January 23, 2017

 
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MMA Board Adopts Statement on Reform of the U.S. Health Care System

Following up on months of work by an Ad Hoc Committee on Health Care Reform beginning last summer, on Wednesday, January 18, 2017, the MMA Board of Directors adopted a new Statement on Reform of the U.S. Health Care System.

Following up on months of work by an Ad Hoc Committee on Health Care Reform beginning last summer, on Wednesday, January 18, 2017, the MMA Board of Directors adopted a new Statement on Reform of the U.S. Health Care System.

The members of the 2016 Ad Hoc Committee on Health Care Reform are:

  1. Hani T. Jarawan, M.D., Chair
  2. Maroulla S. Gleaton, M.D.
  3. R. Scott Hanson, M.D.
  4. Jabbar Fazeli, M.D.
  5. Paul R. Cain, M.D.
  6. Philip Caper, M.D.
  7. Cathleen London, M.D.
  8. Richard B. Swett, M.D.
  9. Thomas R. Sneed, M.D.
  10. Samuela E. Manages, M.D.
  11. Lani Graham, M.D., M.P.H.

The MMA Board thanks these committee members for their service. It was not an easy task to develop a statement on health care reform that achieved consensus support by the membership at large and a majority of the Board of Directors. The MMA surveyed both the membership and the Board of Directors as the document was refined. The Ad Hoc Committee began the process of updating the MMA's policy document on health care reform by reviewing the MMA's standing policy on the subject, a 2001 Resolution and a 2003 White Paper prepared in anticipation of Governor Baldacci's Dirigo Health Program reform proposal. The MMA Board reviewed and considered the extensive comments submitted by members in response to the survey and acknowledged very strong support for a "Medicare for All" single payer approach to health care reform. Other respondents indicated their vehement opposition to a single payer approach to health care reform. It is perhaps not surprising that there are deep divisions in the physician community about the "right" approach to health care in this country just as there are in our society generally. These divisions are particularly evident in the current political environment.  

This Statement will be useful in the next two years during health care reform discussions in Washington, D.C. with the new Trump Administration and new Congress, as well as with the 128th Maine Legislature.

If you have questions or comments about the Statement or the process, please contact Andrew MacLean, Deputy EVP & General Counsel, who staffed the Ad Hoc Committee at amaclean@mainemed.com or 622-3374, ext. 214.

 

MMA Weekly Legislative Call Tuesday, January 24th, 8:00 p.m.

MMA Legislative Committee Chairs Katherine Pope, M.D. and Stephen Meister, M.D. welcome 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, January 24th 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:  207-480-4790

Passcode:  057614#

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 480-4187, or Peter Michaud, Associate General Counsel at pmichaud@mainemed.com or 480-4199.

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first.  This will be important when the list grows in the next few weeks.

LD 92: An Act To Require a Person Who Provides Illegal Drugs To Give Medical Aid to Another Person in Medical Distress Due to That Illegal Drug Transaction (Psychiatry & Public Health) (monitor)

*LD 105: An Act To Create a Centralized Authority To Combat Opiate Addiction in Maine (Psychiatry & Public Health) (monitor)

*LD 107: An Act To Increase the Effectiveness of Opioid Addiction Therapy (Psychiatry & Public Health) (support)

*LD 108: An Act To Allow a Law Enforcement Agency That Treats a Person with Naloxone Hydrochloride To Bill That Person for That Treatment (Psychiatry & Public Health) (oppose)

*LD 114: An Act To Increase the Number of Suboxone Prescribers (Psychiatry, Surgery & Public Health) (oppose)

LD 118: An Act To Require Moped Riders under 18 Years of Age To Wear a Helmet (Public Health, Pediatrics) (support)

*LD 125: An Act To Allow an Order Not To Resuscitate To Be Presented in the Form of an Indelible Mark (Emergency) (oppose)

LD 130: An Act To Provide Funding for Costs Associated with Requiring the Licensing of Midwives (Obstetrics) (support)

*LD 132: An Act To Authorize Podiatrists To Perform Certain Routine Procedures (Orthopedics & Family Physicians) (support)

LD 144: An Act To Create a Pilot Project To Reduce Substance Use Disorders among Youth in Piscataquis County To Be Used as a Model for All Maine Communities (Psychiatry & Public Health) (support)

*LD 153: An Act Regarding Transportation of Methadone Patients (Psychiatry & Public Health) (oppose)

LD 161: An Act To Remove the Treasurer of State from the Maine Vaccine Board (Public Health & Pediatrics) (monitor)

LD 162: An Act To Improve Care Provided to Forensic Patients (Psychiatry) (monitor)

*LD 164: An Act To Require Tamper-evident Packaging for Recreational Marijuana Products (Psychiatry, Pediatrics & Public Health) (support)

*LD 183: An Act Requiring the Use of the Electronic Death Registration System (Geriatrics, Medical Examiners) (monitor)

LD 184: An Act To Allow Hospitals To More Efficiently Monitor the Prescribing of Controlled Substances by Amending the Laws Governing Access to Prescription Monitoring Information (monitor)

*LD 185: An Act To Establish a Pilot Project for Medicaid Reimbursement for Acupuncture Treatment of Substance Abuse Disorders (Psychiatry & Public Health) (monitor)

LD 186: An Act To Improve Peer Support Services (Psychiatry) (monitor)

LD 192: An Act To Require Insurance Coverage for Hearing Aids (ENT) (monitor)

LD 194: An Act To Ensure Equity in the Awarding of Compensation for Tort Claims (monitor)


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POLITICAL PULSE: 128th Maine Legislature Continues Organizing; Governor will Deliver State of the State Address

128TH MAINE LEGISLATURE BEGINS WORK OF ITS FIRST REGULAR SESSION

The 128th Maine Legislature returned to work at the State House for its First Regular Session on Wednesday, January 4th and is expected to consider more than 1800 bills, including a biennial budget for State Fiscal Years 2018-2019, and other matters between now and their statutory adjournment deadline of June 21st. During the first few weeks of the session, the legislature's joint standing committees are organizing and participating in various briefings by Executive Branch agencies and others with expertise in their areas of jurisdiction.  

