October 18, 2004

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MMA Executive Committee to Meet Wednesday; Hospital Study Commission on Agenda
The MMA's 25 member Executive Committee will meet on Wednesday, Oct. 20. The agenda includes a discussion of the current status and potential recommendations expected from the Commission to Study Maine's Hospitals and an update on the efforts of the Maine Quality Forum to establish a public website including data on geographic variations in surgical and medical procedures and admissions.
The Executive Committee is now chaired by Kevin Flanigan, M.D. of Pittsfield.  Dr. Flanigan is an internist and pediatrician in private practice.  He has served on the Executive Committee for several years representing Somerset County and has served on the MMA's Steering Committee for the past two years.

The Hospital Study Commission has circulated an early draft of its report to Commission members and those reports have now become widely available.  The Maine Hospital Association has expressed strong opposition to two proposals appearing in the early draft of the report: 1) State mandated regionalization through the establishment of regional boards of overseers and 2) steep reductions in overall hospital budgets.

Maine Medical Association members may comment on either of these proposals to the physician members of the Commission, Josh Cutler, M.D., a Portland cardiologist and Louis Hanson, D.O., a family physician also practicing in the Portland area., or to MMA via e-mail to Gordon Smith at gsmith@mainemed.com or Andrew MacLean at amaclean@mainemed.com.

The draft recommendations have not yet been finally adopted or approved by the Commission.  Therefore, it is premature to assume that any particular provision in the draft report will remain as part of the final report.  On the other hand, it is not too early to advocate for positions consistent with the views of and interests of Maine physicians on this important issue.

At a recent meeting of the Maine Quality Forum Advisory Council, Dennis Shubert, M.D., PhD., Executive Director of the Forum reported on his recent modifications to the MQF website, which is expected to be available to the public within the next couple weeks.  Dr. Shubert noted that the delay in getting the information on the site related to the need to have the data and an explanation of the data be presented more clearly.  Council members have consistently expressed some level of concern about the data selection process, the patient's ability to interpret the meaning of the data outside of the mean and the need to clarify that the posted information is not intended to be a roadmap for consumers to make their own health care decisions.

All MMA Committee meetings are open to any MMA member, whether they are a committee member or not.

MMA Legislative Committee Will Discuss Legislative Agenda on 11/9
The MMA's Legislative Committee, chaired  by Katherine S. Pope, M.D., will meet at the MMA office at 6 p.m. on Tuesday, November 9, 2004 to begin planning for the 122nd Maine Legislature that will begin work in Augusta in early January 2005.  The agenda for the meeting will include a review of the state legislative races and the composition of the next legislature and a discussion of the MMA's legislative agenda for the 2005-2006 biennium.  D. Joshua Cutler, M.D., a physician representative on the Commission to Study Maine's Hospitals has also been invited to attend the meeting and discuss the draft report of the Commission.  The final Commission report is likely to include recommended legislation to be presented to the 122nd Legislature.

The Legislative Committee welcomes any physician with an interest in advocacy to attend.  As you may remember, any physician may participate in the weekly conference calls in which the Legislative Committee develops a position on each bill identified by the MMA staff as relevant to the practice of medicine in Maine.  Representatives of each organized specialty society in Maine also are encouraged to attend this meeting and to participate in the MMA's advocacy. 


Dinner will be available at 6 p.m. and the meeting should run from approximately 6:30 p.m. to 8:30 p.m.  If you would like to attend, please contact Charyl Smith, Legislative Assistant, at csmith@mainemed.com or by phone at 622-3374.  If you have further questions about the agenda for this meeting or the MMA's advocacy activities, please contact Andrew MacLean, Vice President & General Counsel, at amaclean@mainemed.com. [return to top]

Baldacci Administration is Working to Meet Flu Vaccine Needs
In a release posted on the Governor's web site on October 13, the Baldacci Administration announced that the Bureau of Health has about 14,400 doses of flu vaccine on hand, well short of the 150,000 doses ordered from the CDC, but more than the 9900 doses on hand last week.  The Governor also announced that several Maine businesses, including Medical Mutual Insurance Company of Maine, have donated their supplies so that the most vulnerable Maine citizens may be immunized. 

