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Anthem-Cigna Merger Set for Trial Nov. 21 with Decision Expected by Dec. 30
The Federal Judge Overseeing the U.S. Justice Department attempt to stop the proposed merger of Anthem and Cigna health plans stated on Friday that the trial would begin on Nov. 21 with a conclusion by Dec. 30. Judge Amy Berman Jackson gave the government 10 days to present its case and gave Anthem 6 days to respond.
The proposed merger of Anthem and Cigna, which would create the largest health plan in the nation, has been opposed by the American Medical Association and many state medical societies, including MMA. The Justice Department filed lawsuits on July 21 asking the federal court to stop both the Anthem-Cigna merger and the Aetna-Humana merger, claiming that the mergers between competing health plans violated existing anti-trust laws. Maine, along with as many as 13 other states, would be significantly impacted by the Anthem-Cigna merger because of the consolidation of the market share that the plans already have in the state. The Maine Attorney General's Office joined the Justice Department lawsuit in opposition to the $45 billion merger. Anthem has fought back with full page advertisements in national publications stating its intention to fight the Justice Department action and further claiming that significant savings could result from the merger, in part from reducing reimbursement rates to physicians and hospitals.
The Justice Department claims that the proposed mergers would reduce competition, raise prices for consumers and stifle innovation if the number of large, national health plans drops from five to three.
Anthem had sought to accelerate the time for the trial and decision as it faces an April 30, 2017 deadline to complete the merger and Cigna is unlikely to agree to extend the date as the relationship between the two plans has allegedly deteriorated.
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Community Health Options Sues Federal Government for $22.9 Million
Community Health Options (CHO), one of the few non-profit co-op health plans still remaining under the provisions of the Affordable Care Act, announced last week that it was filing a lawsuit against the federal government for $22.9 million it is claimed to be owed to offset losses it suffered in 2015. CHO is designed to offer individual and small group coverage under the provisions of the ACA in the marketplace exchange. It currently insures over 80,000 people in Maine and in New Hampshire. While the plan made money in 2014, in 2015 it reported a loss of $31 million and it also set aside $43 million in reserves to cover potential losses in 2016 as its rates had been set early in 2015 and are likely inadequate to cover all claims likely to be filed for medical care received in 2016. At this point in 2016, the amounts set aside in 2015 are tracking quite well to cover the month to month losses sustained by CHO. These losses are monitored closely by the Maine Bureau of Insurance and the monthly results are available on the Bureau's website.
The legal claims involve "risk corridors" which were established to help insurers manage costs during the first few years of the ACA. Insurers with lower-than-expected costs pay a portion of their profits into the program (which CHO did in 2014) while insurers which experience higher-than-anticipated costs receive payments to help offset their losses. There are several other lawsuits pending in other states raising similar issues with respect to the federal government not paying promised amounts owed.
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Proposed Amendments to MMA Bylaws Posted on Website
As required by the MMA bylaws, proposed amendments to the bylaws to be voted on by the membership at the upcoming Annual Meeting have been posted on the MMA website at www.mainemed.com. These amendments have been prepared and recommended by the MMA Bylaws Committee chaired by David McDermott, M.D. The amendments clean up some language in the current version of the bylaws and do not contain major changes. Any MMA member wishing a paper copy of the proposed amendments may receive them by mail or electronically by contacting Diane McMahon at dmcmahon@mainemed.com or by calling her at 622-3374 ext. 216.
The amendments will be voted on at the annual membership meeting held in conjunction with the Annual Meeting Sept. 9-11 in Bar Harbor at the Bar Harbor Club adjacent to the Harborside Hotel. The membership meeting will be conducted from 7:30am to 10:00am on Saturday morning, Sept. 10. The meeting will again be moderated by Richard Evans, M.D., Moderator and John Garofalo, M.D., Vice-moderator. There is no charge for an MMA member to attend the Annual Meeting although there is a registration fee for all other aspects of the Annual Session. Four and one half hours of CME are available at the Session on Saturday and Sunday morning. Registration is available on the MMA website at www.mainemed.com. [return to top]
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MMA Website Features New Q&A on Opioid Law
The Maine Medical Association website now features a new Questions-and-Answers document
about PL 2015, chapter 488--the new Maine opioid law. It addresses
questions that have been raised most frequently to MMA staff by our
members and others since the bill was signed into law in April.
