November 14, 2016

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What Does the Trump Presidency Mean for Health Care in Maine and in the Nation?

While only five days have transpired since the prospect of a Trump Presidency became reality, it is possible to speculate on how the surprising national election may impact health care in Maine and in the nation.  First and foremost is the question of the future of the Affordable Care Act.

Health care experts and policy pundits have spent the last few days speculating on what will happen to health care beginning with the Affordable Care Act.  On the website of the President-elect, it is still stated that, "On day one of the Trump Administration we will ask Congress to immediately deliver a full repeal of Obamacare."   While the pledge to "Repeal and Replace" the ACA was a popular part of the Trump campaign, most observers do not believe it will happen.   The major barrier, along with the rules requiring 60 votes in the Senate, is that the ACA is inextricably interwoven into our health system, as blogger and ACA expert Professor Tim Jost stated this past week.  The ACA contains hundreds of provisions affecting Medicare, program integrity, healthcare workforce, and Medicaid.  Even if the Democrats did not filibuster an attempt at full repeal, it would be virtually impossible to undo all the changes to the various federal programs impacted in the past six years by the ACA.

So, while repeal and replace of the ACA is unlikely, over a reasonable period of time, President-elect Trump and Republicans could fatally wound the ACA by using the budget reconciliation process which does not require 60 votes in the Senate.  In fact, the final ACA in 2010 contained provisions passed through the budget reconciliation process after the election of Senator Scott Brown in Massachusetts following the death of Ted Kennedy.  The loss of the Senate seat in Massachusetts cost the Democrats their filibuster-proof majority.  Because much of the ACA impact has been achieved by executive branch action, much of the ACA could also be removed or impacted negatively via executive orders, guidance, and regulations.  


Assuming many of the ACA provisions are removed, what will they be replaced with, if anything?  The challenge for the new President and Congress is to honor campaign commitments to eliminate the ACA, but to do so without removing 20 million individuals from coverage. At the new website,, replacement proposals include using health savings accounts, allowing health insurers to sell policies state lines and establishment of high risk pools.  All three of these approaches have been associated with Republicans for many years.   Block grants for Medicaid is another proposal likely to gain traction.


No immediate changes are likely in the open enrollment going on presently in the exchanges. The inauguration is not until January 20 and the open enrollment period ends on Jan. 31.  Most experts believe that any change in the subsidies on the exchange or in the operation of the exchanges will take place gradually and that individuals will not risk losing subsidies or coverage during 2017 calendar year.


In addition to speculation regarding policies, media and political observers are also anxiously awaiting word as to what individuals may sit in the Trump cabinet.  As announcements are made, MMA will report this information in the Weekly Update.  


As the new MACRA payment provisions were enacted on a bi-partisan basis (and are not technically part of the ACA), physicians and medical practices should continue to prepare for implementation of MACRA and the resulting MIPS or alternative payment vehicles.  Previous issues of the Weekly Update have included references to many of the educational resources on MACRA available on the AMA website.





American Medical Association Convenes Interim Meeting of House of Delegates

AMA Delegates from Maine, Richard A. Evans, M.D. and Maroulla Gleaton, M.D., along with MMA President Charles Pattavina, M.D. and EVP Gordon Smith, Esq. are in attendance at the AMA Interim Meeting this week in Orlando, FL.  MMA also is supporting the participation of four medical students at the AMA Medical Student Section meeting:  Tufts Maine Track Students Kim Dao, Nick Knowland, and Sebastian Reeve, and UNECOM student Brooke Learned.  As the meeting does not adjourn until Tuesday, watch for the Weekly Update next week which will contain in depth information on what was accomplished at the meeting.

Several important resolutions are being introduced and debated at the meeting regarding AMA policy on health care reform and the Trump Administration.  Other major topics are the high cost of prescription drugs, the opioid epidemic, and the recent IOM "Dying in America" report.  The IOM report is the subject of Board of Trustees Report 05 which reviews how the AMA already has extensive policy in end of life care.  Considerable discussion has also taken place around Maintenance of Certification with many AMA delegates expressing concern about a number of aspects of MOC.