Before bills a printed for public review and assigned "L.D." or "Legislative Document" numbers, the Office of the Revisor of Statutes assigns a "LR" or "Legislative Request" number. If you would like to get an overview of the bills filed by the cloture deadline, you can find lists of bill requests submitted by legislators by sponsor or by subject area, as well as a list of bills submitted by Executive Branch agencies and approved by the Governor's Office here. As anticipated, you will see many bills on the opioid abuse problem and the principal bill on that topic from last session. P.L. 2015, Chapter 488, as well as aspects of implementation of the new recreational marijuana law.

Also, earlier in the month in accordance with his constitutional obligation, Governor LePage released his proposed biennial budget. You can find the budget documents on the web page of the Bureau of the Budget here.  The following is a quick overview of some of the noteworthy health policy items in the Governor's budget proposal.

  • Nothing specific on the opioid crisis;
  • Nothing specific on appropriations for hospitals or physicians or other practitioners, so we would assume level funding for these services, including the primary care “bump,” except where otherwise noted – critical access hospital rate, for example
  • Shift of FHM funding to MaineCare
  • Multiple references to 192 positions eliminated in DHHS
  • Reduce CAH ("Critical Access Hospital") funding from 109 to 101% of cost; $2.2M/$2.2M (p. A-339)
  • Eliminate provider-based reimbursement; $5.7/$5.7M (p. A-339)
  • Eliminate coverage for 19 and 20 year olds effective 1/1/18; $3.3M/$6.6M (p. A-339)
  • Eliminate coverage for adults between 40-100% of FPL; $33M in second year (p. A-340)
  • Language Part IIII sets hospital tax base year to 2014
  • Language Part E extension of the sales tax to “personal services” does not this time appear to include any medical services, cosmetic or otherwise.

The Appropriations has not yet announced a public hearing schedule for the biennial budget, but hearings probably will begin in early February.

MMA EVP TESTIFIES BEFORE MARIJUANA LEGALIZATION COMMITTEE

The 128th Legislature has convened a Joint Select Committee on Marijuana Legalization Implementation and last week held a public hearing on L.D. 88, An Act to Delay the Implementation of Portions of the Marijuana Legalization Act. MMA EVP Gordon Smith joined other members of the coalition opposing Question 1 on the November ballot in supporting the measure to give the legislature more time to develop a regulatory framework for recreational marijuana in Maine.

GOVERNOR LEPAGE'S STATE OF THE STATE ADDRESS

 Governor LePage has accepted the legislature's invitation to present a State of the State address to a joint session of the legislature on Tuesday, February 7th at 7 p.m.
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Federal Action Begins to Repeal and Replace ACA

Despite the dismay of many ACA supporters, the Republican lead Congress took initial steps last week to repeal the ACA. The U.S. House of Representatives on Friday passed a budget resolution by a vote of 227-198 that prevents a Senate filibuster from derailing the repeal effort. The intent of Republican Leadership is for both the Senate and the House to complete action on the budget resolution by Jan. 20 when President-elect Trump is inaugurated. Now, Republicans in Congress must decide which parts of the ACA must end and how to address the twenty million plus people who receive coverage under the ACA through the exchanges or through Medicaid expansion. President-elect Trump has urged Republican lawmakers to pass the budget and concurrently develop and pass a replacement plan. Given the enormous impact the ACA has had on virtually every part of the health care delivery and finance system, astute observers have expressed doubt that Republican leadership can develop a comprehensive plan in such a short time frame.

Maine's senior Senator Susan Collins is a pivotal player in the drama surrounding the future of the ACA and any replacement plan. The AMA and MMA have communicated with the Senator the absolute necessity to not terminate coverage for those individuals brought into coverage via the ACA. Physicians and all health care professionals are encouraged to communicate with Senator Collins as well as Senator Angus King and Representatives Chellie Pingree and Bruce Poliquin regarding your thoughts on where health care reform should be heading in our nation, which will also have a profound impact on our state.

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New Opioid Prescribing/PMP Rule Released

There continue to be many questions about the emergency rule published by the state on Jan. 1, 2017. MMA continues its educational programs on the law and the rule and our attorneys are available to present one, two or three hour CME program which will also count toward the three hours of education on opioid prescribing required by Dec. 31, 2017.The emergency rule can be found through this link. The educational presentations can be given at your practice, at your medical staff or specialty society. Many of these presentations are supported by grant funding or state contracts so there is no charge. MMA has provided over forty such presentations and they are not only beneficial to the attendees but MMA staff also learns a great deal in the give and take regarding the issues that the new law is presenting in the practices. To arrange a presentation at your location, contact Gail Begin at gbegin@mainemed.com or Gordon Smith at gsmith@mainemed.com.

The rule was promulgated on an emergency basis, meaning that it becomes effective immediately, with a period for public comment which will expire on an unspecified (as yet) date. The "routine technical" parts of the rule are effective for up to 90 days, while the "major substantive" parts are effective for up to 12 months while the Legislature conducts its review. The rule became effective on January 1st.