You can
find it by going to the MMA website at www.mainemed.com and clicking on Question and Answer Document under the "Spotlight" section of the page. Or, to make it easier, you can just click here. [return to top]
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Some Confusion Remains on New Opioid Prescribing Limits
A significant amount of confusion still exists regarding the provisions of Chapter 488 which took effect on July 29. The Governor and the Legislature were well aware that not all 16,000 patients currently receiving opioid medication in access of 100 morphine milligram equivalent (MME) would be able to be tapered immediately. Therefore, a medical necessity exception was added (to expire on Jan. 1, 2017) in addition to the provision for patients who are currently at 100 MME to be prescribed up to 300 MME until July 1, 2017. For those patients over 300 MME on Jan. 1, 2017, other exceptions may be established through state rule-making or the exception for palliative care may be considered.
Other exclusions in the law include prescribing opioid medication to a patient for:
- Pain associated with active and aftercare cancer treatment;
- Palliative care, as defined in Title 22, section 1726, subsection 1, paragraph A, in conjunction with a serious illness, as defined in Title 22, section 1726, subsection 1, paragraph B;
- End-of-life and hospice care;
- Medication-assisted treatment for substance use disorder; or
- Other circumstances determined in rule by the Department of Health and Human Services pursuant to Title 22, section 7254, subsection 2; and
- When directly ordering or administering a benzodiazepine or opioid medication to a person in an emergency room setting, an inpatient hospital setting, a long-term care facility or a residential care facility.
- Until Jan. 1, 2017, a prescriber can utilize an exception for medically necessity. In order to inform the pharmacy that it is within the law to fill a particular script over 100 MME, the prescriber should write "Medically Necessary" on the script.
Although the requirement to check the Prescription Monitoring Program (PMP) for a new script does not take effect until January 1, 2017, it would not be possible to know what opioid medication the patient may be receiving from other prescribers without checking the PMP. So, in effect, the PMP mandate should be observed beginning July 29th if a prescriber is not already routinely checking the PMP for new scripts for an opiate based medication. On January 1, 2017, the PMP mandate will include a first script written for a benzodiazepine in addition to an opioid.
Other information on the new law can be found on the MMA website at www.mainemed.com. MMA attorneys are available to present CME programs on the new law. If you are interested in a presentation at your practice or facility contact MMA's CME Coordinator Gail Begin at gbegin@mainemed.com or EVP Gordon Smith at gsmith@mainemed.com or by calling Gordon at 215-7461. Presentations are scheduled over the next month in Fort Kent, Patten, Damariscotta, Skowhegan, Calais and Ellsworth.
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MAT Training Through Maine Quality Counts
Maine Quality Counts has received funding to support
“Improving MAT in Primary Care” (IMAT), a program designed to help build and
expand clinicians’ capacity to offer Medication Assisted Treatment (MAT) in
Maine primary care settings. QC is looking to enroll 3 additional practices
to participate in this collaborative. Practices selected for participation will
have access to the following benefits of participation:
· Tailored support by local experts designed to
assist with the development and implementation of workflows
· Optional, half-day X-Waiver training to increase
prescribing capacity on September 9
· Active participation in Project ECHO
Buprenorphine - virtual monthly education and case presentations beginning in
September
· Access to educational resources and practical
tools via an MAT Implementation Toolkit
· Participating providers can earn Continuing
Medical Education (CME) and Maintenance of Certification (MOC) credit
In
addition, participants will be expected to complete the following activities:
· Two pre- and post-participation assessments
using an online assessment tool
· Attend one in-person, day-long learning session
in October
· Submit and review practice data on a monthly
basis
· Complete a project aims statement and submit at
least two Plan-Do-Study-Act (PDSA) cycles for review
· Participate in project status meetings via
teleconference at the mid-point and end of the project
Participating practices should
have at least two participating prescribers, who may attend the x-waiver
training on 9/9 if they do not currently have a waiver to prescribe
buprenorphine. Interested practices will need to fill out a short, online
application. This application includes 15 – 20 questions (number varies
depending on your responses) and is estimated to take approximately 30 minutes
to complete. To review or complete the survey, please click here.
Questions and requests for
additional information may be directed to caringforme@mainequalitycounts.org. [return to top]
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MMA Room Block for Annual Meeting Expires August 15. Make Your Reservations NOW.
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Maine Medical Association
163rd Annual Session
September 9-11, 2016
Harborside Hotel, Bar Harbor, ME
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Renewing the Joy & Passion in Medicine
4.5 AMA PRA Category 1 CME Credits TM |
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Dear Colleagues & Friends:
Recognizing the signs of professional exhaustion is
the first step to reintroducing joy and purpose to your career.
