Maine Medicine Weekly Update - May 8, 2017
A Message from AAP President Fernando Stein, MD, FAAP
Today, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213. The AAP opposed the bill and urged the Senate to start over as it considers the measure.
Your advocacy efforts played a pivotal role in blocking previous versions of AHCA and in making this vote a difficult one for the House. It also gave us the momentum we need now to continue the fight.
Even if AHCA in its current form does not become law, it sets a dangerous precedent. The most drastic cuts to Medicaid since its inception are now included in a bill that passed a chamber of Congress, making it easier to include similar proposals in the future. We cannot let that happen.
When so much is at stake, we cannot afford to let up in our advocacy, or to become defeated after a setback. We must continue to speak up for children and tell our legislators what they need to be healthy. We are our patients' voices and they are counting on us to use them.
The House is now going on a one-week recess following today's vote. I encourage you not to relent in your opposition to AHCA. Consider attending a town hall or district event next week. Or reach out via email or phone by going to federaladvocacy.aap.org and clicking on "Oppose the American Health Care Act" in the Advocacy Action Center.
If your representative voted yes on this bill, they should continue to hear from you about why you oppose that decision, and you should urge your senators to oppose the bill in their chamber. If your representative voted no, encourage them to continue pressing for better policies that prioritize children's health and protect Medicaid, and urge your senators to do the same.
Thank you for your continued dedication to this issue. As we've learned, together we can make a difference.
Fernando Stein, MD, FAAP
Last week Anthem announced that it would ask the U.S. Supreme Court to reverse the U.S. Court of Appeals for the District of Columbia upholding of a lower court ruling halting the proposed $54 billion mega insurance merger between Anthem and Cigna. The decision was seen as a victory for both patients and physicians.
Both the American Medical Association and the Maine Medical Association had opposed the proposed merger since it was announced and both had worked with the Justice Department to build a case against it. MMA lawyers had met with the Justice Department back in January of 2016 and expressed concern about the impact of the merger on Maine physicians and their patients. The AMA submitted an amicus brief to the appellate court in support of preserving the merger injunction issued in February of this year. Based on existing policy established by the AMA House of Delegates, the AMA advocated in 2016 that the Department of Justice block the two proposed mergers between health insurers Aetna and Humana and Anthem and Cigna.
Maine Attorney General Janet Mills also entered the litigation against the Anthem and Cigna merger. In July, 2016, MMA joined a group of organizations led by the AMA and Connecticut State Medical Society in urging the DOJ to carefully review the impact of large insurance company mergers on individual states and the country as a whole. Ultimately, the trial court found that the Anthem-Cigna merger would harm patients because ti would likely lead to higher premiums, eliminate the existing head-to-head competition between Anthem and Cigna, reduce the number of national carriers from four to three, and diminish innovation.
The ruling is the result of 21 months of advocacy by the AMA and the coalition of physician organizations, including MMA, before the DOJ, congressional leaders, state attorneys general, insurance commissioners, and federal court. Barring an appeal to the U.S. Supreme Court, the decision last week concludes a successful campaign by the AMA and 17 state medical associations - on behalf of patients and physicians - to stop the Anthem-Cigna merger.
Join your professional colleagues at a day-long conference on the topic of professionalism on Saturday, June 17 in Portsmouth.
Keynote speakers are Thomas Bodenheimer, M.D., MPH and Eric Campbell, PhD. Five of the leading clinical ethicists in northern New England will also participate on two panels moderated by Vikas Saini, M.D., President of the Lown Institute of Brookline, MA and MMA EVP Gordon Smith, Esq. Following lunch, a special presentation of the one act play, Side Effects, will be performed by actor Michael Milligan. The play tells the story of a physician stressed out by the many administrative responsibilities that can interfere with taking care of a patient.
A complete agenda and registration materials will be included with the next issue of Maine Medicine arriving around May 10. But registration is available now on the MMA website.
AMA delegates from New England met together in Providence, RI on Saturday to discuss resolutions that will be presented to the AMA House of Delegates in June.
On Saturday, May 6, the New England Delegation to the AMA met in Providence, R.I., to consider proposed resolutions to present to the AMA House of Delegates at the Annual Meeting in June in Chicago. Attending from Maine were AMA delegate Maroulla Gleaton, M.D., MMA President and alternate AMA delegate Charles Pattavina, M.D. and EVP Gordon Smith. AMA delegate Richard Evans, M.D., who chairs the New England Delegation was unable to attend because of an illness in his family.
Resolutions considered and receiving the two-thirds vote for endorsement of the delegation include the following:
The AMA House of Delegates will convene on Saturday, June 10 in Chicago.