 Here is a quick summary of the rule's highlights (with primary attention to prescriber requirements):

  1. The rule defines a number of terms, such as acute and chronic pain, benzodiazepine, controlled substance (Schedules II through IV), inpatient status, prescriber and dispenser, and several others. The term "opioid medication" is limited to those opioids in Schedule II, which would mean it does not apply to Tramadol, buprenorphine, some (but not all) forms of codeine, and others. Prescribers are cautioned to check the latest version of the controlled substances list from the US Drug Enforcement Administration (DEA) to determine the Schedule of any particular medication.
  2. Prescribers are required to include the ICD-10 diagnostic code "on the prescription for any opioid which will cause the patient to exceed the 100 Morphine Milligram Equivalent aggregate daily limit." Codes are not required on prescriptions that do not exceed the limits.
  3. If a patient is claiming an exemption from the 100 MME or time limits, prescribers must include the "exemption code" on the prescription. There are 7 such codes: A (active & aftercare cancer treatment, limited to 6 months post remission); B (palliative care in conjunction with a serious illness); C (end-of-life and hospice care); D (medication assisted treatment for substance use disorder, limited to 12 consecutive months); E (pregnant person with a pre-existing opioid prescription in excess of 100 MME, only during the duration of the pregnancy); F (acute pain for a patient with an existing opioid prescription for chronic pain, with conditions); G (person in active taper of opioids, with a 6 month maximum tapering period to below 100 MME).
  4. Opioids must be prescribed electronically beginning July 1, 2017, unless a waiver is obtained from DHHS.
  5. Prescribers must check the PMP as described in the statutory law, PL 2015 c.488 (opioids and benzodiazepines, initially and every 90 days thereafter). In so doing, prescribers must review aggregate MME for the patient (including the anticipated new prescription), the number of prescribers currently prescribing controlled substances (Schedules II, III or IV) to the patient, and the number of pharmacies currently filling controlled substance prescriptions for the individual. The inpatient and long-term care exceptions apply.
  6. The PMP may be checked by the prescriber, any staff member authorized by the prescriber and the PMP, any staff member of a hospital if authorized by the hospital's CMO (for ED or inpatient treatment). The PMP will issue credentials to prescribers and authorized staff members who register as data requesters
  7. Dispensers are required to notify the PMP coordinator and decline to fill a prescription before contacting the prescriber if the patient has a contemporaneous prescription for the same substance from a different prescriber, a contemporaneous prescription being filled for the same substance by a different dispenser, or if filling the prescription would result in exceeding the MME or time limitations. Those conditions are described as "fraudulent or duplicative" prescriptions, which is the statutory requirement. The rule does not address the criteria for filling a prescription after contacting the prescriber.
  8. Licensing boards, MaineCare, and the Chief Medical Examiner's office will have access to PMP data, after meeting certain requirements. Data will also be shared with other states and Canadian provinces. Strict confidentiality rules apply to all PMP information, with criminal sanctions for violations of confidentiality.
  9. De-identified data may be provided to researchers, and aggregate information based on PMP data may be made available to the public.
  10. The PMP information will be reviewed at least quarterly to determine cases of "questionable activity by patients or prescribers." This includes the following information, as determined by the DHHS: "high number" of prescribers in a short period; "high number" of doses in a short period; overlapping "days supply" prescriptions exceeding a few days; "inappropriate combinations" of controlled substances; multiple payment methods within a short time; multiple out-of-state prescribers in a short time; multiple pharmacies on the same day, more than one pharmacy in different public health districts within one month; and "dangerous levels of specific" (but unspecified in the rule) drugs.
  11. Prescribers are immune from liability for disclosing information under these rules, and pharmacists are immune from civil liability for dispensing medication in accordance with a prescription in excess of the limits.

Please note that this summary does not address in detail the requirements for dispensers, whether they be pharmacies, providers or institutions. (There have already been substantial complaints about the burden placed on emergency department personnel by the "dispenser" requirements of the rule.) 

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MMA Renews Agreement with BayState Financial, Watch for Educational Offering in April

MMA has renewed a marketing agreement with Baystate Financial which calls upon the firm to provide financial planning services to MMA members at a discounted fee. As MMA's Board theme for 2017 include a focus on physician well being, Baystate's Fiscal Fitness program and related educational offerings will complement the Board's theme. Baystate's initial educational offering will be on April 26 and 27 in the Auburn and Portland areas. [return to top]

From the AMA: The Top Issues that will Affect Physicians in 2017

The year ahead in medicine, tumultuous as it promises to be, holds several key issues on which physicians should focus their attention. Health insurance coverage and access, prescription drug pricing, the new Medicare payment system and the opioids epidemic all require a strong physician voice present in the conversation.

Health insurance coverage and access
A new administration entered the White House on Jan. 20 and President Trump has expressed his intention to repeal and replace the Affordable Care Act (ACA), which could reduce insurance coverage that more than 20 million Americans gained under President Obama's signature legislation.

Acknowledging that the health system reform is an ongoing process, the AMA has expressed its willingness to work with the incoming administration and Congressional leaders on addressing the shortcomings of current law while maintaining the insurance enrollment gains of the ACA and expanding health insurance affordability and choice. Read more about the AMA's vision on health care reform.

Implementation of new Medicare pay system
The Centers for Medicare and Medicaid Services (CMS) released its final rule for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) in October, which repealed the flawed Sustainable Growth Rate (SGR) formula in 2015. Thanks to physician feedback, the new payment system—the Quality Payment Program (QPP)—should transition the health care system toward one that supports physician efforts to provide high-quality care.

The AMA will continue its work to make sure this implementation offers the best possibility for success for physician practices. To help your practice transition smoothly, the AMA has put together a collection of resources, such as the payment model evaluator, that are housed on its understanding Medicare payment reform webpage. Learn more about the numerous terms and acronyms associated with the QPP.

