committee weekly conference call for the Second Regular Session of the 127th Maine Legislature will take place tomorrow, Tuesday, February 9th 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:  1-302-202-1092

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 is a report generated through our tracking system software program called StateTrack from CQRoll Call.  Please click on the report link and you should go to the bills highlighted by MMA staff for review from the bills printed that day.  You will be able to click on a link to the text of the bill for review and you will find the same staff recommendations you have seen in the past - a suggested category or "profile," a suggested position (support, monitor, or oppose), and any medical specialty society or MMA committee that might have a particular interest in the bill.

Weekly Bills for Review, LDs 1579-1583: http://www.cqstatetrack.com/texis/statetrack/insession/viewrpt?report=56b8f7131a83&sid=&Report.workflow=

Top 4 Issues Physicians will Take to State Legislatures in 2016

Throughout the year to come, physicians will see some key issues play out across all 50 states as medical associations and policymakers put forth new legislation and protect existing policy on critical components to the practice of medicine.  Four issues weigh heavily at the top of the list.

Medical association leaders recently met in Tucson, Arizona, at the 2016 AMA State Legislative Strategy Conference to discuss the most imperative state legislative and regulatory priorities.  Leading the 2016 agenda are these four issues:

1. Ensuring physician-led team-based care.  Many state medical associations plan to strengthen care delivery through legislation that supports physician-led team-based care.  The states will be considering AMA model state legislation that encourages flexible, innovative health care teams under a framework of physician leadership to achieve the “triple aim”—providing the highest quality of care at the lowest cost possible while improving patient outcomes.

The AMA’s STEPS Forward™ collection offers several modules to help physician practices move toward team-based care.  These physician-authored modules include instructions for implementing team documentation, strengthening team culture, conducting effective team meetings and setting your practice up for successful change.

2. Improving patient health.  State and national medical specialty societies plan to expand efforts to advance legislation that will promote healthier communities.

Last year, incursions on the patient-physician relationship continued in many statehouses with legislation that attempted to prescribe the content of information exchanged between physicians and their patients.  In the year ahead, 11 state medical associations will promote legislation aimed at protecting the patient-physician relationship. Another big focus will be tobacco use and availability, with legislative efforts in 17 states.

3. Reducing prescription drug abuse and overdose.  The opioid overdose epidemic has cast a spotlight on pharmaceutical and prescribing issues, drawing the interest of state policymakers and placing considerable focus on prescription drug misuse, diversion, overdose and death.

22 state medical associations and two national medical specialty societies plan to consider legislation on the use of prescription drug monitoring programs (PDMP), while 15 states will look to expand access to naloxone and other overdose and abuse prevention efforts.

“America’s physicians must do a better job of using all available tools to help stop this epidemic,” Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees, recently wrote.   “Among the powerful tools in our arsenal that we must regularly use are PDMPs, enhanced education and naloxone.”

4. Managed care and payer issues.  Progress was made in 2015 to pass reforms and educate lawmakers on issues such as network adequacy, prior authorization, fair contracting and transparency of insurer practices. Expanded efforts and models bills from the AMA’s private payer campaign are intended to achieve further improvements on these issues in the year to come.

18 state medical association and seven national medical specialty societies are expected to focus on network adequacy legislation.  Additionally, 19 state medical associations plan to pursue legislative changes to prior authorization, which poses roadblocks to patient care, delays much needed services and can stall the delivery of patients’ treatment.

Other issues physicians will be taking to their state lawmakers this year include medical liability reform, Medicaid reform, and the legislative and regulatory environments for telemedicine and telehealth.

The AMA Advocacy Resource Center will continue to provide relevant legislative support to state and national medical specialty societies to advance these priorities through model bills and state-specific activity.

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Community Forum on Opioid/Heroin Epidemic this Week in Belfast, March 7th in Aroostook County

The Maine Opiate Collaborative has announced the next Community Forums, as follows

• February 10th:  Belfast, Troy Howard Middle School Cafeteria, 173 Lincolnville Ave., Belfast  6:00 - 8:00 pm.

• March 7th:   Fort Kent, at noon, location to be announced.

• March 7th    Presque Isle, evening, exact time and location to be announced.

