MMA's 163rd Annual Session Concludes Successfully

Sunny skies and the best attendance in recent years combined to provide MMA with a very successful Annual Meeting.  Along with CME featuring talks on resilience, mindfulness, and preventing burnout, the members at the business meeting voted to oppose the upcoming ballot question which would legalize recreational use of marijuana for adults.

During Saturday's Annual Banquet, Brian Pierce, M.D. presented the President's medallion to incoming President Charles Pattavina, M.D. of Winterport.  Dr. Pattavina is an emergency physician and serves as Director of Emergency Medicine at St. Joseph's Hospital in Bangor.

Senator King Asks for Financial Support for Comprehensive Addiction and Recovery Act (CARA)

Senator Angus King last Thursday asked his colleagues in the United States Senate to provide financial resources to support the recently passed Comprehensive Addiction & Recovery Act (CARA).  He also wrote to President Obama requesting that the White House negotiate with Congress to make sure the $181 million authorized in CARA is included in the continuing resolution expected to pass later this month.  

Congress did not fund CARA when it passed the legislation in March.  Senator King pointed out that 15,000 individuals have died of accidental overdoses since the bill was passed.  And, they continue to die at the rate of nearly 80 a day.   The Senator went on to call the opioid crisis, "the greatest public health crisis of my lifetime."

MACRA Penalties Can Now be Avoided, CMS Says

Avoiding penalties under the Medicare Access and CHIP Reauthorization Act (MACRA) just got easier.  The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt last Thursday announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct reporting options in 2017.

In a blog post, Slavitt announced that CMS heard physicians’ concerns about the proposed start date for performance reporting under the new Medicare payment system and that the agency will offer three reporting options for the Merit-based Incentive Performance System (MIPS)—and if you choose one for 2017, you will not receive a negative payment adjustment in 2019.

The options will be described fully in the final rule, but here are the basics:

• Option one:  Test the program
  As long as you submit some data to the Quality Payment Program, including data from after Jan. 1, you will avoid a negative payment adjustment, Slavitt said.  This option is intended to ensure that the system is working and that physicians are prepared for broader participation in the coming years as they learn more.

• Option two:  Partial-year reporting
  Physicians can choose to report Quality Payment Program information for a reduced number of days.  Your first performance period could begin well after Jan. 1 and your practice could still qualify for an incentive payment.
  
  Slavitt offered an example. “If you submit information for part of the calendar year for quality measures, how your practice uses technology and what improvement activities your practice is undertaking,” he said, “you could qualify for a small positive payment adjustment.”

• Option three:  Full-year reporting
  If your practice is ready to get started on Jan. 1, you can choose to report Quality Payment Program information for the full calendar year.  Your first performance period would begin on Jan. 1, and if you submit information for the entire year your practice could qualify for a modest positive payment.

• Advanced Alternative Payment Model (APM) option.
  This option is still available and qualified participants in advanced APMs will be eligible for five percent incentive payments in 2019.

Choosing any of these options guarantees that you will not receive a negative payment adjustment.

The announcement confirms that physician input is playing a critical role in the development of the final MACRA rule.  Slavitt stated his appreciation for the constructive participation of physicians in the feedback process and added that CMS looks forward to further engagement with physicians to make sure the new Medicare payment system works for everyone, including patients.

"By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA,” said AMA President Andrew W. Gurman, MD, in a statement commending Slavitt and Department of Health and Human Services Secretary Sylvia Mathews Burwell.

“This approach better reflects the diversity of medical practices throughout the country,” he said. "The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.”

This kind of flexibility is what physicians were seeking throughout the draft rule comment period—and now it is a reality. The only way to receive a negative payment adjustment now is by not participating at all.

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Surgeon General's Opioids Mailing to Physicians

Check your mailbox over the next two weeks—there should be a letter from U.S. Surgeon General Vivek H. Murthy, MD, calling on all physicians throughout the nation to raise awareness and further efforts to end the opioid misuse epidemic.

Physicians are in a unique position of leadership when it comes to this epidemic—they are on the front lines witnessing the impact every day from emergency department overdoses to substance use disorder treatment. The letter asks directly for physicians' help to solve and bring an end to the opioid misuse epidemic.

"We will educate ourselves to treat pain safely and effectively," Dr. Murthy said in the letter, suggesting physicians examine the many resources from the Centers for Disease Control and Prevention Guideline.

"We will screen our patients for opioid use disorder and provide or connect them with evidence based treatment," he said.  "We can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing."

Awareness can make a difference
This style of raising awareness has worked before.  In 1988, U.S. Surgeon General C. Everett Koop, MD, sent a seven-page brochure, "Understanding AIDS," to all 107 million households in the country.  The mailing raised awareness that the AIDS epidemic affected every one and not just a small group of Americans.  The opioid epidemic the country now faces similarly affects those of all ages, races and economic status.

Dr. Murthy earlier this month launched TurnTheTideRx.org, where physicians can take a pledge and make a commitment to end the opioid crisis.

"Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way," he said in the letter.