Reversing the opioid epidemic
The latest data from the Centers for Disease Control and Prevention provide a sobering reminder that more work remains to reverse the nation's opioid epidemic. From 2014 to 2015, opioid-related deaths increased from 28,647 to 33,091—with significant increases in death from heroin and illicit fentanyl. At the same time, physicians have been using prescription drug monitoring programs with greater frequency, prescribing opioids more judiciously, taking more education, and becoming trained to treat substance use disorders. And tens of thousands of lives have been saved through the opioid antidote naloxone—thanks in part to nearly every state now having improved naloxone-access laws. While physicians must continue their efforts, to truly turn the tide, greater access to treatment for substance use disorders and non-opioid and non-pharmacologic pain care must occur.

The AMA's Task Force to Reduce Opioid Abuse, a coalition of numerous state and medical specialty societies, will continue efforts to increase registration and use of PDMPs, enhance physician education, reduce stigma of chronic pain and substance-use disorder, enhance access to treatment, and expand access to naloxone through co-prescribing and standing orders.

Prescription drug pricing
Recent increases in prescription drug prices are of major concern to patients. These increases have created higher costs and price swings, making it difficult for some patients to afford much needed medications. The AMA's grassroots initiative, TruthinRx.org, was launched late last year with the purpose of collecting patient stories about how rising drug prices are affecting their lives. Achieving greater transparency in prescription drug costs and coverage will be significant issues in the coming year as the nation attempts to address these concerns. The AMA's grassroots network is asking the public to join the initiative to uncover the truth about prescription drug pricing.

EHR interoperability
Physicians enjoy treating patients. A recent qualitative study found that physicians spend nearly two hours on EHR and other clinical desk work for every hour of direct face-to-face time with patients. One of the major sources of professional dissatisfaction found in the study was poor EHR usability and interoperability. This is a battle physicians have been fighting since the introduction of EHRs and the fight isn't over. One key step was taken late last year when Carequality and CommonWell, representing more than 90 percent of the EHR marketplace in acute care settings and nearly 60 percent of the office-based EHR market, entered an agreement to advance nationwide interoperability.

This is a step in the right direction, but physicians have also taken matters into their own hands. It will be important in the coming year to continue progress toward interoperability and make sure that these tools, which hold so much promise, are not just another roadblock to the patient-physician relationship.

Regulatory relief
The regulatory burden placed on physicians is a major component of physician burnout. Physicians spend too much of their time on administrative tasks rather than providing care to patients. The evolving health care system needs easier enrollment, more rational program integrity rules and, overall, fewer reporting requirements.

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AMA: Court Order in Aetna-Humana Merger Halts a Bad Deal for Elderly Patients

Statement Attributed to:  Andrew W. Gurman, M.D., President, American Medical Association

“Elderly patients were the big winners today as a federal court imposed an injunction on Aetna’s $37 billion acquisition of Humana. The court ruling halts Aetna’s bid to become the nation’s largest seller of Medicare Advantage plans and preserves the benefits of health insurer competition for a vulnerable population of seniors.

“Aetna’s strategy to eliminate head-to-head competition with rival Humana posed a clear and present threat to the quality, accessibility and affordability of health care for millions of seniors. The AMA applauds the extraordinarily well documented, comprehensive, fact-based ruling of U.S. District Judge John D. Bates, which acknowledged that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal. Importantly, Judge Bates further concluded that the merger would unlawfully restrain competition in the sale of individual commercial insurance on the public exchanges in three counties in Florida identified in the complaint.

“The court’s ruling sets a notable legal precedent by recognizing Medicare Advantage as a separate and distinct market that does not compete with traditional Medicare. This was a view advocated by the AMA, as well as leading economists. AMA also applauds the decision for protecting competition on the public exchanges.

“The AMA’s stand against this anticompetitive merger shows again that when doctors join together, the best outcome for patients and doctors can be achieved. Given the troubling consolidation trends in health insurance industry, the AMA will continue to advocate on behalf of patients and physicians to foster more competitive health insurance markets." 

In 2016, the MMA Board of Directors voted to oppose both the Anthem-CIGNA and Aetna-Humana insurance carrier mergers and the MMA staff has been working with the AMA staff and state and federal regulators from the U.S. Department of Justice, the Federal Trade Commission, the Maine Office of the Attorney General, and the Maine Bureau of Insurance to ensure that the views of Maine physicians are considered in these proceedings.

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Are You Ready To E-Prescribe? Find Out More About DrFirst and their E-Prescribing Products

July 1, 2017, is when Maine’s new EPCS (e-prescribing controlled substances) law takes effect for the prescribing of opioids. Despite the limited application of the law, the benefits of e-prescribing are significant, which is why MMA encourages our members to implement eprescribing technologies in their practices now instead of waiting for the legislative deadline.

To save you the time of vetting potential vendors and offer you another tangible membership benefit, we have chosen DrFirst as our preferred e-prescribing platform and negotiated a generous discount for MMA members. DrFirst offers a superior clinical workflow that is easy to use and affordable (especially with the discount we have negotiated for MMA members). Their package includes Rcopia® for legend drug e-prescribing, EPCS Gold 2.0℠ for controlled substance e-prescribing, and iPrescribePro℠, an app for mobile e-prescribing.

Aside from legend drug and controlled substance e-prescribing within one workflow, you’ll also get

  • 24 months of patient medication history

  • real-time benefit check (formulary data, drug cost, suggestions for cheaper alternatives)

  • clinical alerts (e.g., duplicate therapy and allergy warnings)

  • one-on-one guidance through DEA identity proofing and authentication

  • patient adherence monitoring

  • electronic prior authorization

For more information, MMA members can visit DrFirst’s website and/or contact DrFirst’s Eric Landry, a New Gloucester resident, at 888-481-4303. [return to top]

AMA CEO: Before Repealing ACA, Offer Replacement Details

The AMA welcomes legislative proposals that make insurance coverage "more affordable, provide greater choice and increase the number of those insured," AMA Executive Vice President and CEO James L. Madara, MD, said in a Jan. 3 letter to House and Senate leadership.