Opiate Collaborative Treatment Task Force Meetings: 2/18, 3/3 and 3/17

The next three meetings of the Maine Opiate Collaborative Treatment Task Force meetings will be from 9:00 to 11:00 am on February 18th, March 3rd, and March 17th.  The meetings will be held at the offices of the Maine Medical Association at 30 Association Drive in Manchester, Maine.  All the meetings are open to the public.

New Federal Funding Proposal for Addiction Treatment

 Last week President Obama announced a proposal to provide more than $1 billion in new funding to expand patient access to treatment for opioid use disorder.  The funding announcement is a follow-up to the White House’s high-priority initiative to prevent opioid and heroin overdose deaths and expand access to treatment announced last October.

Ninety percent of the new funding will go to support cooperative agreements with states to expand access to medication-assisted treatment by increasing treatment capacity and making services more affordable.  Expanding treatment access is one of the five major goals of the AMA Task Force to Reduce Opioid Abuse and the AMA applauded the funding announcement.

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POLITICAL PULSE: Governor LePage Issues State of the State Letter to Leglslature

Today, Governor LePage issued a 7.5-page State of the State letter to members of the 127th Maine Legislature in which he referred to "socialist politicians in Augusta" who have "wasted so much time over the past year" and complained generally about the legislative branch of government.  You can read the Governor's press release on the letter and find a link to the letter itself on the web here.

With no supplemental budget and relatively few new bills before the legislature this session, the MMA staff is focusing on a few important carry-over bills from the 2015 session, including those on the licensing of Certified Professional Midwives (CPMs) (LD 690); price transparency and "shoppable services" (LD 1305); ACA Medicaid expansion (LD 633); a so-called "patient compensation" system as an alternative to the current medical liability system (LD 1311), as well as several new bills dealing with the opioid abuse problem in Maine.  Last week, MMA also participated in continuing work sessions before the HHS and Criminal Justice Committees respectively, on bills proposing a revised approach to a MaineCare ombudsman service (LD 1498) and a secure, therapeutic treatment unit in Maine jails (LD 440).  Tomorrow afternoon at 1 pm, the Judiciary Committee will hold a public hearing on LD 1311, the patient compensation system proposal.  MMA attorneys Gordon Smith and Peter Michaud each are scheduled to testify in opposition to the bill joining colleagues from the Maine Hospital Association, Medical Mutual Insurance Company of Maine, and other medical interests.

Avoid Meaningful Use Penalties: Apply for Exemption by March 15th

Physicians have until March 15th to apply for a hardship exemption from the electronic health record (EHR) meaningful use financial penalties for the 2015 program year.  Those who don’t apply could face up to a 3 percent cut in their Medicare payments in 2017 since the meaningful use program operates on a two-year look-back period.  New this year, individuals can apply on behalf of a group of physicians.

Everyone should apply:  The Centers for Medicare & Medicaid Services (CMS) has stated that it will broadly grant hardship exemptions as a result of the delayed publication of the Stage 2 meaningful use modifications rule, which left physicians with insufficient time to report under the modified program requirements issued in late 2015.

This inclusive approach to hardship exemptions is a result of the Patient Access and Medicare Protection Act, passed just before Congress adjourned for the holidays, which directed CMS to make AMA-supported changes to the previously limited exemption process.

All physicians should apply for the exemption since there isn’t a downside to doing so.  Even physicians who believe they met the requirements of the meaningful use program in 2015 can apply.  Submitting an application for a hardship exemption will not prevent those who qualify from receiving an incentive payment.

How to apply:  Physicians should be sure to submit their applications before midnight Eastern Time on March 15, 2016.  To get started, download an application from CMS and consult step-by-step instructions (log in) the AMA compiled to help simplify the submission process.

While CMS has given a deadline for applications, it has not yet indicated when physicians will receive confirmation of their exemption status.  [return to top]

DHHS Proposes Amendments to MaineCare Ambulatory Surgical Center Rule

The Maine Department of Health & Human Services has proposed amendments to the MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services.  The Department's summary of the proposed changes to the rule is below.