Physician efforts already underway
Steven J. Stack, MD, AMA immediate-past president, in May issued an open letter to America's physicians calling on them to take re-examine prescribing practices and help reverse the epidemic. "We must accept and embrace our professional responsibility to treat our patients' pain without worsening the current crisis," he said.

The AMA Task Force to Reduce Prescription Opioid Abuse has been working to raise awareness of the crisis for almost two years. The task force put forth recommendations for physicians to register for an use state prescription drug monitoring programs, educate themselves on pain management and safe prescribing, support increased access to naloxone, reduce the stigma of substance use disorder and enhance access to comprehensive treatment. [return to top]

Free Direct Primary Care Conference in Dallas Oct. 14 - 15

The Texas Medical Association and the Docs 4 Patient Care Foundation are sponsoring a Direct Primary Care (DPC) conference in Dallas, Texas Friday and Saturday Oct. 14-15.  Thanks to a generous grant from The Physicians Foundation, this conference is free to physicians ($100 registration fee refunded at the door).  Talks appropriate to both beginner and experienced DPC physicians are planned.  See:  https://www.heartland.org/_template-assets/documents/publications/pf_registration_brochure-smaller.pdf

CHO Continues Financial Recovery, Withdraws from NH Market

After a $31 million loss in 2015, Maine-based health insurer Community Health Options (CHO) appears to be on a solid track to financial recovery. On August 31, CHO reported a second quarter 2016 loss of $3.3 million following a first quarter loss of $8.4 million. It still has reserves of over $45 million.

As reported in the Portland Press Herald, CHO had a total of 77,031 members at the end of the second quarter, down from 82,813 members at the end of the first quarter, and up from 74,981 members at the end of 2015. As of June 30, 2016, total net assets were $146.4 million and total net liabilities were $100.8 million.

Because of a very successful 2014, CHO filed for a rate increase of less than 1 percent early in 2015, for the calendar year 2016. Due to significant increases in both membership and utilization, along with significantly increased costs for prescription drugs, those rates proved to be seriously inadequate. In the spring of 2016 CHO sought a rate increase of 25.5 percent for 2017, an increase approved by the Maine Bureau of Insurance on August 16, 2016. Many of CHO's insureds benefit from rate subsidies under the Affordable Care Act. In addition, the company. It also stopped accepting individual enrollments in December 2015. Small and large group policies will remain in effect until their next renewal date. Many of those policies have policy years which do not coincide with the calendar year.

On September 1st CHO announced it will be withdrawing from New Hampshire as of January 1, 2017 to focus on its core Maine business. Existing individual policies will remain in effect through the end of 2016 but will not be renewed for 2017. Individuals currently insured by CHO will have until December 31, 2016 to enroll in a new plan.

New Hampshire memberships currently constitute 15% of CHO's business. The move has been approved by the Maine Bureau of Insurance, the New Hampshire Insurance Department, and CMS. CHO will retain its license and its provider contracts in New Hampshire.

Community Health Options (Health Options) is a non-profit, Member-led health plan providing comprehensive, Member-focused health insurance benefits for individuals, families, and businesses. Health Options is a Consumer Operated and Oriented Plan (CO-OP) licensed in Maine and New Hampshire that is dedicated to providing affordable, high-quality health benefits through productive partnerships with Members, businesses, and a broad network of providers. For more information about Health Options, visit the website: HealthOptions.org.

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State Organ Donor Rate 54% for 2016

Figures released by the Maine Bureau of Motor Vehicles for 2016 show that 54% of driver's license applicants have signed up to be organ donors through the BMV's program.  The online renewal system, InforME, shows a 60% rate of volunteering, while the local and mobile units show a range for 2016 from 35% for the Stacyville mobile unit to 60% for the Topsham branch office.

Statewide rates have been 55% for the most recent three months, thanks in large part to the work of the New England Organ Bank and the Maine Organ Donation Advisory Council. [return to top]

Maine Obesity Rate at 30%

Maine's self-reported adult obesity rate, at 30%, is 24th highest in the country, according to new figures released September 1st by the US CDC.  That makes Maine and Pennsylvania the only two states in the Northeast at or above 30%.

Four states (Louisiana, Alabama, Mississippi, and West Virginia) have rates over 35%, while six states (Colorado, Hawaii, Montana, California, Massachusetts, and Utah) and the District of Columbia are below 25%.

2015 rates were up in Kansas and Kentucky when compared to 2014, but there is some good news:  rates were down in four states: Minnesota, Montana, New York, and Ohio. [return to top]

Clicks and Keyboards Stealing Face-time with Patients

Almost one-half of the physician workday is now spent on electronic health record (EHR) data entry and other administrative desk work while only 27 percent is spent on direct clinical face-time with patients, a time-motion study published Monday in the Annals of Internal Medicine found.  This finding is further proof that administrative burdens are directly affecting the patient-physician relationship.  Though efforts are underway to make EHRs more practical for clinical use, there are ways to relieve this burden through team-based care.

The time-motion study, conducted by experts at the AMA and Dartmouth-Hitchcock Health Care System, also found that for every hour of face-to-face time with patients, physicians spend nearly two additional hours on their EHR and other clerical desk work throughout the day.