But policy makers ought to provide "reasonable detail" about their replacement plan before moving to alter coverage provided under the Affordable Care Act, Dr. Madara wrote. "Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform."

As policy makers consider systemic reforms designed to make insurance coverage more affordable and accessible, he added, "it is essential that gains in the number of Americans with health insurance coverage be maintained."

The letter to Capitol Hill leaders comes as Congress prepares to repeal portions of the ACA through the budget reconciliation process. The AMA supported passage of the ACA "because it was a significant improvement on the status quo at the time," Dr. Madara wrote, adding that "we continue to embrace the primary goal of that law—to make high quality, affordable health care coverage accessible to all Americans."

Yet, Dr. Madara added, President Obama's signature legislative achievement "is imperfect and there are a number of issues that need to be addressed." The AMA looks forward to engaging lawmakers on proposals that are consistent with the Association's vision for health care reform. That vision arises out of a comprehensive policy framework refined over two decades through the AMA House of Delegates, which is composed of representatives of more than 190 state and national specialty medical societies.

The AMA, Dr. Madara wrote, is ready to work with lawmakers to continue the "ongoing quest for improvement" that health system reform represents. Such work, he wrote, is intended to meet the goal of "ensuring that all Americans have access to high quality, affordable health coverage."

Congress considers budget resolution

The Senate passed the Fiscal Year 2017 Budget Resolution (S. Con. Res. 3) with plans to hold a vote by the end of the week. The House of Representatives is expected to take up and pass the measure shortly afterward, though House leadership is still working to secure the votes needed for passage. The Budget Resolution generally establishes Congressional spending levels for a given year or years, and also serves as a messaging tool for policy priorities. It cannot be used to make actual policy changes.

The resolution currently under consideration is for the 2017 Fiscal Year, which actually started on October 1, 2016. The primary purpose for adopting a budget at this late date is triggering the reconciliation process. Reconciliation provides for expedited procedures in the Senate that will allow for repeal of key portions of the Affordable Care Act (ACA) with only a simple majority.

If the resolution is adopted, House and Senate committees will work on legislation targeting critical spending and revenue provisions of the ACA. However, the path to ultimate consideration of the reconciliation bill and any possible legislation to provide new health coverage options is still uncertain.

House passes AMA-supported public health bills

The House of Representatives Jan. 9 passed four AMA-supported public health bills that would better coordinate care and clarify existing law. All of the bills previously passed the House by voice vote in the 114th Congress. The bills include:

  • The "Sports Medicine Licensure Clarity Act of 2016" (H.R. 302), sponsored by Rep. Brett Guthrie, R-Ky., would ensure that sports medicine professionals are covered by their medical liability insurance when providing care to athletes or teams in other states. The bill passed by voice vote.

  • The "National Clinical Care Commission Act" (H.R. 309), sponsored by Rep. Pete Olsen, R-Texas, would establish a National Clinical Care Commission to evaluate and recommend solutions to better coordinate and use federal programs to provide care for patients with metabolic syndromes and related autoimmune disorders. The bill passed by voice vote.

  • The "Protecting Patient Access to Emergency Medications Act" (H.R. 304), sponsored by Rep. Richard Hudson, R-N.C., would improve the Drug Enforcement Administration registration process for emergency medical services (EMS) agencies and clarify that EMS professionals are permitted to administer controlled substances pursuant to standing or verbal orders when certain conditions are met. The bill passed by a vote of 404-0.

  • The "Improving Access to Maternity Care Act" (H.R. 315), sponsored by Rep. Michael Burgess, MD, R-Texas, would increase data collection by the Department of Health and Human Services to place maternal health professionals in more appropriate geographic regions through their participation in the National Health Service Corps. The House passed the bill by a vote of 405-0.

CMS releases 2017 QPP quality measure benchmarks

If a physician or practice plans to participate in the 2017 Quality Payment Program (QPP), also known as the Merit-based Incentive Payment System (MIPS), with the goal of receiving a bonus in 2019, it is highly recommended that they review the recently released 2017 QPP measure benchmark information. The quality benchmark information does not apply to physicians who plan on minimal participation in 2017 only to avoid a 2019 penalty—submit one measure, one time in 2017.

The 2017 QPP benchmark information was released late last week and posted to the Centers for Medicare and Medicaid Services (CMS) QPP website. The benchmark calculations for the 2017 performance year use data submitted for the Physician Quality Reporting System (PQRS) in 2015 by QPP provider types who were eligible for MIPS but not newly enrolled that year, or by groups with at least one such clinician. When a clinician submits measures for the QPP Quality Performance Category, each measure is assessed against its benchmarks to determine how many points will be earned. A clinician can receive anywhere from three to 10 points for each measure, not including any bonus points.

Benchmarks are specific to the type of submission mechanism: EHRs, QCDRs/Registries, CAHPS and claims. For CG-CAHPS, the benchmarks are based on two sets of data: 2015 PQRS CAHPS and 2015 ACO CAHPS data. Submissions via the CMS Web Interface will use benchmarks from the Shared Savings Programs.

Each benchmark is presented in terms of deciles. Points will be awarded within each decile (see Table 1). Clinicians who receive a score in the first or second decile will receive three points. Clinicians who are in the third decile will receive somewhere between three and 3.9 points depending on their exact position in the decile, and clinicians in higher deciles will receive a corresponding number of points. For example, if a clinician submits data showing 83 percent on the measure, and the fifth decile begins at 72 percent and the sixth decile begins at 85 percent, then the clinician will receive between five and 5.9 points. For measures where a positive performance is seen in a lower score, the scores are reversed in the benchmark deciles.