You may read the Governor's press release at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=3888&v=article-2004.

Also last week, the CDC and manufacturer Aventis Pasteur USA announced that they will make 14.2 million doses of flu vaccine available directly to providers serving priority populations.  The CDC will keep the remaining 8.2 million doses in reserve to cover high priority gaps in the emergency vaccination plan announced in the wake of the October 5th action by British health authorities to suspend the license of Chiron Corporation's Liverpool manufacturing facility.  The CDC estimates that between 42 and 50 million people meet the high-risk standards of the emergency plan.  The flu causes approximately 36,000 deaths and 200,000 more hospitalizations each year.  [return to top]

FDA Announces "Black Box" Warning on Antidepressants
On Friday, October 15th, Acting FDA Commissioner Lester Crawford announced the agency's decision to require antidepressant manufacturers to include a "black box" warning, the most serious type of warning, on drug labels for antidepressant medications stating that these medications could lead to suicidal tendencies in children and teenagers.  The FDA is not proscribing the use of antidepressants for children, but is urging prescribers to balance the risk of suicidality with the clinical need for the medication.

The "black box" warnings, expected to appear on packaging in pharmacies in a week or two, are aimed at health care professionals.  A simplified version of the information in the "black box" warning will appear in a Medication Guide intended for patients or parents.

You may find more information about the recent FDA action on the agency's web site at:  www.fda.gov/cder/drug/antidepressants/default.htm. [return to top]

GAO Issues Report on Medicare Sustainable Growth Rate (SGR)
Adopted in the Balanced Budget Act of 1997, the Medicare Sustainable Growth Rate (SGR) sets annual spending limits for physician services reimbursable by the Medicare program.  While 2002 reimbursement rates calculated according to the SGR would have resulted in a 5.4% reduction in physician fees, the cuts were offset by administrative and legislative action.  Although fees are scheduled to increase from 2003 to 2005, rates are scheduled to fall 5% per year from 2006 to 2012.

Released October 13th, the GAO report, Medicare Physician Payments:  Concerns about Spending Target System Prompt Interest in Considering Reforms (GAO-05-85), concludes that the SGR makes Medicare spending on physician services more stable and predictable, but may punish physicians.  The GAO suggests two options for reforming the SGR system:

  • Stop using spending targets and set fees on the cost of providing care efficiently.  In its March 2001 report to Congress, the Medicare Payment Advisory Commission supported the elimination of spending targets.
  • Continue using spending targets, but change certain elements of the SGR system to "automatically adjust fee updates if spending growth deviates from a predetermined target."

The report points out that either option likely would raise costs in the Medicare program.

You may read the report on the web at:  www.gao.gov/new.items/d0585.pdf. [return to top]

National Institutes of Health Expands its Website
This past summer, the National Institutes of Health (NIH) expanded its health information website, http://health.nih.gov, to offer a wider range of features, links, and interactive activities.  Additions to the site include three colorful new sections:  Healthy Lifestyles links to popular day to day health topics; Research in Action links to the latest scientific innovations; and Now Online links to interactive quizzes and exhibits. [return to top]

The Coding Center offers "The Business of the Physician Office" Oct. 27 (Lewiston) and Nov. 3 (Bangor)
The Coding Center and MMA are teaming up to present an innovative educational program on practice management to be offered Oct. 27 in Lewiston and Nov. 3 in Bangor.  Entitled, "The Business of the Physician Office",  topics include contract evaluation, the use of forms in the office, determining practice expense, RVU tracking and establishing fee schedules, implementing an electronic medical records system and Dirigo Health.  Margaret Palmer, PhD will give the keynote talk entitled, "WHO'S ON FIRST? Confusion in a Medical Practice."  Dr. Palmer is an organizational psychologist who has worked extensively with many health care organizations in Maine.  Her talk will focus on the dynamics that are created by all of the individuals at work in the practice and will demonstrate how to restore value, respect and appreciation for each person's role in the "big picture."