Physicians do not feel these are the tasks that should be taking up a majority of their work day—they undercut the patient-physician relationship.

The time-motion study correlates with a study published recently in the Journal of Graduate Medical Education that tracked the average “mouse miles”—or active time—residents spent using EHRs. The study found that first-year residents spent an average of five hours per day on the EHR caring for a maximum of 10 patients.

(Excerpt from AMA Wire® article by Troy Parks. For the entire article, click here.) [return to top]

CMS Finalizes Disaster Preparedness Rule for Medicare, Medicaid Providers

The New York Times (9/10, A14, Fink, Subscription Publication) reported that some 72,315 healthcare providers and suppliers “will have a little over a year to meet federal disaster preparedness requirements completed this week by” CMS, but they will have to “scramble” to comply with the “unusual” rule, which “has provisions for 17 different provider types.” Nicole Lurie, MD, assistant secretary for preparedness and response at HHS, explained that the rule “will make it more likely that facilities will be able to stay open and able to care for patients, and if they need to close or stop work temporarily, get back up and able to care for patients quickly.”

       Modern Healthcare (9/10, Muchmore, Subscription Publication) reported that the rule applies to medical facilities which participate in Medicare and Medicaid. Under the rule, providers are required to “adhere to four best-practice standards: developing an emergency plan, creating a communications plan, having a training program and developing appropriate policies and procedures.” Lurie was also quoted as saying, “As people with medical needs are cared for in increasingly diverse settings, disaster preparedness is not only a responsibility of hospitals, but of many other providers and suppliers of healthcare services.”

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HHS Office of Civil Rights Issues New Ransomware Guidance

In light of recent FBI guidance and media reports of increasing cyberattacks on health IT systems, the U.S. Department of Health and Human Services Office of Civil Rights (OCR) has released new guidance on ransomware.

The new guidance reinforces activities required by the Health Insurance Portability and Accountability Act (HIPAA) that can help organizations prevent, detect, contain and respond to threats, including:

• Conducting a risk analysis to identify threats and vulnerabilities to electronic protected health information (ePHI) and establishing a plan to mitigate or remediate those identified risks
• Implementing procedures to safeguard against malicious software
• Training authorized users in detecting malicious software and reporting such detections
• Limiting access to ePHI to only those persons or software programs requiring access
• Maintaining an overall contingency plan that includes disaster recovery, emergency operations, frequent data backups and test restorations

The guidance makes clear that a ransomware attack usually results in a "breach" of health care information under the HIPAA Breach Notification Rule. Under the rule, and as noted in the guidance, entities experiencing a breach of unsecure PHI must notify individuals whose information is involved in the breach, HHS and in some cases the media, unless the entity can demonstrate and document that there is a "low probability" that the information was compromised.

The AMA is preparing a series of cybersecurity resources for physicians, which will be available on its new cybersecurity web page. The page currently contains information about steps physicians can take today to improve their cybersecurity practices.

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Job Openings

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.

11/7/16

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Upcoming Events

Risk Adjustment Documentation & Coding Seminar

  September 15-16, 2016

Sheraton Portsmouth Harborside Hotel - Portsmouth, NH

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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It (still) Takes a Village -
Forging Lasting Partnerships to Support Healthy Aging

September 21, 2016 - Augusta Civic Center

15th Annual Downeast Ophthalmology Symposium

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

MAINE CHAPTER - AMERICAN ACADEMY OF PEDIATRICS
FALL CONFERENCE - OCTOBER 15 & 16 IN BAR HARBOR

HOT TOPICS IN PEDIATRICS: FROM INFANTS TO ADOLESCENTS

Register Here

The conference features national and local speakers on topics including:

·         Neonatal Abstinence Syndrome and care for drug affected babies and their mothers

·         Strategies from VT and CT to address the influx of drug affected infants

·         Addiction as a Pediatric Disease

·         Immunization Controversies: influenza, meningococcal B and HPV

·         The Impact of Chronic Disease and Health on Child’s School Attendance, Education and Well-Being

·         The Use of Proton Pump Inhibitors

·         The Status of Foster Care in Maine

·         OB Thresholds of Viability

·         and more!

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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Maine Health Management Coalition and Maine Medical Association's 2016 Symposium

Thursday, October 27 

Holiday Inn By The Bay, Portland

About the Symposium

For this year's symposium we will be continuing to highlight and explore actionable strategies that each of us can take to help improve health and lower costs.  Our keynote speaker, David Blumenthal, MD, President of The Commonwealth Fund, will share examples of how organizations around the country are getting more value from their health care dollars, and breakout sessions will dive into the details to highlight individual efforts that organizations in our state can emulate.  There will be presentations on tackling prescription drug abuse for providers and employers, alternative payment arrangements being tested through employer/provider partnerships, and overview of how MACRA will impact the payment landscape in our state, and more!

When: Thursday, October 27, 2016, 8am - 5pm

Where: Holiday Inn By The Bay, 88 Spring Street, Portland ME 04101

Register Here!