Patient-facing encounter codes now available

The Centers for Medicare and Medicaid Services (CMS) last week released and posted to the Quality Payment Program (QPP) website the list of patient-facing encounter codes. The list is used to determine the non-patient facing status of clinicians eligible for the Merit-based Incentive Payment System (MIPS). Given the flexibility in program requirements for non-patient facing clinicians, the encounter codes are critical for CMS to identify MIPS-eligible clinicians.

A non-patient facing MIPS-eligible clinician is:

  • An individual MIPS-eligible clinician who bills 100 or fewer patient-facing encounters, including Medicare telehealth services defined in section 1834(m) of the Act, during the non-patient facing determination period; and
  • A group in which more than 75 percent of clinicians billing under the group's TIN meet the definition of a non-patient facing MIPS-eligible clinician during the determination period

The list of patient-facing encounter codes are categorized into three overarching groups of codes—Evaluation and Management Codes, Surgical and Procedural Codes and Visit Codes. The use of these codes classifies MIPS-eligible clinicians as non-patient facing and patient-facing.

CMS takes steps to help physicians identify dual eligibles

As an AMA notice reminded physicians in July, balance billing of Medicare patients enrolled in the Qualified Medicare Beneficiary (QMB) program is prohibited. The QMB program is a Medicaid program that helps very low-income patients who are enrolled in both Medicare and Medicaid with their Medicare cost-sharing.

In response to physician concerns that it can be difficult to identify their QMB patients, the Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt recently notified the AMA of new steps the agency is taking to inform physicians of patients' QMB status:

  • If a QMB patient contacts CMS about persistent inappropriate billing, the Medicare Administrative Contractor will send a letter to the provider identifying the patient's QMB status and associated billing policies
  • CMS is modifying its billing systems so that it will be able to notify physicians through the Standard Provider Remittance Advice if their patients are enrolled in the QMB program
  • CMS is exploring options for improving its eligibility query system to inform physicians of patients' QMB enrollment before claims are submitted

Additional information is available from the Medicare Learning Network.

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Health Insurance Marketplace 2017 Open Enrollment Ends on Tuesday, January 31

The Health Insurance Marketplace 2017 Open Enrollment period ends on January 31, 2017.  After January 31, you can enroll in or change a plan only if you qualify for a Special Enrollment Period. 

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 with a 2016 health insurance plan through the Marketplace should review their current plan, update their healthcare.gov account, and either renew coverage or select another plan for 2017.  5 Steps to Staying Covered Through the Marketplace

Health Insurance Marketplace assistance is available:

  • Call the Consumers for Affordable Health Care HelpLine at 1-800-965-7476
  • Find local help at www.enroll207.com.  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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Upcoming Events

Choosing Wisely: MOC Application Due February 8

Maine Quality  Counts is pleased to offer ABMS Maintenance of Certification (MOC) for physicians interested in Choosing Wisely® (CW).  Credit is available for physicians involved with Choosing Wisely and certified by one of the 24 specialty boards by the American Board of Medical Specialties (ABMS). 

If interested, physicians will need to sign up and return a signed Memorandum of Understanding (MOU) by February 8, 2017 (extended date).  

Interested physicians can review the CW MOC application outlining the MOC requirements and educational interventions here.  The CW MOC project cycle is January 2017-December 2017.


Please join us for the first webinar in the Choosing Wisely series: 

February 8, 2017 12:00-1:00pm  Register Here

How Does Choosing Wisely Help Reduce Unnecessary Care in the Practice Setting?

If you have questions about Choosing Wisely, contact Kellie Slate Vitcavage, Project Manager, at kslatevitcavage@mainequalitycounts.org or by phone at 207-620-8526 x1011.

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                   PROGRAM ON MEDICAL MARIJUANA – FEATURING JOHN KNIGHT, MD, Harvard

Maine's Marijuana Law and Its Impact on Youth

Saturday, March 4, 2017 at Sunday River Resort ~ 4:00pm

Dr. John Knight, a leading researcher in adolescent substance use and abuse is the developer of the CRAAFT Screening Test (a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents and he has developed an informational website for teens which has proved quite effective in changing attitudes and behavior. In addition to reviewing the science of what is known about effects of marijuana on youth, Dr. Knight will also summarize what is known about screening, prevention, and early intervention of adolescent substance abuse (alcohol, marijuana, and opioid)

Following his talk, there will be an expert panel (which includes Gordon Smith, Esq) discussing policy implications, prescribing issues, penalties, DHHS regulations, and how the law will be implemented.

To register:http://events.r20.constantcontact.com/register/event;jsessionid=0A40478B82B9F1AB2798844A7308AE87.worker_registrant?llr=yz5qzmuab&oeidk=a07ednyzs0q4a66acff

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SAVE THE DATE

25th Annual MAFP Family Medicine Update & Annual Meeting 

March 29 – April 1, 2017

at Hilton Garden Inn, Freeport, Maine 

  • Mar. 29 – Pre-conference SAM Study Group
  • Mar. 30-31 – Annual Update programming with Annual Meeting
  • **Just Added - April 1st – AM – Opioid Prescribing training (will meet Maine Medical Licensing requirements for new law)

Complete schedule and registration information available after January 15th on our website – http://www.maineafp.org/cme/mafp-cme-meeting

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Job Openings

PHYSICIAN ASSISTANT OR NURSE PRACTITIONER HOSPITALIST - Full Time or Per Diem, Bridgton Hospital, Bridgton, Maine

Bridgton Hospital, part of the Central Maine Medical Family, seeks a physician assistant or nurse practitioner to join its well-established hospitalist program. The full time hospitalist PA/NP would be responsible for two regular weeknight shifts and every fifth weekend, allowing for a healthy work/life balance. The candidate would be responsible for overnight admissions and care of acute inpatients and swing bed patients in our 21-bed critical access hospital. This is a contracted position with opportunities for loan repayment and additional per diem hours. Previous hospital experience necessary.

