January 27, 2003

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Welcome to Maine Medicine: Weekly Update
Welcome to this inaugural edition of Maine Medicine: Weekly Update, published by the Maine Medical Association for the benefit of its members. Designed to supplement the printed monthly version of Maine Medicine, this briefer e-mail/fax publication will contain brief titles and then direct the reader to a longer version of the article. Appropriate links to other relevant articles and materials will be included in the on-line edition.

 While the monthly edition of Maine Medicine necessarily has a long lead time, this weekly edition will be published each Monday and will contain the timely information that Maine physicians need to know that week.

Readers not interested in the publication can easily unsubscribe by following the simple directions at the bottom of the newsletter.

The Maine Medical Association hopes that members will find the publication useful.  Suggestions may be directed to Gordon Smith, Executive VIce President via e-mail at gsmith@mainemed.com or via fax at 622-3332 or by telephone at 622-3374.






U.S. Senate Passes Bill to Stop 2003 Medicare Payment Cut
On Thursday, January 23, 2003, the Senate passed a $390 billion omnibus appropriations package which includes a provision to stop the impending 4.4% Medicare physician payment cut scheduled to go into effect March 1st.  The Maine Medical Association appreciates the efforts of Senators Snowe and Collins, both of whom voted for the package which passed 69 to 29.  The bill will now go to a conference committee.  The congressional leadership hopes to complete conference negotiations by early February.  The legislation must be signed into law before March 1st in order to effectively stop the payment cut.

The legislation would freeze the existing Medicare physician fees at the 2002 rate until Sept. 30th, 2003.  A longer term fix for physicians is likely to be a broader Medicare bill to be considered later this year.

While last week's action is a very positive step toward fixing the problem, physicians need to continue to contact their congressional representatives to ensure that the necessary further steps take place. [return to top]

Maine Legislature Targets License Fees
This afternoon, the Maine Legislature's Committee on Appropriations and Financial Affairs will consider Governor Baldacci's supplemental budget proposal aimed at cutting the existing 2003 state budget by $44 million.  Unfortunately, the Association has learned that part of the bill would take funds in several licensing boards, including $57,000 from the Board of Licensure in Medicine.  Historically these licensing fees have been considered dedicated accounts used solely for Board purposes.  Other Boards including those regulating dentists, osteopathic physicians, optometrists, nurses and engineers have also been targeted. 

As Andrew MacLean, MMA lobbyist, will say in testimony before the Committee this afternoon,  while the amount proposed to be taken from the Board may seem modest, to a small board such as the medical board, this mis-appropriation of reserves could impair the ability of the Board to carry out the essential functions of licensing and discipline. Taking these funds will be likely to increase licensing fees, thus essentially taxing physicians to help close the budget deficit.   This action is simply the imposition of a tax in another guise.

Physicians should call their legislators and object to this unprecented attack on dedicated licensing fees. [return to top]

Physicians and Employers Working Together on Performance Measurement
The Maine Health Management Coalition (MHMC) is taking the first steps in attempting to measure performance at the medical practice level through its project called, Informing Patients and Rewarding Providers (IPRP).  MHMC is a coalition of 14 public and private employers, 9 hospitals, 5 physician groups and 4 healthplans who are collaborating on a mission to measure and improve the value of healthcare in Maine.  The Informing Patients and Rewarding Providers project is lead by a Steering Committee of 8 physicians, 5 employers and 3 healthplan Medical Directors.

The IPRP project has surveyed all primary care practices in Maine with more than 2 physicians to gather information on the systems in place to manage chronic disease.  The results have been reported back to the participating practices and a list of participating practices will be posted on the Coalition's website for employees.  This year (2003) a revised survey will be administered that will attempt to quantify what each practice is doing.

The group has also retained the Maine Health Information Center to use the coalition claims database on its 275,000 employees to measure compliance of practices in Maine on three measures drawn from well-established guidelines using the HEDIS methodology developed by the National Council on Quality Assurance (NCQA).  Statistically  valid results have been produced on 47 practices and these results will be mailed to those practices next week.  A consumer version of the results will be made available to employees and family members in March.  The group is planning to collect outcomes data directly from practices in 2003.  The three measurements looked at in 2002 included HbA1C's and LDL-C's for diabetes care and the use of controlled meds for patients with asthma.

The employers in the Coalition realize that the current mechanisms for paying for healthcare do not reward investments in quality improvement.  Therefore, a key part of this initiative is to create financial and non-financial incentives that will create a business case for quality.  The members have created a $125,000 fund to recognize those practices that have invested in systems that are producing better results and to provide some assistance to those who want to improve systems.  More importantly, MHMC members are working with their healthplans to incorporate stronger performance incentives for a standardized set of metrics into the reimbursement model.

While the Maine Medical Association does not endorse this effort, MHMC has kept the Association well informed of this project from its inception and all of the physicians on the steering committee are MMA members.  MHMC has also retained Jan Wnek, M.D. as a clinical advisor to the project.  Anyone wishing additional information on the project can contact Dr. Wnek at janicewnek@blazenetme.net.

Presentations on the project will be part of the Association's Annual Physician Survival Programs being held in the Spring.  The programs this year will be held in Bangor on May 28th and in South Portland on June 25th.  Registration materials for the all-day programs will be mailed with the March and April issues of Maine Medicine. [return to top]

Additional HIPAA Program Scheduled for March 26th
The Association announces an additional HIPAA program to be held in Waterville on Wednesday, March 26th.  The program will be at the Holiday Inn from 8:30a.m. to noon.  Registration will begin at 8:00a.m.  The program will focus on the privacy rule which takes effect on April 14th, but will also give attendees helpful information on the upcoming rule on Transactions and Code Sets and Security. Confirmed speakers at this time include Gordon Smith, Esq., Executive Vice President of the Association and Jeffrey Bardin of Treadstone 71, an expert in security.

The program will be an enhancement of the the Association's previous HIPAA programs offered last Fall.  Additional information can be obtained from Susan Feener at MMA. [return to top]

Governor Baldacci Announces Health Advisory Team
Governor John Baldacci on January 21st announced his Health Advisory Team assembled to assist his health policy staff in drafting a proposal (by June 1) to provide health insurance coverage to all Mainers.  Twenty-seven different organizations are represented on the Team, including MMA, the Maine Osteopathic Association, the Maine Hospital Association and other provider, business and insurance groups.  MMA will be represented on the Team by Maroulla Gleaton, M.D., an ophthalmologist from Augusta who serves as MMA President-elect.  Dr. Gleaton also serves on the Advisory Committee to the Maine Health Access Foundation and as the Chair of MMA's Ad Hoc Committee on Health System Reform.  The complete list of the Health Advisory Team is available from MMA by emailing Charyl Smith. [return to top]

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