January 12, 2004

 
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DHS Hears Public Criticism over Medicaid Cuts
The Baldacci Administration heard public comment on its emergency rulemaking proposal to cut MaineCare payments and services as part of its plan to close a $109 million shortfall in the existing year's budget.
A couple hundred people showed up last Thursday morning to express their concern over the recent announcement of Medicaid cuts to help fill the $109 million shortfall.  These cuts are part of a proposed emergency rule by the Department of Human Services which will become effective in one form or another on January 20.  The Legislature is holding hearings on these cuts this week (Wednesday and Thursday at 1pm in room 228 of the State House). 

Several themes ran through the testimony, including how these cuts are inconsistent with the intent of Dirigo, how frustrating and time consuming prior authorization is, concerns over the rationing of health care, and that good medical care saves money.  Kevin Lewis, head of the Maine Primary Care Association, which represents the rural health centers, testified to the devastating effect of cutting the case management fee and raised the possibility that it would cause two centers to be shut down.  A group of providers and patients made a compelling case for reinstating gastric bypass coverage, arguing that it was offensive for it  to be considered elective surgery and that the potential cost savings for comorbidity is extensive.

Proposed cuts to hospitals alone would be $25.5 million, resulting in a total reduction in proposed payments to hospitals of 25% when considered with the cut passed in the biennial budget last March.  While the proposed reduction in fees to physicians has been restored, physicians and patients alike will obviously be impacted by the proposed cuts to facilities and by the elimination of some services.  Thanks to those physicians who have taken the time to attend the hearing or to communicate with the Department.  MMA representatives are meeting with DHS officials again on this coming Wednesday to discuss the impact of these proposed cuts and the more severe cuts likely to be included in the next year's budget.

The panel accepting testimony included Jude Walsh and Chris Lukas-Lessard of the Bureau of Medical Services and Trish Riley of the Governor's Office of Health Policy.

Early Legislative Action This Week
Not wasting any time, committee work began in earnest this past week at the State Legisature as the 121st State Legislature began the first week of its Second Regular Session. 

The Health and Human Services Committee started the year by banning bottled drinking water laced with Nicotine (L.D. 1631) by a vote of 6-5, unless the FDA were to approve it.  Rite-Aid immediately released a statement that it would no longer sell the water in Maine, leaving currently no other drug store carrying it in the state.  The committee also rejected a bill which would have raised Medicaid reimbursement rates (L.D. 59) by a vote of 9-1, with Dr. Thomas Shields as the lone supporter.  The vote is more indicative of the current fiscal crisis than it is of the legislators'  position on the need to increase reimbursement rates.

The Business, Research and Economic Development Committee held a hearing on L.D. 1152, An Act to Authorize Collaborative Practice for Emergency Contraception.  This bill would allow pharmacists, as part of a collaborative practices agreement with a physician, to dispense emergency contraception (Plan B) to a pharmacy customer.  The MMA has yet to take a formal position on this bill and will be discussing it at our Legislative Committee on Tuesday.  Anyone interested in joining us is welcome (please rsvp to csmith@mainemed.com).  Most of the supporters of the bill were from Family Planning and victim's services organizations.  Opposition came mostly from religious organizations.  Anna Bragdon testified that MMA is generally supportive but  would let the committee know of their position after Tuesday's meeting.  She reviewed the AMA position, which is supportive of over-the-counter status, and expressed the concerns outlined by the MMA Public Health Committee, which included proper medical screening and the need for follow-up care. Concern over the future scope of practice of pharmacists is also an issue of concern.