Please join your colleagues at this year's Annual Session
where you will learn new tools that will help you develop resiliency
and renewal in your personal and professional life.
Click Here to view the
full schedule and register for this event. Bring your family so
they can enjoy Mt. Desert Island and Acadia National Park. |
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Saturday,
Sept. 10, 10:00 a.m.
Tuning Up Your Resilience Program features five
physicians who have extensive experience in physician resilience
and burn-out prevention. Dr. Jo Shapiro serves as Chief, Div of
Otolaryngology, Dept of Surgery, at Brigham and Women's Hospital
and is an Associate Professor at Harvard Medical School. She was
one of the first woman division chiefs and was recently named as a
finalist for the Schwartz Center Compassionate Caregiver Award. Dr.
George Dreher, knowing what a habit of mindfulness brought to his
life and career at Maine Medical Center, started offering a Mindful
Practice of Medicine course and helped create a medical staff
subcommittee on practitioner health and resilience. Dr. Christine
Hein, who is the Medical Director of the Emergency Medicine
Workgroup, knows first-hand the pressure practitioners face in
their daily work and how important self-resiliency strategies can
be in maintaining ideal standards of care for patients. Ben Tipton,
PAC, has been working to improve resiliency at the Mid Coast
Hospital and has built a Mindfulness-based Stress reduction program
which is providing training for an increasing number of staff. Dr.
David Strassler is the chair of the Martin's Point Provider
Resiliency Team and has recently undertaken a drive to reduce
burdensome paperwork. | |
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Saturday,
Sept 10, 12:00 p.m.
Speakers
Kevin Mannix and Linda Rota, LSW, will deliver the Saturday noon
keynote. Kevin and Linda have co-authored the book, Weathering
Shame, an autobiography on their personal experience
growing up with the stigma and shame of
 alcoholism
and mental illness. Kevin is a veteran weatherman at WCSH6, Portland
and WLBZ 2, Bangor. His spouse, Linda Rota, LSW, has been a
social worker for more than thirty years. She is a 1982 magna cum laud
graduate of USM with a B.A. in social welfare and criminal justice.
Linda served in the Peace Corps in Sierra Leone, West Africa and
trained volunteers on cross-cultural issues. Their book will be
available for purchase and book signing.
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Sunday,
Sept. 11, 9:00 a.m.
Simple Mindfulness Applications to Cultivate Joy &
Passion in Work & Life. Countless
demands and rushing about are the norm these days. We live in
stressful, chaotic times. The speed of life around us is going faster
and faster. This way of living affects our health, our relationships,
our families, and the quality of our lives. We do have the ability,
the strength, and the stability within us to meet these challenges in
a way that brings more happiness into our everyday lives. Mindfulness
is a way to access these inner resources.
 Nancy
Hathaway, M.Ed., LpastC, has been studying and teaching mindfulness
for 40 years. She has interned and worked with Jon Kabat-Zinn, Ph.D.
in the Mindfulness Stress Clinic at the University of Massachusetts
Medical Center and the State of Massachusetts, Department of
Corrections. She teaches Mindfulness nationally including Harvard
University's Work and Family Center, MIT, hospitals, universities,
high schools, colleges, parent groups, and couples courses. She
is an Adjunct Professor in numerous colleges in Maine teaching
Mindfulness courses. She has studied internationally with
teachers in the Zen, Vipassana, and Tibetan traditions and holds
a Masters in Education degree with a Counseling Psychology track.
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7th Annual Silent Auction |
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Request for Donations
The auction proceeds will
benefit the Maine Medical Education Trust (MMET) Scholarship Fund
which directly benefits Maine students and relies on this auction
as a primary revenue source.
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Donation Examples:
Gift
Certificates to a Maine restaurant, hotel or resort
Gift
Baskets
Weekend
or week-long stay at a Condo, Camp or Vacation Home
Concert,
Theater or Sporting event tickets
Painting,
sculptures, drawing or other artwork
Wine and
Spirits
Personal
Services (such as spa treatments, car detailing, etc)
Pottery
Handmade
Items
For more information on
donations
click
here. | | |
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Maine
Medical Association
30
Association Drive
PO Box 190
Manchester, ME 04351
info@mainemed.com
207-622-3374 | |
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Copyright © 2016. All Rights Reserved.
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Jackson Lab to Study Role of Genetic Traits in Addiction
The Portland Press Herald reports that Bar Harbor's Jackson Laboratories has received an $11.7 million federal grant to study what role, if any, genetic traits play in addiction disorder development. Researchers hope to illuminate the problem of substance use disorder without the stigma and value judgments sometimes attached to society's view of the issue.