See guidance for group practices that intend to use the CMS Web Interface or administer the Consumer Assessment of Healthcare Providers Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey to meet 2017 Quality Payment Program (QPP) requirements.
Group practices that intend to use the CMS Web Interface or administer the Consumer Assessment of Healthcare Providers Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey to meet 2017 Quality Payment Program (QPP) requirements must register with CMS by June 30. To register or learn more information, visit CMS' QPP website. Registration is open now.
For 2017, only groups of 25 or more eligible clinicians that have registered can report via the CMS Web Interface. Groups or individuals that participate in MIPS through claims, qualified registry, qualified clinical data registry, or electronic health record (EHR) data submission mechanisms do not need to register. For 2017, only groups of two or more eligible clinicians that have registered can participate in the CAHPS for MIPS survey.
Of note, CMS automatically registered groups for the CMS Web Interface for the 2017 performance period that previously registered for group reporting under the Physician Quality Reporting System (PQRS) via the Group Practice Reporting Option (GPRO) Web Interface. If you need to remove your registration for Web Interface submission because your group now has fewer than 25 eligible clinicians or is reporting through a different mechanism, you must cancel your registration. If your group wants to administer the CAHPS for MIPS survey, your group will need to make an election via the registration system.
Groups that participate in a Shared Savings Program accountable care organization (ACO) are not required to register or report; the Shared Savings Program ACO is required to report quality measures on behalf of participating eligible clinicians for purposes of MIPS.
To register, visit the QPP website. You will need a valid Enterprise Identity Management (EIDM) account with a Physician Value-Physician Quality Reporting System (PV-PQRS) role in order to register.
EIDM account information
Open a new account: To create or modify an EIDM account, review the CMS guide on this topic.
Reactivate an account: To reactivate or confirm the status of an account, contact the Quality Payment Program at (866) 288-8292 (TTY: (877) 715-6222) or email@example.com, Monday –Friday, 8 a.m.–8 p.m. EDT and provide the group name and TIN.
Use a current account: To request a role to access the "Physician Quality and Value Programs" application in the CMS Enterprise Portal, review the CMS guide.
MaineCare's new Opioid Health Home (OHH) program has begun accepting applications from organizations wishing to be considered for the designation.
The Opioid Health Homes are a new component of MaineCare’s Value-Based Purchasing Initiative, providing counseling, care coordination, medication-assisted treatment, peer support and medical consultation for individuals who have been diagnosed with an opioid dependency.
This OHHs will provide services to MaineCare members and the uninsured through grant-funded contracts with the Department of Health and Human Services’ Office of Substance Abuse and Mental Health. The upcoming application and the program requirements apply to programs serving both the MaineCare population and the uninsured (with a few minor exceptions).
To be an OHH, an organization must:
More information is at http://www.maine.gov/dhhs/oms/rules/emergency.shtml.
There are two options for reimbursement:
(Thanks to Dr. David McDermott and the Maine Hospital Association for permission to share this article which first appeared in MHA's Friday Report)
Group recommends that Secretary Price approve two proposals: Project Sonar and the Episode Grouper for Medicare. Learn more here!
In April, the Physician-Focused Payment Models Technical Advisory Committee (PTAC) had its first meeting to review and vote on proposals it has received. Following an in-depth review and discussion with the physician leaders who had submitted the proposals, the PTAC voted to recommend two proposals to Health and Human Services Secretary Tom Price, MD, for limited testing.
The first, called Project Sonar, has been spearheaded by Lawrence Kosinski, MD, an Illinois gastroenterologist. With support from a private payer, it has demonstrated significant improvements in care for patients with inflammatory bowel disease (IBD). Project Sonar engages these patients in an interactive process that allows the gastroenterology team to take steps to reduce exacerbations that would otherwise lead to emergency visits and hospital admissions.
The second model recommended by PTAC for testing is the Episode Grouper for Medicare (EGM) developed by the American College of Surgeons and Brandeis University. The EGM model will provide data to teams of physicians managing episodes of care that can help them to improve quality and outcomes of care and lower avoidable spending.
Both models hold promise for improving patient care as well as providing a means for specialist physicians who have had few opportunities to participate in alternative payment models to effectively do so. In remarks at the PTAC meeting, Secretary Price strongly encouraged the physician community to submit additional proposals for new models to the PTAC. He emphasized the need to avoid a one-size-fits-all approach and noted that we are in a time of great innovation in clinical medicine that requires innovation in payment models as well.
Learn more about both of these models at AMA Wire, and listen to a podcast interview with Dr. Kosinski about Project Sonar. The AMA website offers additional details on APMs and how to develop APMs.