Over a hundred bills were printed this week, including L.D 1826, An Act to Encourage the Proper Disposal of Expired Pharmaceuticals, which is a direct result of MMA's resolution from the Annual Meeting.  Also printed was L.D. 1713, Resolve, To Establish the Commission to Study Access to Prescription Medication for Persons with Mental Illness. This bill was initially going to give psychologists prescriptive authority but was watered down by the bill's sponsor Mike Brennan (D-Portland) to more accurately reflect his legislative intent of studying the issue of access and in doing so consider the possibility of expanding prescriptive authority.  Despite the new language, the bill is likely to draw strong opposition from the Maine Psychiatric Association and other mental health groups, as psychologists are not educated or trained to prescribe medication.  No state in the country, except for recent activity in New Mexico, allows psychologists to prescribe. [return to top]

MMA Legislative Committee Meets Tuesday Night
The 121st Maine Legislature  began its Second Regular Session on Wednesday, January 7th & is expected to finish its work by late March or early April.  The MMA's legislative advocacy team will be at the State House every day to represent the interests of Maine physicians.  The MMA Legislative Committee will meet on Tuesday, January 13th at 6 p.m. at the MMA office.  The weekly legislative update, Political Pulse, will begin second session publication on Friday, January 16th.  If you would like to receive the Political Pulse, please send your email address to Charyl Smith, Legislative Assistant, at csmith@mainemed.com.

You can become involved in the MMA's legislative advocacy in a number of ways -  by signing up for the Political Pulse & responding to its legislative alerts, by participating in the "Doctor for the Day" program, or by joining the Legislative Committee conference calls.  If you would like more information about this aspect of the MMA's work, please contact Andrew MacLean at amaclean@mainemed.com. [return to top]

CMS Reports U.S. Health Care Spending Hits $1.6 Trillion in 2002
In a report released on January 8th, the Centers for Medicare & Medicaid Services (CMS) states that U.S. health care spending was $1.6 trillion in 2002, up from $1.4 trillion in 2001 and $1.3 trillion in 2000.  The health care share of GDP was 14.9% in 2002, up from 14.1% in 2001.  The 2002 growth was 5.7% faster than the overall growth rate of the economy as measured by the GDP.

Read the press release on the CMS web site. [return to top]

Dirigo Health Hospital Study Commission Hears from Maine Hospital Association
On Monday, January 5, the Commission established in the Dirigo Health Legislation to review Maine's hospitals held its second meeting and heard a presentation from the Maine Hospital Association.  The presentation provided an overview of Maine hospitals, hospital finances, the impact of chronic under-funding by MaineCare and Medicare, the role of hospitals in the continuum of care and the impact of these services on reducing health care costs.  The talk included a Power Point presentation which is available on MHA's website at http://www.themha.org/advocacy/presentationHospstudcom_files/frame.htm.

The Commission will meet twice monthly until it issues a final report November 1.  The next meeting will be held on Jan. 20th.  Drs. D. Joshua Cutler and Richard Wexler represent physician interests on the study commission. [return to top]

Dirigo Health Board Appoints Executive Director
Tom Dunne, formerly of the consulting firm Accenture, was named this past week as permanent Executive Director of Dirigo Health.  Dunne had previously been serving as interim executive director.  It has been publicly reported that Dunne has taken the position without taking a salary, essentially working as a volunteer.

The announcement was made by the Dirigo Health Board of Directors which held its third meeting on Jan. 5.  The board also discussed results of focus groups conducted to test the viability of the various insurance plans that Dirigo may consider.  The focus groups included various employers and employees.  Preliminary results seem to indicate what the rest of us already know:  that cost effective premiums are the key to attracting small businesses to purchase such products for their employees.

The Board also received a presentation from Gino Nalli, of the Muskie School of Public Health, which has been contracted to assist the Board.  Mr. Nalli described the current offerings from Anthem, Aetna, and others. [return to top]

MaineCare Drug Utilization Review Committee to Meet Tuesday
The MaineCare Drug Utilization Review Committee will meet on Tuesday, January 13, 2004 in Conference Room 1A&B at the Department of Human Services/Bureau of Medical Services offices, 442 Civic Center Drive, Augusta from 6:00pm to 8:00pm.  A public comment period will begin at 6:00pm.  In addition to the public comment period, the agenda includes the following:

          Approval of November Minutes

           Preferred Drug List Update

            PDL-PA request; volume and determination times

             Additional supplemental rebate updates

             Any outstanding issues regarding PDL:

                  1.  Review letters received regarding PDL and criteria since last meeting.

                   2.  Discuss current status and implementation dates for GI, Diabetes provider education program.

               Discuss next steps for PDL

                           *  Antipsychotic provider education project

                            *  Bipolar disease/mood stabilizer/anticonvulsant initiative

                             *  Discuss:  Cialis, Proscar, Biaxin XL, Phenytek, Oxycontin, Elidel Cream.