“We don’t judge mice. So when I say I have a mouse with a genetic
variation that influences how likely it is to take cocaine, we don’t
think ‘That’s a bad mouse,’ ” said Elissa Chesler, the principal
investigator of the grant.
Dr. Mark Publicker, an addiction specialist in Portland and an MMA member, said about 40% of addictive disorders are related to a genetic predisposition. The same is true of diabetes and many other diseases. The hope is to identify, and later mitigate the effects of, these predispositions. [return to top]
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Upcoming Events
MPCA HPV Summit: Improving Rates to Reduce Cancer in Maine
August 24, 2016
10:00am - 2:00pm
Bangor Saving Bank (Dirigo Conference Room) - Augusta, ME
We hope you will join us for a half day summit to discuss promising practices in completing the HPV series through collaboration between state agencies, schools, medical providers and community partners. We are excited to showcase the work in Rhode Island for their Vaccinate Before you Graduate program, in addition to sharing the most up to date evidence around the HPV vaccine and its effectiveness in preventing cancers in both men and women.
Registration: http://www.cvent.com/d/pvqj10 Fee: $25
Agenda
10:00-10:30: Welcome, CDC “You Are the Key Presentation”
- Jessica Reed, GNP-C, American Cancer Society
10:30-11:00: What to know about HPV Related Cancers
11:00-12:00: Perspectives from the Field: Practice-based strategies for improving HPV rates
- Theresa Knowles, FNP-C, Penobscot Community Health Care
- Jessica Reed, GNP-C, American Cancer Society
12:00-12:45: Lunch (provided)
12:45- 2:00: Innovative Programs in New England: Vaccinate Before You Graduate – Rhode Island
- Randall Linn, CEO, The Wellness Company
- Lesa Volpe, Vaccinate Before You Graduate, The Wellness Company
2:00 PM Thank You and Evaluations
This Summit is being offered through a partnership of the American Cancer Society and the Maine Primary Care Association, with support from the Maine AHEC Network.
The University of New England College of Osteopathic Medicine (UNECOM) is accredited by the American Osteopathic Association (AOA) and the Maine Medical Association’s Council on Continuing Medical Education and Accreditation (MMA CCMEA) to provide continuing medical education for physicians. UNECOM has requested that the AOA Council on Continuing Medical Education approve this program for 3.25 hours of AOA Category 1B CME credits. Approval is currently pending.
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163rd Annual Session
September 9-11, 2016
Harborside Hotel - Bar Harbor, Maine
The theme of this year's program is "Renewing the Joy & Passion in Medicine." For more information and to register click here.
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Risk Adjustment Documentation & Coding Seminar
September 15-16, 2016
Do you contract with a Medicare Advantage Organization or other payer using a risk adjustment methodology? Are your coders accurately capturing chronic health conditions? Does the thought of risk adjustment coding keep you up at night?
Join the Baker Newman Noyes (BNN) revenue cycle team, including certified risk adjustment coders (CRC™), for a two-day seminar for healthcare professionals interested in risk adjustment documentation and coding. While risk adjustment has been around for a long time, a solid understanding is essential for proper documentation of a patient's overall health status. BNN has put together a hands-on program to ensure an understanding of risk adjustment coding, the importance of documentation, how to optimize and improve overall risk scores, and much more.
We are excited to offer this comprehensive two-day workshop that will also help in preparation for the Certified Risk Adjustment Coder (CRC™) examination offered through the AAPC.
For more information and to register click here. Act now to take advantage of early bird pricing.
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15th Annual Downeast Ophthalmology Symposium
September 23-26, 2016
Harborside Hotel - Bar Harbor, Maine
15 Hours Category 1 AMA PRA CME Credits Offered
Topics include Glaucoma, Cataract, and Uveitis. Michael X. Repka, MD, MBA will deliver the Keynote address on Ophthalmology in an Era of Health Care Evolution. There will also be time to enjoy the beautiful area!
For more information and to register visit: https://maineeyemds.com/symposium-home or contact Shirley Goggin at 207-445-2260 or sgoggin@mainemed.com.
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MaineGeneral Medical Center's 2016 Geriatric Symposium
October 6, 2016
7:45am - 4:30pm
Alfond Center for Health - Augusta, ME
This
year’s keynote speaker will be Dr. Michael LaMantia MD, MPH, the new Section
Chief of Geriatrics at the University of Vermont. There will also be
talks by Cliff Singer MD, Annette Beyea DO MPH, Sarah Hallen MD, Kim Church RN
& Jane O’Rourke LMSW, Nancy Rushton APRN and Noreen Flanagan MD. Lunch will
be provided and CMEs are available.