For more information visit our website at ww.bridgtonhospital.org. Interested candidates should contact Donna Lafean, CMMC Associate Professional Staff Recruiter, 300 Main Street, Lewiston, ME 04240; email: lafeando@cmhc.org; call: 800/445-7431; fax: 207/344-0658.

3/20/17

FAMILY PRACTICE PHYSICIAN -  Machias, Maine

Down East Community Hospital would like to find a quality focused Board Certified Physician to join our Outpatient Clinic team in Machias, Maine. We welcome Family Practice/Internal Medicine physicians with experience to share as well as new graduates looking to start their career.  We offer comprehensive benefits, aggressive incentive plans, and a four day workweek.

Whether you’re a weekend wanderer or an avid outdoorsperson, the communities of Downeast Maine have a lot more to offer than sailing craggy coastlines, hiking to spectacular vistas, and fishing vast river systems and lakes. Machias is community oriented town with an endless opportunities to explore a rich historical past as the site of the first naval battle of the American Revolution, art galleries, antique shops, traditional cultures, artisanal foods, and performing arts.

Contact Information: Elizabeth Hines Human Resources 207.255.0468 elizabeth@dech.org  EOE 

2/13/17

PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER - Bangor, Maine

A Psychiatric Mental Health Nurse Practitioner is needed for the Hope House Health and Living Center in Bangor, Maine! Requirements include a Master’s Degree in Nursing (Psychiatric Mental Health NP), Maine Advanced Practice Registered Nurse License, Certification by the American Nurses Credentialing Center as a Psychiatric Mental Health Nurse Practitioner, Certification in Healthcare Provider Basic Life Support, and 24 months’ experience as a Psychiatric Mental Health Nurse Practitioner. Please visit www.pchc.com/careers to access our Career Portal and apply today! For additional questions, contact Vanessa Sanderson, Recruitment Coordinator at (207)404-8015 or vsanderson@pchc.com. PCHC is an equal opportunity/affirmative action employer.

2/13/17

NP or PA - Jackman Community Health Center

If you want to enjoy Maine, the way it should be, come and experience the simple pleasures of small town medicine while being surrounded by over 250,000 acres of woodlands. Each season offers something for everyone except a traffic light. Jackman Community Health Center is in need of a full-time NP or PA to work in their highly unique primary care and urgent care facility.

JCHC is a part of Penobscot Community Health Center which is a nationally recognized health care facility that focuses on patient-centered care, innovation and collaboration. Signing, retention, and relocation bonuses are up for grabs with this position! This site is also loan repayment eligible.

Give yourself the opportunity you deserve, by working for a healthcare facility that always puts the patient first…for you, for your family, for our community.

For more information, please contact Vanessa Sanderson, Recruitment Coordinator, Penobscot Community Health Center at (207) 404-8015 or vsanderson@pchc.com

2/13/17

FAMILY NURSE PRACTITIONER/PHYSICIAN'S ASSISTANT

Katahdin Valley Health Center (KVHC) is seeking a Family Nurse Practitioner for the Urgent Care/Open Access practice located in Houlton Maine.  Open Access hours are 11am – 7pm, Monday – Friday, and 9am – 7pm, Saturday and Sunday.  Weekends are rotated between providers.  This position requires knowledge, experience and active support for rural, community oriented primary care.

With the mission of providing community accessible, quality healthcare with compassion and dignity, KVHC is the largest Federally Qualified Health Center organization in Northern Maine.  KVHC offers integrated, comprehensive, and affordable healthcare for the whole family through six Patient Centered Medical Homes. 

Benefits:  competitive salary and benefits package, generous paid time off, 401K, CME reimbursements, medical, disability and life insurance and FTCA malpractice coverage.  Practitioners at KVHC are eligible for NHSC Loan Repayment. 

Requirements: Current Maine License

Submit Cover Letter and Provider Application to http://www.kvhc.org/wpSite/wp-content/uploads/jobs/ProviderApp.pdf or email your resume to linda.mcgee@kvhc.org.

2/6/17

FAMILY MEDICINE PHYSICIAN - Pittsfield, Maine

Sebasticook Valley Hospital is seeking a full time Family Medicine physician to join Sebasticook Valley Family Care a modern practice located just off I-95 in Pittsfield.  Be part of a ten member collegial medical staff providing primary care services in a rural community. Work schedule is 4 days per week, with limited telephone call from home.  This position comes with competitive compensation, fringe benefits, assistance with medical education debt, signing/relocation bonus negotiable. 

SVH is a 25-bed modern critical access hospital located in Pittsfield which is 20 minutes north of Waterville, and 40 minutes south of Bangor. The hospital serves a population of 30,000 in this central Maine area.  SVH takes a proactive approach in helping people in the Sebasticook Valley improve the quality of their lives. The hospital works with local businesses, schools, the religious community, other healthcare providers, area organizations, and private individuals to make the Valley a healthy place to live. SVH serves has a wide range of outpatient services, including over 20 specialty services.

For more information, please contact Sherry Tardy, PHR, DASPR, at 207-487-4085 or email a CV for review to stardy@emhs.org.