Take Advantage of Online Learning Opportunities Offering CME Credits - Available 24/7 now from the Northern New England Practice Transformation Network (NNE-PTN)
Take Advantage of Online Learning Opportunities Offering CME Credits - Available 24/7 now from the Northern New England Practice Transformation Network (NNE-PTN)
The Northern New England Practice Transformation Network, led by Maine Quality Counts in collaboration with the Citizens Health Initiative at the University of New Hampshire's Institute for Health Policy and Practice, and Vermont Program for Quality in Healthcare, Inc., is funded through the Centers for Medicare and Medicaid Services' Transforming Clinical Practice Initiative to provide technical assistance to support you, your practice, and your consumers in the transition to value-based payment. The QC Learning Lab has been designed to support health care practitioners and professionals, and practice teams with a wide range of continuing education offers including online courses, webinars, and learning sessions.
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. In addition to discussing newly printed bills, MMA staff will report on the status of bills which have come up for public hearing or work session.
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 First Regular Session of the 128th Maine Legislature will take place tomorrow, Tuesday, May 2nd, 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
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 firstname.lastname@example.org or 480-4187, or Peter Michaud, Associate General Counsel at email@example.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.
NOTE: The MMA positions stated in parentheses after the bill titles are simply staff suggestions. They are not necessarily the positions taken by the Legislative Committee or the MMA.
This year is marked by two topics that have been the subjects of an inordinately large number of bills: recreational marijuana legalization and opioids. In order to allow clearer discussion of these bills during the legislative calls, the marijuana bills will be marked with a superscript "m" and the opioid bills with a superscript "o". We welcome your comments on whether this makes things easier or more difficult for you. Following are the bills of the week:
*LD 1564: An Act To Conform State Law to Federal Law While Promoting Safe Working Environments for Minors (Pediatrics, Family Medicine) (Monitor)
*LD 1587: An Act To Provide Economic Security to Maine Families through the Creation of a Paid Family Medical Leave System (All) (Monitor)
Read what happened this past week in the Maine Legislature: hearings, work sessions and more.
Health & Human Service
Most of the bills heard in the HHS Committee this past week were peripherally related to the practice of medicine, including bills concerning transportation and housing for persons with disabilities and a controversial bill that would allow creation of safe spaces for persons with substance use disorder to inject drugs. There were also hearings on a number of bills relating to MaineCare. The MMA did express concern about the additional administrative burden to physician practices and potential additional cost to patients about a bill (L.D. 1300) proposing a prescription requirement for methamphetamine precursor drugs.
The Labor, Commerce, Research and Economic Development Committee held hearings and work sessions on several bills of interest to the medical community. LD 1200, dealing with maintenance of certification, was modified to cover only a prohibition for MOC requirements in licensing. In that form, it was voted unanimously "ought to pass." The same result occurred with LD 1359, approving Maine's participation in the Interstate Medical Licensing Compact. Because the Compact requires specialty certification at the time of compact licensing (but not maintenance of certification after that time), the reciprocity language was removed from LD 1200. Unanimous "ought to pass" was also the result for LD 911, which will prohibit drug manufacturers from offering gifts to physicians beyond a nominal value. It will not interfere with reasonable honoraria for speaking engagements. The MMA was successful in keeping the focus of the bill on the behavior of manufacturers, rather than on physicians who might be receiving such gifts.
The Education & Cultural Affairs Committee took testimony on May 1st on a bill to allow the concealed carry of firearms on public college campuses (excluding dormitories and places of public entertainment). While there was little testimony in support of the proposal (the NRA submitted written testimony but did not appear), those testifying against included college professors and students, the Chief of Police for the University of Maine, a physician, and the Maine Gun Safety Coalition. The MMA testified in opposition to the bill, pointing out that brain science has shown that people in the age range of college students have brains which are not yet completely developed, and the last areas that mature are those dealing with judgment, executive function, and impulse control. A work session on the bill will take place this week.
The Department of Health and Human Services MaineCare section has proposed rule changes relating to opioid (including MAT) prescribing for MaineCare recipients. On May 8th a public hearing was held. While the MMA did not testify orally at the hearing, we, the Maine Hospital Association, and others will be submitting written testimony by the filing deadline, May 18th. Anyone who wishes to comment on the proposed rules should do so in writing by the deadline.
