January 10, 2005

 
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Governor's Proposed Budget Includes Medicaid Fee Increase for Physicians
In releasing his proposed two-year state budget beginning July 1, 2005, Governor John Baldacci on Friday noted that he had included $3 million in new funds for Maine physicians treating MaineCare patients. With federal matching funds, nearly $10 million would be available to increase fees for the first time in over 20 years.
The fee increase is likely to be implemented through adoption of an RB-RVS system based upon Medicare.  The increase is likely to result in MaineCare fees rising to about 60% of Medicare, according to MMA EVP Gordon Smith who was briefed on the proposal on Thursday.

"MMA and the Maine Osteopathic Association have been working with the Baldacci administration very intently over the past few days to try to bring about this increase.  While it is modest, it is still very significant when one considers that the state faced a $733 million deficit," noted Smith.   "We are very appreciative of the Governor and his staff recognizing the dire need for this increase in order to enhance and ensure access to medical care for the 260,000 Maine citizens currently on MaineCare," he added.

While inclusion in the proposed budget does not assure that the increase will be included in the final budget, certainly it is an important first step.  Physicians will still need to communicate with their legislators over the course of the coming weeks to ask for support of the increase.

The total two-year budget is $5.7 billion which represents a 3.7% increase from the last budget.  The deficit is filled through both increased revenues and by streamlining and restructuring departments and programs.  $10 million is proposed to be cut in benefits to 22,000 persons in MaineCare who are adults without children.  This so-called non-categorical group represents one of the last expansions of the program.  There are also other reductions proposed to providers of community mental health services and children's behavioral programs.

Also of particular interest to physicians is a provision allowing for primary enforcement of Maine's seat-belt law.  Currently, motorists who are 18 or older must be stopped for another violation or defect before they can be issued a summons for being unbuckled.  The proposed budget seeks to change that by allowing a police officer who observes a motorist without a safety belt on to issue a summons for that violation.  The proposal is in the budget because it generates additional income from increased fines and from the savings associated with increased work productivity and decreased healthcare costs.

Hospital Study Commission Hears Feedback on Draft Report
Members of the Commission to Study Maine's hospitals took to the road Thursday and Friday to receive public comment on their draft report.  Very few members of the public testified, but many representatives of Maine's hospitals took the opportunity to object to both the tone of the report and several of its recommendations.

Ralph Gabarro, CEO of Mayo Regional Hospital in Dover-Foxcroft and Chairman of the the Board of the Maine Hospital Association, presented formal testimony on behalf of the MHA and complained that the tone of the draft report was demeaning to "the day-to-day work of hospitals, their boards of trustees, and their staffs." MHA also accused the Commission of using inaccurate data in developing its recommendations and opposed the establishment of a new consortium to encourage hospital collaboration and cooperation.  This same criticism was repeated by several hospital CEOs and trustees.  Several hospital representatives noted the lack of strong recommendations regarding the Medicaid and Medicare shortfall, which they cited as being a major factor the sharp increase in health insurance premiums.

Both MMA and MHA testified that the recommendation in the report on the impact of medical liability needed to be strengthened and MMA presented members with the package of liability reform legislation being presented to the Legislature and urged the Commisson to support the package.

The hearings were notable for the lack of testimony from many business representatives or consumers.  Given the hospital communities strong opposition to much of the report, the recommendations are likely to run into serious difficulty in the legislature without widespread public support, including certainly support from the business community.

MMA did support strongly the recommendations for public financial support of electronic medical records, standardized reporting and voluntary limits on hospital operating margins.  While supportive of the concept of a consortium, MMA noted that it could only be successful with the support of the hospitals.  "You can not have a successful voluntary effort if the hospitals themselves do not wish to participate," noted MMA EVP Gordon Smith in testimony offered at the public hearing in Portland.

MMA President Larry Mutty, M.D. testified at the Augusta hearing, focusing on the exclusion in the study of the four psychiatric hospitals and the lack of integration with the VA hospital and the VA system.  Dr. Mutty encouraged the consideration of the system as a whole.

The Commission meets for the last time today (Monday) to consider the public comments and to finalize its report to the legislature. [return to top]

Maine Society of Eye Physicians and Surgeons Sponsor Free Screenings for Eye Care Month
The Maine Society of Eye Physicians and Surgeons announces free eye screenings in recognition of Eye Care Month, Jan. 17 - Jan. 28, 2005 for patients without health insurance coverage.  Eye Care Month, sponsored each January by the ophthalmology society, is dedicated to prevention with a call for all Mainers to, "decide today to see tomorrow."

The eye-MD's will be screening for a variety of eye-related diseases or disorders, such as glaucoma, cataracts, diabetic retinopathy or age related macular degeneration in adults and amblyopia or strabismus in children.

Interested patients may contact the Maine Society of Eye Physicians and Surgeons at 207-622-3374 for free eye screening locations and times in their areas.  Dates, hours and arrangements will vary from office to office.  In some locations, insured patients may be eligible to be screened, subject to payment for applicable co-payments or deductibles. [return to top]

109th Congress Gets Underway; Busy Two-year Session Ahead
On Tuesday, January 4, 2005, the 109th Congress convened, starting a new two-year session with an increased Republican majority and plans to implement a broad range of initiatives.  New members include four physicians:  Representative Tom Price (R-GA, orthopedic surgeon), Charles Boustany (R-LA, thoracic surgeon), Joe Schwarz (R-MI, otolaryngologist) and Senator Tom Coburn (R-OK, family physician).  Physicians now comprise two percent of the Congress.

Both parties will hold retreats in the next few weeks to establish priorities and set agendas.   Both Senator Bill Frist, M.D. and Speaker Dennis Hastert have pledged to make medical liability reform a top priority.  Dr. Frist is the Senate Majority Leader.