The Oct. 27 program will be held at the Ramada Conference Center in Lewiston from 8:30am to 4:45 pm.  The Nov. 3 program is at Spectacular Events in Bangor, also from 8:30am to 4:45pm.

Registrations materials were included as an insert in the Sept.-Oct. Maine Medicine which arrived on member's desks last week.  If you can't put your fingers on it, call Maureen Elwell at MMA at 622-3374 or contact her via e-mail at melwell@mainemed.com to register.  The fee for the day long program is $150 for members and $200 for non-members. [return to top]

Karen Bell, M.D. now at Centers for Medicare and Medicaid Services (CMS)
Karen Bell, M.D., formerly the Medical Director at Anthem Blue Cross Blue Shield of Maine, and most recently Senior Medical Director at BCBS of Rhode Island, has joined CMS as Director of the Division of Quality Improvement Policy for Chronic and Ambulatory Care.  This is a newly created division which will have responsibility for the CMS quality improvement work related to physician offices, Part D, and ESRD Networks.  She began her new position yesterday (Oct. 18).

Dr. Bell is board certified in internal medicine.  In Maine, she was widely credited with moving forward an agenda of quality improvement, including advancing medical technology and pay for performance. [return to top]

Pathways to Excellence Web Site about to go Live
The Pathways to Excellence Program sponsored by the Maine Health Management Coalition is about to go live on its website with the results of the 3rd year of its primary care office systems survey.  Slightly more than half of the state primary care practices completed this year's survey (211 practices).  The website will include the results of the survey, along with the results of the 2nd year of the survey of process measures based upon HEDIS.  Nine such measures were used in the survey.  These measures were taken from the coalition data base of some 550,000 covered lives, enhanced this year with the addition of the Anthem data base.  Each practice being reported had an opportunity to review its data and to provide feedback prior to the web site being available to the public.

Pediatric practices are being listed separately, and the project is only reporting child asthma, well-child, and well-teen exams for these practices.

For the first time, data is also being reported on a self-reported outcomes project.  Nearly 100 practices are included in that portion of the data which is being collected presently and will be added to the web site after the reporting deadline of Nov. 1.

 If things go as planned, beginning on Monday, October 25, the data can be viewed at www.mhmc.info. Click on "Pathways to Excellence".  From now until Monday, the data can be viewed but it is blinded and the individual groups not identified, at www.mhmc.info/index_new.php.

The project is directed by Ted Rooney at Health and Work Outcomes in Brunswick.  Any physicians or practices with questions can call Ted at 729-4929 or via e-mail at trooney@mhmc.info.   Jan Wnek, M.D. is the clinical advisor to the Coalition and to the project.

Because Cigna and Anthem have already announced Pay for Performance programs based at least partially on PTE, the importance of the project has intensified. Some employers (notably Hannaford Brothers) are also using the data for their individual network and reimbursement decisions., a practice that has been criticized by a number of physicians.   Practices not reporting may eventually be denied increases in reimbursement.

MMA neither endorses nor opposes PTE.  But we do feel it is important for all physicians to be aware of the program and the entire trend toward Pay for Performance.  And even though the program presently impacts only primary care physicians, a study group is currently working on the criteria for a similar program for specialists.

The Maine Health Management Coalition is a coalition of 34 public and private employers, hospitals, health plans and physician groups covering more than 250,000 Maine residents. [return to top]

Guidance Issued on HIPAA Privacy Rule and Law Enforcement
The U. S. Department of Health and Human Services Office for Civil Rights (OCR) recently published guidance on its HIPAA (Health Insurance Portability and Accountability Act) Privacy Frequently Asked Questions Web page.  The directive identifies the circumstances under which the privacy rule allows covered entities to disclose protected health information to law enforcement officials.  To view the OCR guidance, go to http://www.hhs.gov/ocr/hipaa. [return to top]

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