May 19, 2003

 
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MMA Opposes Baldacci Health Care Reform Proposal
Following an analysis of the 72 page Plan and 45 page legislation, the MMA Legislative Committee last week voted to oppose the proposal expressing grave concern about the short timeframe for consideration of the bill and its impact on physician recruitment and retention.
     The two bills comprising the Governor's package were printed and available to the public on Monday, May 12th.  On May 13th, members of the Association's Legislative and Executive Committees spent three hours reviewing and discussing the provisions of both bills before concluding that the MMA had to oppose the proposal in its current form.  The Committees came to a strong consensus that the very concrete threats to physicians and patients outweighed the speculative benefit of  covering currently uninsured patients with some form of insurance.  The bill opposed is L.D. 1611, An Act to Provide Affordable Health Insurance to Small Businesses and Individuals and to Control Health Care Costs.

       Members did agree to strongly support the second bill, L.D. 1612, RESOLUTION, Proposing an Amendment to the Constitution of Maine to Preserve the Fund for a Healthy Maine.  This bill proposes a constitutional amendment to ensure that Maine's share of the national tobacco settlement funds continues to be used exclusively for healthcare purposes.

        On May 14th, Maroulla Gleaton, M.D., President-elect of the Association, Andrew MacLean, General Counsel and Gordon Smith, EVP, met with Trish Riley and Ellen Schneiter of the Governor's Office of Health Policy and Finance to discuss the results of the Tuesday evening meeting.  We were joined at the meeting by Kellie Miller, Executive Director of the Maine Osteopathic Association which shares our concerns.   Ms. Riley is the primary architect of  L.D. 1611.  The following issues were identified as the most significant problems in the legislation  for Maine physicians and their patients.

            1.  The expansion of eligibility of MaineCare (formerly called Medicaid) without  increasing reimbursement fees to at least the level of Medicare.

              2.   The concept of setting global budgets for Maine's hospitals and establishing a 3% 'voluntary' spending cap (for physicians, as well) without impacting positively on the cost drivers in the system, except for the possible impact on bad debt and charity costs.

                3.  The expansion of Certificate of Need to the private physician's office.

                 4.   The onerous provisions regarding the collection of 'quality' data from the physician's office, through rule-making by the Maine Health Data Organization (MHDO).   The bill would greatly expand the authority of the MHDO.

                   5.    A mandate for all physicians to bill electronically by 2005.

                    6.   Disclosure of pricing information, to be 'posted' in the physician office.

            Proposed amendments were discussed and the administration seemed genuinely interested in working with the Association on some new langauage on some of the above points.

       On Thursday afternoon, May 15th, EVP Gordon Smith presented MMA's testimony in opposition to L.D. 1611 at a public hearing before the Legislature's Joint Select Committee on Health Care Reform.   Other physicians attending and in some cases testifying were Lawrence Mutty, M.D., Chairman of the MMA Executive Committee;   Jo Linder, M.D., Chairman of the Maine Coalition on Smoking or Health; H. Burtt Richardson, M.D., a Winthrop Pediatrician; Wayne Moody, M.D. of Central Maine Orthopeadics,  Craig Young, M.D., a former President of MMA and an ophthalmologist currently practicing in Presque Isle and Bangor; and Paul Klainer, M.D., of Owl's Head who operates a free clinic in Rockland.  Representatives also attended from Orthopedic Associates in Portland.

     Other opponents of the bill included Anthem General Manager Jim Parker, Maine Hospital Association President Stephen Michaud and Maine Osteopathic Association Executive Director Kellie Miller.  Proponents included largely uninsured individuals, some small business representatives and advocates for low-income and uninsured individuals.

      Work sessions on the bill will be held this week on Tuesday, Wednesday and Thursday afternoons.  There is still considerable pressure from the administration to vote the bill out of committee this month.  As discussed in Mr. MacLean's 'Political Pulse', which you can access through the following link, MMA encourages all physicians to carefully consider L.D. 1611 and L.D. 1612 and to discuss the issues with your legislators.  L.D. 1611  will have a significant impact upon your practice, regardless of specialty or setting.  The following link will also give you access to MMA's testimony, contact information for the Joint Select Committee and talking points.  http://newsmanager.commpartners.com/mmpp/issues/2003-05-15.html

Medicare Amendment Proposes to Assist Rural Areas
With little notice, the United States Senate on Thursday (May 15), passed a Medicare amendment to its pending tax bill by a vote of 86-12. The amendment, offered by Senator Charles Grassley (R-IA), includes provisions impacting favorably pysicians, rural hospitals, home health agencies and other providers.  In particular, it would make Medicare bonus payments to physicians in shortage areas automatic and would increase geographic adjustment factors in any area where the adjustment is lower than the national average.  Specifically, it would set a floor of 1 for all three geographic indices (work, practice expense and medical liability).  An estimated $25 billion in new spending under the amendment would be offset by (i) reducing payments for Medicare-covered outpatient drugs, (ii) freezing payments for durable medical equipment, prosthetics and orthotics, and (iii) requiring beneficiaries to pay deductibles and copays for clinical laboratory services.

No corresponding Medicare provisions are in the House-passed tax bill, and thus the Medicare provisions will be a discussion item in the House and Senate conference, which is expected to take place in the coming days.

Should the Grassley amendment find its way into the final bill, it would be of significant benefit to Maine physicians because of the current geographic disparities between what Medicare pays in Maine and what it pays for physician services in more urban states. [return to top]

Collins Amendment Would Boost Medicaid Matching Funds
An important amendment offered by Maine Senator Susan Collins passed the United States Senate last Thursday by a vote of 95 to 3.  The amendment would provide a state aid package that would allocate $10 billion to boost Medicaid matching rates to the states by 2.95 percentage points until Oct. 10, 2004.  It would also provide states with $5 billion a year for two years which could be used for education, job training, health care, social services, transportation and infrastructure, law enforcement, public safety or 'essential' government: services.

NOTE: Senator Collins is no longer be reachable through senator@collins.senate.gov.  Instead use: http://collins.senate.gov/low/contactemail.htm.

  [return to top]

MaineCare Fee Increase for Blood Screening for Lead Announced by Bureau of Health
As a result of recent legislative efforts to clarify lead screening reqirements and to increase physician reimbursement, the Bureau of Health announced on May 13th that Mediciaid (now MaineCare)  will be implementing a fee increase for blood screening by paying an additional $3.00 for the blood draw.  The additional fee will be paid in connection with the following two codes: 

                      CPT 36415  venous blood draw (increased from $3.00 to $6.00)

                       CPT 36416  capillary blood draw (increased from $2.70 to $5.70)

This fee is paid in conjunction with ICD 9 code 984.9 (general lead poisening diagnosis code).  Because of HIPAA, the Bureau can no longer create additional local codes.

The change will be effective for dates of service on or after June 1st, 2003. [return to top]

Statewide Training on Emergency Preparedness June 18th via Satellite
A Statewide training session on Emergency Preparedness is being held on Wednesday, June 18th via satellite broadcast at 12 locations around the state.  Additional information about the training can be found at the following link:

      http://www.mcph.org/june.18.broadcast.htm

This training is intended for a broad audience of clinicians, first responders, school nurses, community coalitions, mental health crisis workers, hospital personnel, emergency management and other interested individuals.  Registration is required and can be done by mail, fax or on the website noted above.  There is also more information on the Maine Center for Public Health website at www.mcph.org. [return to top]

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