The following DRAFT resolution is attracting a lot of attention and it is not yet clear what the final language will be. But, some type of Resolution addressing the topic of the AMA, the ACA, and the Trump Administration is likely to be adopted.

      RESOLVED, That our American Medical Association immediately communicate our priorities and firm commitment to our current AMA Policies to the new Administration, Congress and the President-Elect, and offer our ongoing willingness to help them improve our healthcare system, and improve access to high quality, cost effective care while reducing unnecessary regulation, emphasizing the AMA's extensive body of policy on health care reform, and be it further

    RESOLVED, That our AMA immediately convene and reconvene as necessary the State Medical Society leadership to discuss and help develop comprehensive healthcare reform.  Any changes must focus on protecting the physician-patient relationship and ensure access to care.  In developing this alternative, our AMA will perform an analysis of the positive and negative effects of the current healthcare law.  The alternative should seek to reduce administrative burden, decrease cost, increase physician satisfaction and improve patient care.

    RESOLVED, That our American Medical Association craft a strong Public Statement for immediate and broad release, articulating the priorities and firm commitment to our current AMA Policies and our dedication in the development of comprehensive healthcare reform.

   RESOLVED, That our American Medical Association, Board of Trustees report back to the AMA House of Delegates at the Annual 2017 Meeting.

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Congratulations to All Physician Candidates for the 128th Maine Legislature

The MMA has been thrilled that eight physicians stepped forward to run for seats in the 128th Maine Legislature.  This level of interest demonstrates that physicians in Maine are "tuned in," engaged in the significant public policy issues of the day in Maine, not the least of which are matters of health policy, and are prepared to serve.  We congratulate and thank all eight who ran and look forward to working with the three successful incumbents who will be members of the 128th Maine Legislature.  The incumbents returning to the next legislature are Senator Geoff Gratwick,  (D-Penobscot), Rep. Patty Hymanson (D-Ogunquit and parts of York, Sanford, and Wells), and Heidi Brooks (D-part of Lewiston).

We congratulate physician candidates Ann Dorney, M.D., Richard Evans, M.D., Wendy Wolf, M.D., M.P.H., David Edsall, M.D., and Emily Trask-Eaton, D.O. on their strong campaigns for seats in the 128th Maine legislature!
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128th Maine Legislature: Divided Government Continues

The “big picture” of the 128th Maine Legislature is very similar to the last – Republicans will control the Maine Senate, though by a closer margin, 18-17, than in the prior legislature.  While several races were quite close, it does not appear that any of the Senate races are headed for recount.  Senate Republicans caucused last week to choose their leadership candidates & decided upon the same leadership team from the last legislature:  Sen. Michael Thibodeau, R-Waldo, as President, Sen. Garrett Mason, R-Androscoggin, as Majority Leader, & Sen. Andre Cushing, R-Penobscot, as Assistant Majority Leader.

Similarly, the Maine House remains in the control of the Democrats with the count, 77 D, 72 R, 2 U.  Representative Sarah Gideon, D-Freeport, is the likely Speaker of the House.

The 128th Maine Legislature will be seated in early December.  Committee assignments typically are announced around the holidays.  The cloture deadline by which legislators must submit bill requests should be announced in early December.

The MMA will continue to examine the implications of passage of the referenda on marijuana (Question 1), high earner tax in support of public education (Question 2), minimum wage (Question 4), ranked choice voting (Question 5) and will pass those observations on to the membership. [return to top]

Health Insurance Marketplace 2017 Open Enrollment - November 1, 2016 through January 31, 2017

The Health Insurance Marketplace Open Enrollment period for 2017 began on November 1 and goes through January 31, 2017.  If you enroll by December 15, your coverage will begin on January 1. 

Get Ready to Apply for 2017 Coverage

Many people who apply will qualify for some kind of savings.  Depending on household income, you may be able to get lower costs on monthly Marketplace health insurance premiums and out-of-pocket costs.

Already Have Marketplace Coverage?  Anyone who currently has a 2016 health insurance plan through the Marketplace should review their current plan, update their account, and either renew coverage or select another plan for 2017.