4/3/17 

BC/BE FAMILY MEDICINE PHYSICIAN - Kingfield, Maine

Mt. Abram Regional Health Center (Kingfield) seeks a Physician who is BC/BE in Family Medicine to provide outpatient primary care and preventive services to people of all ages for 30-40 hours per week. As a NCQA Patient-Centered Medical Home, we offer accessible, high quality healthcare with integrated behavioral health services focused on the patient’s care experience. We offer check-ups for the entire family, care of acute and chronic conditions and referrals to specialty care and community services. In addition, our specialists assist patients with enrollment in programs that help pay for healthcare and medications.

The health center resides in a welcoming community near Sugarloaf USA and the University of Maine (Farmington) and is part of HealthReach Community Health Centers, a system of eleven practices in Central and Western Maine. HealthReach has been providing healthcare in rural and medically underserved communities for 42 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 salary, generous benefits, and malpractice coverage. The site is eligible for loan repayment. EOE. Contact: Recruiter, HRCHC, 10 Water Street, Suite 305, Waterville, ME 04901 | (207) 660-9913 | Fax: (207) 660-9901 | Communications@HealthReach.org | www.MTAbramCHC.org

1/30/17 

DIRECTOR OF EMERGENCY CARE - Southern Maine Health Care

Southern Maine Health Care is seeking a qualified physician for Director of Emergency Medicine.  

This FT Director position involves working collaboratively with all clinical staff and senior administration to assure that the care of patients in the ED is of the highest quality.  The position involves 24 administrative hours/week, and approximately 53 clinical hours/ month. 

Candidates must be Board Certified in Emergency Medicine, possess excellent communication and organizational skills, an ability to work well within a changing and fast-paced environment, and a strong commitment to the medical community. 

SMHC is a member of MaineHealth. We are a nationally accredited, award-winning 200-bed medical center located on the beautiful southern coast of Maine. 

SMHC is among the largest health care groups in Maine, bringing together York County's largest medical center with over 40 primary care physicians and specialists.

For more information, please contact Kelley Johnson, SMHC Recruiter at (207) 294-8404 or kajohnson@smhc.org.

1/30/17 

INTERNAL MEDICINE-PEDIATRICS or FAMILY MEDICINE TRAINED PHYSICIAN 

Maine Medical Partners Lakes Region Primary Care is seeking an Internal Medicine-Pediatrics or Family Medicine trained physician for their well-established outpatient practice located in Windham, just outside the greater Portland, Maine area.  Outpatient call only, with no attendance at deliveries or hospital call required.

This well established practice has been in the Windham community for almost 20 years and is part of Maine Medical Center’s Internal Medicine-Pediatrics residency program, with opportunities to teach Medicine-Pediatric Residents and medical students from the Maine Medical Center-Tufts University School of Medicine Medical School Program.

Maine Medical Center has 637 licensed beds and is the state’s leading tertiary care hospital and Level I Trauma Center, 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.

1/30/17

PHYSICIAN – Monmouth

DFD Russell Medical Centers (DFDRMC) operates three community health centers in central Maine.  We are seeking a full time Physician, for our Monmouth location.

Our three health centers serve a multicultural, rural population of about 10,000 patients and have a family practice focus serving pediatrics to geriatrics. We have excellent clinical support staff.

This position requires a high degree of flexibility, good clinical skills and commitment to team work and open lines of communication. It is a full-time at 4 days per week.

This position combines making a difference in patients' lives with a family-friendly work life, please e-mail your resume to Laurie Kane-Lewis, CEO. (Laurie.Kane-Lewis@DFDRussell.org) EEO

Requirements:  Current Maine license. Proficiency with electronic medical records.

Benefits:  Excellent benefit package: medical, dental, life, 401(k), flexible spending accounts and a generous paid time-off plan. Salary is commensurate with experience; there is also an incentive plan and a CME reimbursement.

2/20/17

FNP/NP – Monmouth

DFD Russell Medical Centers (DFDRMC) operates three community health centers in central Maine.  We are seeking a full time FNP/NP, for our Monmouth location.

Our three health centers serve a multicultural, rural population of about 10,000 patients and have a family practice focus serving pediatrics to geriatrics. We have excellent clinical support staff.

This position requires a high degree of flexibility, good clinical skills and commitment to team work and open lines of communication. It is a full-time at 4 days per week.

This position combines making a difference in patients' lives with a family-friendly work life, please fax or e-mail your resume to Laurie Kane-Lewis, CEO. (Laurie.Kane-Lewis@DFDRussell.org) EOE

Requirements:  Current Maine license. Proficiency with electronic medical records.

Benefits:  Excellent benefit package medical, dental, life, 401(k) , flexible spending accounts and a generous paid time-off plan. Salary is commensurate with experience; there is also an incentive plan and a CME reimbursement.

2/20/17

OUTPATIENT ONLY - INTERNAL MEDICINE with Loan Repayment & Sign-on Bonus 

The Central Maine Medical Group seeks BE/BC Internal Medicine physician to join cohesive, well-established, hospital-employed practice in Lewiston, Maine.  We offer:

  • Up to $200K in medical student loan repayment
  • $50K sign on bonus
  • Up to $12K moving allowance
  • 4 day work week/generous outpatient call
  • Healthy work/life balance

Central Maine affords easy access to the coast and mountains where you can enjoy four seasons of outdoor activities.  We have a growing arts and restaurant scene in a very safe affordable area to live and raise a family.  To join our growing team, contact Gina Mallozzi, Central Maine Medical Center, 300 Main Street, Lewiston, ME  04240.  Email:  MallozGi@cmhc.org; Fax: 207/344-0696; Call:  800/445-7431; or visit our website:  http://recruitment.cmmc.org/.

3/13/17

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.

2/20/17

 

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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association