                  Parameters for PDL performance exemptions. [return to top]

AMA Lauds FDA Action Banning Ephedra
Last week, the Food and Drug Administration (FDA) announced its decision to ban dietary supplements containing ephedra.  The AMA has long called for a total ban on ephedra in dietary supplements and strongly supports the FDA decision.

"Dietary supplements containing ephedra are a serious health threat," said AMA Trustee Ronald Davis, M.D., and this ban will lead to the removal of these products from supermakets and drugstore shelves nationwide.  Seizure, stroke, psychiatric problems, heart attack and death are all recognized risks of ephedra use.

Visit http://www.ama-assn.org/ama/pub/article/1617-8273.html to read Dr. Davis' full statement. [return to top]

Alcohol Screening Materials Available to Clinicians
The 2004 National Alcohol Screening Day (NASD) has a kit available entitled, "Alcohol and Your Health; Where Do You Draw the Line?"  The kit addresses the full range of alcohol use disorders, from at-risk drinking to dependence, and offers physicians the chance to educate patients about the impact of alcohol on health.  Included in the kit are the video, "Alcohol and Your Health;  Where Do You Draw the Line?"  and educational materials for clinicians, including the newly released National Institutue on Alcohol Abuse and Alcoholism/National Institutes of Health guide, "Helping Patients with Alcohol Problems;  A Health Practitioner's Guide."

The AMA is one of the official co-sponsors of the NASD, which will be held on Thursday, April 8.  Now is the time to begin planning events related to NASD.  Possible activities include encouraging local health care providers to obtain the screening kit and organizing a screening day activity.  For more information about NASD, visit:  http://www.NationalAlcoholScreeningDay.orgor call 1-800-253-7658. [return to top]

AMA Releases CPT Code to Cover Online Consultations
In response to the onset of physicians beginning to communicate with their patients via e-mail, the AMA has created a temporary code for reimbursement of online consultations.  Current Procedural Terminology (CPT) code 0074T will become effective in July 2004.  The new CPT code will cover a physician's reponse to a patient's online inquiry, but will not cover such patient contact as telephone conversations related to pre- or post-visit work.  It will cover phone calls, prescriptions, and lab orders pertaining to the online consultation.  It will be up to the discretion of each insurer whether to pay for e-mail consultations.  Currently, only a handful of health insurers reimburse for online consultations, many through pilot projects or other programs. [return to top]

MMA Has Busy Week Ahead
WIth the holidays behind us, the Maine Medical Association begins a busy legislative and committee season this week.  On Monday evening, the MMA Committee on Physician Health, Chaired by Thomas McDermott, M.D., will meet.  On Tuesday evening, the MMA Committee on Legislation, Chaired by Katherine Pope, M.D. will meet and on Wednesday, the Public Health Committee will meet, chaired by Jo Linder, M.D.

On Thursday evening, MMA representatives will meet with the Executive Council of the Maine Psychiatric Association to discuss pending legislative proposals impacting on mental health.

On Friday and Monday, MMA representatives will attend meetings of the Dirigo Health Advisory Committee to the Maine Quality Forum, the Dirigo Health Advisory Committee on Health Systems Development and the Dirigo Commission to Study Maine's Hospitals.  In addition, staff will monitor several work sessions of legislative committees.

Next week, on Jan. 23rd, the MMA Executive Committee, chaired by Jacob Gerritsen, M.D., will meet in Stowe, Vermont for a three day meeting.  In addition to having a facilitated discussion on the subject of physician leadership, the Committee will meet with representatives of the Vermont and New Hampshire State Medical Societies to discuss the epidemic of opiod abuse and trafficking in the Tri-State region.

The Association begins the year with over 2500 members, an increase of over 200 members in the last year.  If you have an interest in any of the association committees or activities, please communicate with Gordon Smith, EVP at gsmith@mainemed.com. [return to top]

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