The Committee held a work session last Thursday on a bill (L.D. 1426) regarding the use of bioptic telescopic lenses for driving. During the 126th Legislature, a group of physicians including Bob Dreher, M.D., Linda Schumacher-Feero, M.D., and Dan Onion, M.D., M.P.H. participated with BMV staff and other stakeholders in a working group to review the history of the use of BTLs in driving and to make certain recommendations. Members of the Maine Society of Eye Physicians & Surgeons (MSEPS) felt that the recommendations remained sound & that this bill went beyond those recommendations. L.D. 1426 was submitted on behalf of a woman whose family wishes to move to Maine and feared she could not get a Maine license and use her BTLs to drive. Dr. Schumacher-Feero attended the work session to speak briefly about the history of BTLs in Maine, the recent working group, and the circumstances of this bill. Based upon her statement and response to the Committee's questions, the Committee tabled the bill following a motion "ought not to pass" to give the proponent an opportunity to discuss her case with the BMV staff. While the proponent didn't attend the work session, representations made about her level of vision suggested to many that she probably could meet the current Maine standards to get a driver's license.
Insurance & Financial Services
Also last Thursday afternoon, the IFS Committee held a long afternoon of public hearings on a series of bills of interest to many physicians. First, the Committee heard a bill (L.D. 1279) that seeks to protect patient and provider protections in Maine law that precede the ACA, if the ACA is ultimately repealed in Washington, D.C. The MMA joined other consumer advocacy organizations in support of the bill. Next, the Committee heard a bill (L.D. 1385) to clarify the nature of a "direct primary care" relationship between a physician and a patient. Several MMA members attended and spoke in favor of the legislation. Lastly, the Committee heard a bill (L.D. 1274) advocating a single payer approach to health care reform in Maine. The Committee spent several hours hearing passionate testimony from the public, including many physicians who have been engaged in advocacy in favor of single payer health care through Maine AllCare. The MMA delivered a letter in the "neither for nor against" category, including the new Statement on Reform of the U.S. Health Care System approved by the MMA board in January 2017. The MMA also provided member survey data showing that more than 60% of MMA members support a "Medicare for All" single payer approach to health care reform. The Committee will hold an initial work session on the bills tomorrow afternoon.
It's a great opportunity to meet and talk with your state senator and representative, and maybe even the Governor.
The annual "Physicians' Day at the Legislature" will be on May 31st this year. Wear your white coat, come to the Legislature for the day, and demonstrate the political commitment of Maine's physicians to great health care for Maine's people. Your presence on that day not only gives you a chance to share with your representatives the issues that matter most to you, it also puts a strong exclamation point on the work your MMA advocacy staff does all year. So come on down to Augusta and make a statement!
In an ironic but dangerous twist, legislation to add nurse practitioners to the list of individuals exempt from jury duty has resulted in a near unanimous recommendation from the Judiciary Committee to eliminate all the current exemptions, including the exemption for physicians and dentists in active practice.
L.D. 46, An Act to Provide Consistency Among Medical Professionals with Regard to Jury Duty Exemption, was introduced at the request of the Maine Nurse Practitioner Association. MMA took no position on the bill, following discussion during one of the weekly calls of the Legislative Committee. But when the bill was heard before the Joint Standing Committee on the Judiciary, the lobbyist for the Judicial branch presented an amendment which eliminated all of the current exemptions. When MMA representatives were advised of the amendment, we attended the work session but none of the outside interests were provided an opportunity to present the arguments against the amendment at the work session. The bill, now with the amendment, has strong support from the Judiciary Committee but strong opposition from the sponsor of the original bill, Senator Nate Libby (D., Lewiston). As a member of leadership (Assistant Democratic Leader in the Senate) Senator Libby will seek to kill the bill in the Senate.
A vote in the Senate was expected on Tuesday or Thursday of last week, but as of publication time on May 8th the bill remains tabled in the Senate.
Join the Maine Medical Association and DrFirst as we discuss what you need to know to become compliant with opioid prescribing legislation by the July 1st deadline.
Join the Maine Medical Association and DrFirst as we discuss what you need to know to become compliant with opioid prescribing legislation by the July 1st deadline. Bring your questions and concerns for the DrFirst e-prescribing expert to answer, and see a demo on the solution that can help you comply in time.
May 10, 12-1pm: Register Here
May 24, 7-8pm: Register Here
June 7, 12-1pm: Register Here
SAVE THE DATE - Friday, May 12th
SAVE THE DATE
Maine Society of Eye Physicians and Surgeons Educational Program and Business Meeting
May 12, 2017
Brunswick Hotel & Tavern, 4 Noble Street, Brunswick, ME
Contact: Shirley Goggin at 207-445-2260 or firstname.lastname@example.org
SAVE THE DATE - May 19-21, 2017 - REGISTER NOW!