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MCMI Training Programs - Level 1 and Level 2
October 25, 2016
When and where held: On October
25, 2016, the Maine Concussion Management
Initiative will present Level 1 and Level 2 Training as the Youth Concussion
Track at the Brain Injury Association of America-Maine Chapter's 7th
Annual Conference on Defining Moments in Brain Injury in Portland at USM.
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: 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: Conference
- 7:30pm to 4:30pm
MCMI Level 1: 9:30am to 1:00pm
MCMI Level
2: 1:30pm to 4:30pm
Registration:
Fee: $100 for all
participants for the entire day
How to register: online atwww.biausa.org
then click on BIAA-Maine (in the menu on the left)
CMEs will be provided.
Exact contact hours not determined at this time
For more information contact:
Jan Salis, PT, ATC, MCMI - Membership and Education Committee - Chair
jsalis@aol.com or (207) 577-2018
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Job Openings
PRIMARY CARE PHYSICIAN - Eastern Maine Medical Center
Eastern Maine Medical Center seeks a primary care physician, board-certified/board-eligible in internal medicine, to join our well-established, quality-driven, outpatient practice. Husson Internal Medicine is one of seven primary care practices operated by Eastern Maine Medical Center. Our practice was the second in the nation to achieve “Patient-Centered Medical Home” status with NCQA. All physicians are NCQA-certified in diabetes and cardiac care. Our primary care network, largest in our area, has adopted a new practice model to include teams of one physician, one nurse practitioner, two registered nurses, and two medical assistants.
Eastern Maine Medical Center is a 411-bed, regional, tertiary care and level II trauma center serving the more than 500,000 residents living in central, eastern, and northern Maine We offer a collegial atmosphere, cutting-edge EMR, generous vacation and CME benefit, flexible work schedule, and reasonable call schedule. No hospital call required. Candidates in need of J-1 visa waivers welcome to apply.
For confidential consideration, please contact: Amanda Klausing Eastern Maine Medical Center Phone: 207-973-5358 emmccvs@emhs.org
8/22/16
PHYSICIAN - Penobscot Community Health Care
Penobscot Community Health Care is seeking a Physician who
is interested in working on a team dedicated to patient-centered care,
innovation and collaboration for their Belfast location, Seaport Community
Health Center. If this sounds like an opportunity you would be interested in,
consider this:
You will be working on a team that has served its community
for nearly 30 years!
You will be providing comprehensive, integrated primary
health care services for an organization that exemplifies their Mission in everything
they do.
You will be working on a team that recently achieved the
highest level of recognition as a Patient-Centered Medical Home (PCMH) by the
National Committee for Quality Assurance (NCQA).
You will be given the chance to make a difference in the
lives of not only your patients, but the community you serve…every day.
For more information, please contact Vanessa Sanderson,
Recruitment Coordinator, Penobscot Community Health Center at (207) 404-8015 or vsanderson@pchc.com.
8/22/16
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.
Visit http://www.nassonhealthcare.org for an application. Completed cover letter, resume, and employment application will be accepted until position is filled.
9/19/16
INTERNAL MEDICINE PHYSICIAN - Maine Medical Partners Internal Medical Clinic
Maine Medical Partners is seeking a PT BC/BE internal
medicine physician for their Internal Medicine Outpatient Clinic at Maine
Medical Center in Portland, Maine.
The Clinic is the
primary outpatient teaching site for Maine Medical Center’s Internal Medicine
Residency Program and is the medical home for a culturally diverse
population. The ideal candidate
will have an interest in residency education and international/immigrant patient
care. The clinical portion of the
position involves a mix of direct patient care and the precepting of Internal
Medicine Residents.
Maine Medical Center has 637 licensed beds and is the state’s
leading tertiary care hospital, with a full complement of residencies and
fellowships and an integral part of Tufts University Medical School.
For more information please contact Alison C.
Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 661-7383 or nathaa@mainehealth.org.
9/5/16
FAMILY MEDICINE/OUTPATIENT INTERNAL MEDICINE PHYSICIAN
The Maine Highlands offers great outdoor adventures, historic and cultural experiences, many culinary delights and unexpected entertainment opportunities. KVHC’s newest clinic, Brownville, is located in the Maine Highlands and Katahdin Region. As a result of this 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 the Brownville/Millinocket Maine regions. KVHC’s clinics are outpatient only 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.
8/29/16
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