Concise Summary: The Department proposes to align MBM, Section 4, Ambulatory Surgical Center (ASC) Services with the current ASC reimbursement methodology as defined by the outpatient prospective payment system (OPPS) by the Centers for Medicare and Medicaid Services (CMS). The Department also proposes to reimburse physicians or other qualified providers at the facility rate listed in the MaineCare Fee for services delivered in ASCs. CMS-defined all-inclusive rates include prosthetic devices that are considered integral to covered surgical services; MaineCare will no longer reimburse ASCs separately for prosthetic devices that are outside of the all-inclusive rate for covered surgical procedures. Members may procure medically necessary prosthetics through a durable medical equipment provider, physician, or other appropriately licensed provider in accordance with the applicable section of the MBM. Language is also added to Section 4.04 (B), Ancillary Services, to reflect that certain radiology services are eligible for separate payment under the OPPS. Section 4.05, Non-Covered Services, is amended to clarify that per CMS determination, surgeries performed in ASCs are not expected to result in extensive blood loss; when there is a need for blood products, MaineCare considers this a facility service and no separate charge is permitted. Language is also added to describe in more detail which services and supplies are non-covered and where else these services may be covered in the MBM. This rulemaking also adds a general description of which surgical procedures are approved for delivery in an ASC, deletes components of the all-inclusive rate that were listed twice, more closely aligns reimbursement language with the CMS approved State Plan Amendment, removes the disclaimer that the section is dependent upon approval from CMS because approval has been granted, updates the MaineCare provider website URL, and makes minor formatting edits. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.  

A public hearing on the rule is scheduled for Tuesday, February 9, 2016 at 1:00 p.m. in Room 401 of the Cross State Office Building.  The deadline for written comments which may be made online by following the link above, is February 19th.  The MMA staff will compile any comments we receive and submit them by the comment deadline.  If you have an opinion on the rule, please contact Andrew MacLean, Deputy EVP & General Counsel at amaclean@mainemed.com or 622-3374, ext. 214.  [return to top]

Failure of Communication Leads to $1.8M Malpractice Award

The Case:  After deliberating only three hours, a Penobscot County jury rendered a $1.8 million verdict in favor of a Millinocket couple in a case involving the failure to communicate lab test results.  The jury found that all parties to the case, including the patient, breached their standards of care.

The Facts:  John Pierce sued his physician and the hospital that performed the blood tests, which occurred when he visited the emergency room with complaints of recurring fever, shortness of breath and lack of energy.  The test results showed he had a streptococcal infection, but the hospital failed to communicate them to his treating physician.

The evidence showed that a hospital nurse did call Mr. Pierce with the results and told him to return to the hospital, which he did not do, although he did return to his physician a few days later.  The progress notes from that visit showed that he stated the test results were negative.  Mr. Pierce testified that he did not remember the content of his conversation with the nurse, nor did he remember what he said to his doctor.  Treatment was delayed for several months until the patient underwent emergency heart surgery for damage to his heart valves.

How the Lawyers Saw It:  The plaintiffs’ attorney characterized the underlying facts as being, “about a problem in health care that affects everyone, the lack of communication between providers, with results that can be catastrophic.”  Attorney Ben Gideon went on to say that in this case there was a break in trust between the patient and the doctor and hospital involved. Because the jury also found that the patient was partially at fault, it reduced the award from the original $2.1 million amount.

The hospital’s attorney, James Martemucci, admitted to the jury that his client had made an error in failing to send the test results to the patient’s doctor.  The hospital has changed its practice and now duplicates its communications, both sending the test results to the physician and calling the physician to report the results.

The physician’s lawyer stressed the role of communication in this case.  “Inaccurate communication got everything steered down the wrong path,” said Mark Lavoie.  “If you rely on a patient to accurately communicate test results, you do so at your peril.

Important Lesson:  This case illustrates the importance of communication, both in the physician-patient relationship and in the relationship between the physician and other members of the treatment team such as hospital emergency departments, nurses and labs.  It also shows that communicating results to a patient may not be enough, since a patient may be too sick to remember or pass on the results or may simply fail to do so. According to research reported in the November Journal of the American College of Radiology, cases involving a failure to communicate test results accounted for 2.31% of cases (and $91 million in payments) in the National Practitioner Data Bank in the year 2009.