Health Insurance Marketplace assistance is available:

  • Call the Consumers for Affordable Health Care HelpLine at 1-800-965-7476
  • Find local help at  Navigators and assisters are available throughout Maine.
  • Call the Health Insurance Marketplace at 1-800-318-2596
  • Medical practices: order patient brochures about the Health Insurance Marketplace at enroll207
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MMA Leadership Listening Session on December 6th

  • When:  Tuesday, December 6 from 5:30 pm to 8:00 pm
  • The Lucerne Inn, 2517 Main Road in Dedham, ME

MMA members and their guests are cordially invited to join MMA officers and executive staff at a Listening Session, in recognition of the election of Charles Pattavina, MD as the 164th President of the Maine Medical Association.

Stop by for an appetizer and beverage on us and share with us your thoughts and opinions.

Please RSVP to Sarah Lepoff or at 622-3374 x213.

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Did you receive a “Negative Payment Adjustment Notification” letter from CMS?

If you did receive such a letter:

  • If you are part of a Medicare Accountable Care Organization (ACO)—contact your ACO administrator. 
  • If you are not in a Medicare ACO, contact the Northern New England Practice Transformation Network (NNE PTN) a program of Maine Quality Counts.

You can reach them at or to learn more about NNE PTN go to:

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Medicare Releases 2017 Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) set the 2017 conversion factor at 35.7751, a slight increase over what was proposed, with the release of the Physician Fee Schedule final rule recently. The final rule also addressed policies dealing with diabetes prevention, global surgical reporting requirements, add-on payments for primary care and telehealth services.

Because of strong advocacy from the AMA and other physician groups, CMS finalized its proposal to establish the Medicare Diabetes Prevention Program (MDPP) as a preventive service with no cost sharing.  The MDPP is a 12-month program that consists of at least 16 weekly core sessions during the first six months, followed by additional core maintenance sessions over the remaining six months.  The MDPP provider network will be scaled up next year with service delivery to Medicare beneficiaries set to begin Jan. 1, 2018.

CMS finalized a claims-based data collection process on the frequency of and inputs involved in global surgical services that is much less burdensome for physicians than CMS' earlier proposal.  Key changes include:

  • CMS' decision to use 99024 for reporting post-operative services rather than the proposed set of time-based G-codes
  • Reporting is no longer required for pre-operative visits
  • Reporting is only triggered for services that meet certain minimum thresholds annually—CPT codes billed by more than 100 practitioners over 10,000 times or have allowed charges in excess of $10 million

The final rule increases payments for Chronic Care Management services by accepting CPT and RUC recommendations urging CMS to ease the administrative burden and expand the opportunities for physicians.  CPT codes 99358 and 99359 for non-face-to-face prolonged E/M services will also be billable under Medicare beginning in 2017.

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Medicare Finalizes Changes to Site of Service and Meaningful Use Program

The release of the 2017 Outpatient Prospective Payment (OPPS) rule sets the stage for changes in how Medicare pays hospitals for care provided in offsite hospital-owned physician practices, referred to as Provider-Based Departments (PBD).

With a few exceptions, the Centers for Medicare and Medicaid Services (CMS) finalized virtually all of its proposals to eliminate the site-of-service payment differential that has incentivized hospitals to purchase physician practices. CMS, however, did not finalize its proposal to apply reduced payment to exempted PBDs that expand service lines.

In direct response to AMA advocacy, CMS eliminated the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions concerning pain management from the Hospital Value Based Purchasing (VBP) program. Over the years, physicians have expressed deep concerns about the unintended consequences pain questions have had on opioid prescribing practices and patient care. Under HCAHPS, there was a link between high scores on the pain questions and higher payments to hospitals. The AMA looks forward to working with CMS as it develops alternative questions related to pain and the patient experience and quality measures related to opioid prescribing to ensure the measures and questions are clinically appropriate.

CMS also announced Meaningful Use reforms that will help physicians meet reporting requirements—policy changes for which the AMA advocated directly to CMS. The agency is allowing physicians to report Meaningful Use for 90 days in 2016. This is a much-needed reform of the earlier proposal requiring a full year of reporting.