Thursday, June 8, 2017 at the Brunswick Hotel & Tavern, 4 Noble Street in Brunswick
5:00 - 6:30 pm Town Hall Meeting
6:30 - 7:30 pm Quality Counts Member Mingle & Networking
Join community members in Brunswick on June 8 from 5:00 to 6:30 pm at the Brunswick Hotel & Tavern to hear different perspectives on healthcare changes and rising costs. How can you protect yourself against rising health care costs? What are current challenges in Maine healthcare? How can you become more informed about health care costs before you receive treatment? Panelists will share their thoughts to help all choose wisely when it comes to one's own health care.
Free Event - Please register by June 2nd at www.mainequalitycounts.org or by calling 620-8526 x1011.
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.
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.
Lifespan Family Healthcare is seeking a part-time Certified Physician Assistant, with full-time potential in the area.
Bridgton Hospital, part of the Central Maine Medical Family, seeks a physician assistant or nurse practitioner to join its well-established hospitalist program.
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.
Maine Medical Partners Primary Care is seeking a Family Medicine trained physician for their new outpatient practice located in Standish, just outside the greater Portland, Maine area.
Eastern Maine Medical Center seeks a primary care physician, board-certified/board-eligible in internal medicine, to join our well-established, quality-driven, outpatient practice.
Eastern Maine Medical Center seeks a primary care physician, board-certified/board-eligible in internal medicine, to join our well-established, quality-driven, outpatient practice. Husson Internal Medicine is one of seven primary care practices operated by Eastern Maine Medical Center. Our practice was the second in the nation to achieve “Patient-Centered Medical Home” status with NCQA. All physicians are NCQA-certified in diabetes and cardiac care. Our primary care network, largest in our area, has adopted a new practice model to include teams of one physician, one nurse practitioner, two registered nurses, and two medical assistants.
The Central Maine Medical Group seeks BE/BC Internal Medicine physician to join cohesive, well-established, hospital-employed practice in Lewiston, Maine.
Central Maine Medical Center and Maine Research Associates seek a physician to work 50% in your specialty and 50% as medical director of its clinical research company.
Winthrop Family Medicine in Winthrop, Maine is recruiting a Family Medicine Physician!
Winthrop Family Medicine in Winthrop, Maine is recruiting a Family Medicine Physician! We are a MaineGeneral Health hospital-owned outpatient practice with four MD/DOs, three NPs, a PA, and integrated behavioral health with an LSW and LCSW. We are one of the original practices in Maine’s Patient Centered Medical Home pilot. We deliver team-based care to a full range of patients spanning newborns to geriatrics, including two local nursing homes, home visits, osteopathic manipulation and functional medicine consultation. There are lab, imaging and physical therapy services on site. We also routinely teach and precept medical, nurse practitioner, physician assistant and medical assistant students. Our patients are admitted by the hospitalist team at MaineGeneral’s Alfond Center for Health, Maine's newest hospital, completed in November of 2013. There are 192 private rooms at the Augusta facility. Generous benefits package offered.
Contact Tiffiny Parker, Physician Recruiter, email@example.com
Maine-Dartmouth Family Medicine Residency (MDFMR), a community of allopathic and osteopathic physicians in Augusta, Maine who love to teach, is seeking a DO or MD Physician to join our faculty.
Maine-Dartmouth Family Medicine Residency (MDFMR), a community of allopathic and osteopathic physicians in Augusta, Maine who love to teach, is seeking a DO or MD Physician to join our faculty. Come teach and practice family medicine in a community and hospital system where you will be well supported! Ideal candidate has strong clinical skills and a passion for teaching. Must be willing to practice in both inpatient and outpatient settings and practice of full spectrum family medicine is a plus. We are looking for an enthusiastic, flexible candidate dedicated to high quality patient care. Maine-Dartmouth Family Medicine Residency is a successful and innovative dually accredited, community based, thirty-resident program. MDFMR is a mission-driven organization that provides healthcare to patients of all ages, with an emphasis on underserved and rural people. Our graduates go on to practice in Maine and across the country. Generous benefits package offered.
Contact Michelle Bragg, firstname.lastname@example.org
Waterville Family Practice, a five provider private practice in downtown Waterville, Maine, is seeking a Family Medicine Physician to join the all outpatient practice.
Waterville Family Practice, a five provider private practice in downtown Waterville, Maine, is seeking a Family Medicine Physician to join the all outpatient practice. Enjoy the many advantages and flexibility of a private practice in a brand new facility. You will be joining three other doctors and two physician assistants with an option to remain an employee or buy-in and shared ownerships after 2-4 years. Practice the full scope of family practice without OB care with the support of exceptional specialists in the Waterville area.