Watch for Maine Medicine in the Mail this Week

The 2016 first quarterly issue of Maine Medicine will be mailed to you early this coming week.  Watch for your copy in the mail and please review the five inserts which contain additional information of interest.  This issue of Maine Medicine includes articles on the current opioid/heroin problem, MMA's work to license Certified Professional Midwives, and the regular column by MMA President Brian Pierce, M.D., the EVP Corner, the Legislative Report from Andrew MacLean, the Public Health report by Peter Michaud, and the regular article by Quality Counts Director Lisa Letourneau, M.D., M.P.H.

Previous issues of Maine Medicine are archived and available on the MMA website at www.mainemed.com.

Upcoming Events
 

MCMI Training Programs – Level 1 and Level 2

General Information for 2016

When and where held:

              March 11, 2016 in Bangor at St. Joseph’s Hospital  

              April 8, 2016 in Presque Isle at UMPI                   

              June 10, 2016 in Waterville at Colby College

              October 25, 2016 in Portland in conjunction with the Maine Brain Injury Conference

                                (Registration and fees will be through the Maine Brain Injury Conference for October 25)

                 March and April programs will be morning only with Level 1 and Level 2 at the same time.

               June and October programs will be Level 1 in the morning and Level 2 in the afternoon.

Training Programs:

              Level 1 – An Introduction to Concussions and Concussion Management

                            Speaker: Deb Nichols, CPNP or Peter Sedgwick, MD or Bill Heinz, MD

                           Level of Difficulty: beginner

                           Content: The Diagnostic and Return to Play Dilemma

                                           How Concussion Occurs and Pathophysiology            

                                           Concussion Signs and Symptoms

                                           Concussion Evaluation Tools

                                           Concussion Treatment

                                           Recovery Epidemiology

                                           Return to Function – Academics and Play

                                           Risk Factors and Protective Equipment

                                           Short and Long Term Sequelae

                                           Neurocognitive Testing

                                           Concussion Sideline Assessment

                                           Key Points

              Level 2 – Advanced Concussion Management (Level 1 is a prerequisite for taking Level 2)

                           Speaker: Mike Rizzo, FNP-C, CIC or Paul Berkner, DO

                           Level of Difficulty: intermediate

                           Content: Updates from Zurich 2012       

                                           Using ImPACT Testing in Concussion Management

                                           Interpreting ImPACT Test Results

                                           Concussion Case Reviews

Schedule:

              March and April – Level 1 and Level 2 (Offered at same time)

                           8:00am – 8:15am           Registration

                           8:15am – noon               Training Program

              June – Level 1:

                           7:45am – 8:00am           Registration

                           8:00am – noon               Training Program

                           Level 2:

                           12:15pm-12:30pm          Registration

                           12:30pm – 4:30pm         Training Program

Registration Fee:           

              For morning only training programs: March 11 and April 8

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, AT, 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

              For morning and afternoon training program: June 10

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, AT, RN, PT, OT, SLP)

              $175 for Health Care Professionals taking Level 1 and Level 2 - Only June 10

              $40 for school personnel and all other attendees                                                                                                              (School nurses, coaches, athletic directors and administrators, etc.)

              $70 for school personnel taking Level 1 and Level 2 - Only June 10

              $20 for students currently enrolled in a college program            

              $35 for students taking Level 1 and Level 2- Only June 10

CME/CEU contact hours: 3.50

Registration Confirmation will be sent by email.

Refund / Cancellation Policy: If you need to cancel contact Jan Salis, PT, ATC. You can choose to apply your registration fee to another training program or have your check returned.

For more information contact:

              Jan Salis, PT, ATC

              MCMI - Membership and Education Committee - Chair

              jsalis@aol.com

              (207) 577-2018

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Job Openings

Relocate to Beautiful Southwestern Maine

Full-time family practice physician wanted for multi-service, progressive, rural federally qualified community health center in a medically underserved area. Services on site include integrated primary care, dental services, family planning, mental health counseling, psychiatry, nutritionist, optometry, podiatry, social services support, sliding fee coverage, care management, radiology and lab services. NextGen EMR. Practice is outpatient only with no OB. On-call rotation is 4-5 times per month. NCQA Level III PCMH. Located in Porter, ME, between Portland and the White Mountains. Area is known for terrific four season recreational activities. Just two and one-half hours from Boston. Submit CV to: Nancy Buck, Human Resources Coordinator, (nbuck@svhc.org), Sacopee Valley Health Center, 70 Main Street, Porter, ME 04068. EOE. www.svhc.org Sacopee Valley Health Center is an equal opportunity provider and employer .