In addition to medical liability reform, a top priority for physicians is fixing the flawed Medicare payment formula which, without a fix, will result in annual reductions in Medicare reimbursement, totaling a reduction of nearly 20 percent in the next four years. [return to top]

President Bush Kicks Off Medical Liability Reform Campaign
Speaking in Collinsville, Ill., President Bush called for an end to "junk lawsuits" that needlessly drive up medical liability insurance premiums for physicians and hospitals.  The President was joined on the dais by physicians and other health care workers who support his efforts to "address the root causes of rising medical costs."  Among the initiatives the President outlined were the adoption of information technology; the expansion of community health centers and health savings accounts; health insurance risk pools for small businesses, and speeding the development and release of generic drugs.  But the focus of his remarks were on medical liability reform so that physicians could "focus on fighting illness, not on fighting lawsuits."  The complete text of the President's remarks is available at:

                                    http://www.whitehouse.gov/news/releases/2005/01/20050105-4.html

Doctors for Medical Liability Reform (DMLR), an organization of more than 230,000 specialty physicians,  commended the President's efforts in highlighting the growing access to care crisis and his demand that the U.S. Senate take action on reform.For more information on DMLR, go to:

                                     http://www.protectpatientsnow.org [return to top]

One Hundred Seventy Five Primary Care Practices to Divide $400,000 in Performance Bonus
Last week, approximately 175 primary care physician practices received notification from Bath Iron Works, Maine Municipal Employees Health Trust and CIGNA Healthcare that they will be receiving a financial reward for achieving good results on the Pathways to Excellence Primary Care measures.  This is the first round of rewards based upon the PTE program.

Approximately $400,000 is being distributed to the practices, which represent about 40% of the primary care practices in the state.  Most of the rewards are being distributed to the approximately 84 primary care practices who achieved "3 star" status in the PTE Primary Care measurement process (see www.mhmc.info).  Each practice is receiving the same per member per month payment for the number of purchaser lives in their practice.  Actual checks to practices will range from $1,500 to over $20,000 based on their number of BIW, Maine Municipal Employees Health Trust and CIGNA Healthcare lives in that practice.  The average award will be approximately $3,400 per practice.

In addition to rewarding these practices, the purchasers also wanted to recognize those approximately 92 primary care practices who achieved "2 star" status.  Each of these practices will receive a check for $1,000.

The results from the PTE Primary Care measurement process are also being used by other purchasers.  Both Hannaford Bros./MedNet and Anthem announced this fall their intention to go forward with similar programs using the PTE measurement process.

The Pathways to Excellence Steering Committee, sponsored by the Maine Health Management Coalition, is composed of 6 employers, 12 physicians, and 3 health plans.  The committee has worked for three years to develop quality measures that can be used for educating employees and their families and for recognizing and rewarding physician practices which successfully meet the goals and measurements.

The PTE project included three main performance measurement components:

  • Use of office systems to manage chronic disease
  • Adherence to standard clinical care guidelines
  • Measurement of patient care results.

For more information, visit the MHMC PTE web site at http://www.mhmc.info or contact the program at 207-729-4929.

  [return to top]

Coverage Begins for DirigoChoice Enrollees
The Dirigo Health Agency Board of Directors met on last Monday and received an update on plan enrollment.  As of Jan. 1, 2005:

  • 612 sole proprietors have enrolled in the program (sole proprietors and their dependents are 67% of total enrollees)
  • 133 small businesses have enrolled in the program (employees of small businesses are 33% of total enrollees)
  • 1,800 persons are enrolled

In addition, 83 additional businesses have applied for coverage and an additional 255 sole proprietors have applied.

While original projections estimated that 15 percent of Dirigo covered lives would be eligible for Medicaid, but so far, only 3 percent are eligible.

Despite these perhaps sobering numbers, agency staff continues to be upbeat and believe that the numbers will improve as the word gets out.  MMA staff has met with Dirigo staff to see how physician practices can be more involved in promoting the program.  As Dirigo enrollees will frequently be the formerly uninsured, and because Dirigo Health pays physicians at commercial insurance rates, physicians have a clear incentive to encourage enrollment and to welcome Dirigo patients.  In addition, Dirigo coverage encourages prevention and pays first dollar coverage for several preventive services. [return to top]

Health Care Cost Trends: National
The Blue Cross Blue Shield Association published its annual Medical Cost Reference Guide as part of its campaign to track health care costs and to keep health care affordable.  According to the study, the analysis showed that the biggest drivers of health care costs are hospitals, while the fastest growing categories of health care expenditures are prescription drugs and hospital outpatient services.  Physicians were not named as a major driver of increasing health care costs.  However, the study notes that Blue Cross plans report rising malpractice insurance premiums are responsible for driving up physician fees, especially for Ob/Gyns, and surgeons. [return to top]

Medicare to Cover Smoking Cessation Counseling
The Centers for Medicare & Medicaid Services (CMS) recently announced a proposal to pay for certain Medicare beneficiaries to receive counseling to quit smoking.

A CMS draft decision memo issued Dec. 23 would expand Medicare's focus not only to cover the treatment of smoking-related illness, but also the prevention of further illness by providing seniors with a new resource to help them quit.  The new counseling services would cover Medicare beneficiaries who have a smoking-related illness, including heart disease, cerebrovascular disease, lung disease, weak bones, blood clots and cataracts.  It also would apply to patients on medications that can be made less effective by smoking, such as insulins and medicines for high blood pressure, seizures, blood clots and depression.

The public has until Jan. 21 to comment on the draft decision memo.  Visit http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=130 to learn more. [return to top]

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