CMS has developed a hardship exception that allows first time Meaningful Use participants to report once in 2017 to satisfy both Meaningful Use and the Advancing Care Information performance category in the Merit-based Incentive Payment System track of the Medicare Access and CHIP Reauthorization Act.

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Medicare Announces New RAC Contracts

Recently, Medicare announced the new Recovery Auditor contracts, which sets limits for the post-claims review process and dictates when Recovery Audit Contractors (RAC) will be eligible to receive their contingency fees.

Among the changes specified in the new contracts, RACs will no longer automatically receive contingency fees for each identified overpayment.  This new policy requires the RACs to pass the second level of a five-level appeals process before receiving their contingency fee.  The new RAC contracts also establish new audit timelines—the RAC lookback period for inpatient claims is reduced from three years to six months—and the two midnights rule will continue to be exempted from RAC audits.

These changes are in addition to Medicare's recent pilot program that directs RACs to consider as a low-priority reviewing claims from providers participating in Advanced Alternative Payment Models under the new Quality Payment Program.

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Upcoming Events

American Medical Association MACRA Webinars November 21st & December 6th

The AMA will host two educational webinars to help physicians prepare for the new Medicare Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act. Both sessions will cover the same material. Registration is open for the first webinar on Nov. 21, at 7 p.m. EDT, and the second webinar on Dec. 6, at 8 p.m. EDT. Physicians and medical society staff are welcome.

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Job Openings

BC/BE Family Medicine Physician - FLOAT 

HealthReach Community Health Centers seeks an experienced full-time, part-time or per diem BC/BE Family Medicine Physician to join our team of float providers. The selected candidate will travel to health centers in Central and Western Maine and provide acute, chronic and preventive services to patients of all ages. 

HealthReach has been providing healthcare in rural and medically underserved communities for 41 years. Annually, 28,000 Maine residents access medical, dental and behavioral health services at our facilities, which are located in Albion, Bingham, Belgrade, Bethel, Coopers Mills, Kingfield, Livermore Falls, Madison, Rangeley, Richmond and Strong. 

We offer competitive compensation including a generous float differential and malpractice coverage. Contact Recruiter, HRCHC, 10 Water Street, Suite 305, Waterville, ME  04901. (207) 660-9913 ~ Fax: (207) 660-9901 ~



The Maine Public Employees Retirement System (MainePERS or Retirement System) administers a disability retirement program for eligible members of the Retirement System.   The Board of Trustees engages physicians as independent contractors to serve on a Medical Board.  That Board evaluates medical records and provides written consultations to MainePERS and its hearing officers regarding the existence of diagnosable conditions and the presence and permanency of functional limitations in disability cases.

MainePERS seeks to engage additional physicians for the Medical Board.  Physicians of the Medical Board must hold a Maine Physician’s license in good standing and be Board Certified in their area of practice.  Preferred candidates will have experience in one of the following disciplines: Psychiatry, Neurology, Internal Medicine, Physiatry, Occupational Medicine, and case review.  Medical Board physicians work under contract in an advisory capacity on an hourly fee basis.  Typical time commitment is 10-25 hours per month with flexibility of scheduling.  Some case file review and discussion can be done via videoconferencing.    This is a contract position and not eligible for benefits.

To apply, please forward your Curriculum Vitae and introductory letter to or via mail to:

Maine Public Employees Retirement System

Human Resources Department

P.O. Box 349

Augusta, Maine  04333-0349



Mid Coast Medical Group is seeking a full time General Surgeon. This is a community hospital oriented job with needed skills in all core aspects of general surgery.  The surgeon will be part of a long standing 4-5 provider general surgery group. The office is conveniently located adjacent to Mid Coast Hospital. New graduates and experienced candidates are encouraged to apply.

Part of the Mid Coast–Parkview health family of services, Mid Coast Hospital offers competitive benefits and compensation package, along with an excellent work environment. Please send CV to Melanie Crowe, Physician Recruiter, at or call (207) 406-7872, for more information.


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



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