3/7/16

EXECUTIVE DIRECTOR - Sacopee Valley Health Center

Sacopee Valley Health Center, a federally qualified health center located in Porter, Maine, seeks a full-time Executive Director to provide leadership, overall direction, and management of programs, operations, and finances of the Corporation.  Advanced degree in healthcare administration field and/or business administration with two to five years senior management experience, preferably in health care or equivalent combination of education and management experience is required; not for profit management experience preferred. Anticipated start date is June 1st. 

Submit resume and letter of interest by February 19th to:  nbuck@svhc.org or Human Resources Coordinator, Sacopee Valley Health Center, 70 Main Street, Porter, ME 04068 Sacopee Valley Health Center is an Equal Opportunity Provider and Employer

HOSPITALIST

Northern Maine Medical Center, a 49-bed JCAHO accredited hospital nestled in the foothills of the St. John Valley, is seeking a Hospitalist to provide inpatient care. MD/DO, BE/BC in internal medicine, and Maine Medical licensure or immediate eligibility for licensure required.  Area offers a casual, laid-back lifestyle in a crime-free environment which is a great place to raise a family. Interested candidates should send CV to Dorine Deschaine, Recruiter, Northern Maine Medical Center, 194 East Main St., Fort Kent, ME  04743 or e-mail to: dorine.deschaine@nmmc.org or call at (207) 834-1434.  Equal Opportunity Employer.

2/29/16

PSYCHIATRIST

Northern Maine Medical Center, a 49-bed JCAHO accredited hospital, Psychiatric Units; 9-bed Adult, 7-bed Child, is seeking a Psychiatrist to provide inpatient/outpatient care. Maine Medical licensure or immediate eligibility for licensure required.  Area offers a casual, laid-back lifestyle in a crime-free environment which is a great place to raise a family. Interested candidates should send CV to Dorine Deschaine, Recruiter, Northern Maine Medical Center, 194 East Main St., Fort Kent, ME  04743 or e-mail to: dorine.deschaine@nmmc.org or call at (207) 834-1434.  Equal Opportunity Employer.

2/29/16

Experienced Internist or Family Physician Wanted for Per Diem Work 

Southern Maine Geriatrics Associates (SMGA) is recruiting physicians to work for physicians and midlevel providers during vacations and CME in a long term care practice in skilled/rehab, nursing home and assisted living.  Great work-life balance.  No call, no weekends, no holidays with hours typically 8 to 5.  Southern Maine Geriatrics provides geriatric medical care to residents in facilities in southern and central Maine.   Must have current Maine license, DEA, and meet hospital credentialing requirements.  Interested candidates should send their CV to Susan Pratt, Southern Maine Geriatrics Associates, 50 Marquis Road, Freeport, ME  04032,pratts@smga.me.  

2/22/16

E.M. BC/BP Physicians

St. Joseph Hospital is recruiting E.M. BC/BP physicians for its dedicated group.  Collegial, nurturing workplace with latest technology and just-completed expansion.  Members support each other and know patient satisfaction is achieved through staff satisfaction.  Leadership development and participation in policies and direction available. 

Equitable scheduling based on 1440-1472 clinical hours per year; more flexible arrangements available. 

Staffing: 51 hours per day, mostly physicians, for 27,000 visits.  We have great E.D. nurses.   

Area offers many cultural attractions, including the University of Maine, natural and organic food producers, pleasant pace, low crime, friendly people, great public schools and affordable housing.  Acadia National Park, Baxter, scenic towns and harbors, Sugarloaf,  I-95 and Bangor International Airport are right here or close.

Highly competitive package includes relocation, signing bonus, loan repayment, retirement and protected vacation and CME time with allowance.

Contact: Charles F. Pattavina, MD, F.A.C.E.P., Chief, Emergency Medicine at 207.907.3350  or cpattavina@sjhhealth.com

7/18/16

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 mlefay@kvhc.org or visit our website at www.kvhc.org.  KVHC is an equal opportunity employer.

2/22/16

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