February 21, 2005

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Medicaid Fee Increase in Jeopardy without Your Support
The $3 million General Fund appropriation which would infuse nearly $10 million into the MaineCare physician fee schedule is in jeopardy if more physicians don't take the time to communicate with their legislators about the dire need. It is critical that members of the Appropriations and Health and Human Services Committees hear from you this week that the fee increase is necessary to ensure continued broad access to physician services by those covered by the MaineCare program!
Governor Baldacci's proposed 2-year state budget for State Fiscal Year 2006-2007 includes a $3 million general fund increase each year in MaineCare reimbursement rates for physicians.  With federal matching funds, this initiative would infuse nearly $10 million into the MaineCare fee schedule.  On last Wednesday, Feb. 16, 2005, the MMA, the Maine Chapter of the American Academy of Pediatrics and the Maine Academy of Family Physicians presented testimony in favor of this proposal at a public hearing conducted by the Joint Standing Committee on Appropriations & Financial Affairs and Health and Human Services.  The key decisions on the budget in both committees will take place in the next two weeks.

Maine's physician reimbursement rates are 44th in the country, according to a study conducted by the Medical Policy Institute in June of 2001.  The rates are frequently inadequate to cover even the basic cost of providing the service and have not been increased in over twenty years.

The following is a link to this week's Political Pulse, the publication prepared each week by Andrew MacLean, Esq., the Association's Vice President and General Counsel.  The first article in the publication contains further information on this topic as well as home phone numbers and several e-mail addresses for the ley legislators involved in this decision.  You may also click on janus.state.me.us/legis and click on "The House of Representatives" or "The Senate" to find contact information on your local legislator.  Or you may always call Andy, Gordon or Charyl at MMA at 622-3374 and we will provide you with that information.

Trend Towards More Hospitalists Likely to Continue Study Says
On February 1, 2005, the Center for Studying Health System Change released, "Health Market Trends and the Evolution of Hospitalist Use and Roles" published in the Journal of General Internal Medicine.  The study found that the number of physicians specializing in hospital-based medicine has risen from hundreds in the mid-1990s to more than 8000 in 2003.  This trend is likely to continue because of financial pressures on primary care physicians and hospitals, problems with patient flow in hospitals, patient-safety initiatives, and malpractice cost concerns.

The study examined the following 12 markets during the study:

  • Boston
  • Cleveland
  • Greenville, SC
  • Indianapolis
  • Lansing, MI
  • Little Rock, AR
  • Miami
  • Northern NJ
  • Orange County, CA
  • Phoenix
  • Seattle
  • Syracuse, NY

You can read an abstract of the study and a press release from the Center on the web at:  http://www.hschange.org/. [return to top]

Crawford Named FDA Chief; FDA Creates Oversight Board on Drug Safety
On February 14, 2005, President Bush named Lester Crawford, currently Acting Commissioner of the Food & Drug Administration, to lead the agency.  Dr. Crawford received his Doctorate of Veterinary Medicine degree from Auburn University and a Ph.D. in pharmacology from the University of Georgia.  Prior to coming to the FDA, Dr. Crawford was administrator of the Food Safety and Inspection Service at the Agriculture Department, director of the Center for Food and Nutrition Policy at Georgetown University and Virginia Tech, and adviser to the U.N. World Health Organization.

The Senate Health, Education, Labor, and Pensions Committee chaired by Sen. Mike Enzi (R-WY) will hold hearings on the nomination soon.  Dr. Crawford will face questions about the agency's handling of drug safety issues.

On February 15, 2005, DHHS Secretary Michael O. Leavitt announced that the FDA would create an independent oversight board to address drug safety issues and to provide information about drug safety concerns identified through the process to patients and physicians.  The oversight board will be composed of government officials appointed by the FDA Commissioner and will have the authority to consult with outside experts and patient advocacy groups.

You can read more about the FDA's drug safety initiatives on the web at:  http://www.fda.gov/cder/drugsafety.htm[return to top]

Ask the Contractor Teleconference: New Preventive Services February 24th

NHIC, National Heritage Insurance Company, Medicare B is holding an open teleconference call regarding the New Medicare Preventive Services that became effective January 1, 2005. The newly expanded services are a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Providers and their staff will be able to ask their local carrier, (NHIC), questions about the topics listed below:

  • The Initial Preventive Physical Examination
  • Cardiovascular Screening Blood Tests
  • Diabetes Screening Tests

The one-hour teleconference will be held on Thursday, February 24th at 10am (PST), 1pm (EST). The toll free teleconference number is 888-913-9966; participant code 33636.

No registration is needed; however the number of lines is limited to the first 100 callers.

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AMA Releases Data on Impact of Reductions in Medicare Fees by State
The American Medical Association last week released figures by state predicting the impact of Medicare's proposed reduction in physician reimbursement.  From 2006-2013, the Medicare program is predicting that physician payment rates will be reduced by 31% as the result of the flawed payment formula which is based upon the notion of a sustainable growth rate.

Over this eight year period, Maine's payments are expected to decline by a total of $520 million.  For each physician in Maine, this reduction amounts to an average loss of $16,000 per year.

The first of the eight annual Medicare pay cuts is slated to occur on January 1, 2006.  Medicare physician payment rates in Maine would be cut by 12% in 2006.

These figures represent the impacts on Medicare Physician Payment Schedule services only and do not include potential spillover effects from private, Medicaid, and other plans that tie payments to Medicare rates.

In addition, per physician impacts may vary considerably within the state depending on each physician's Medicare patient load and utilization.

These figures are derived from the 2004 Medicare Trustees' Report, table III.B.1.  The source of the impact analysis is the American Medical Association Division of Economic and Statistical Research, Oct. 2004.

The AMA, MMA and virtually all state medical societies and state and national medical specialty societies are lobbying Congress to change the payment formula in order to avert these drastic cuts which will seriously erode access to care for Medicare patients. [return to top]

MMA Payor Liaison Committee to Meet with Anthem Officials Wednesday Night
The Association's Payor Liaison Committee, chaired by Thomas Hayward, M.D.  will hold its next meeting on Wednesday night, Feb. 23 at 6:30pm.  The program will feature a presentation by Jeffrey Holmstrom, D.O., the new medical director for Anthem Blue Cross Blue Shield of Maine and Dan McCormack, Director of Provider Contracting for Anthem.  Updates will also be provided on MaineCare, Medicare, and the Coding Center.

Any MMA member wishing to attend may do so by calling Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com. .  Dinner will be available beginning at 6:15pm and the meeting will be at the Frank O. Stred Building in Manchester. [return to top]

MaineCare Expansion for Childless Adults, Due April 1, Cancelled
The Baldacci administration has called off a plan to increase the number of childless adults eligible for MaineCare.  24,000 persons are already enrolled in the so-called "non-categorical" part of the MaineCare program.  The state had planned to expand eligibility in the category on April 1 from 100 percent of the federal poverty level to 125 percent.

The cancellation is due largely to the fact that the non-categorical enrollees have required expenditures beyond what was planned and the federal government sets an annual cap on what it will contribute to this category.  The cap was surpassed last year and that could happen again this fiscal year as spending is currently $46 million away from the $102 million annual limit (with about seven months left in the federal fiscal year ending in Sept.).

Under an agreement entered into by the state and the federal government, the state is responsible for all costs incurred after the cap is exceeded.

The cancellation of the planned expansion has disappointed low-income advocate groups which had hailed the passage of the original program in 2001 as a milestone in Maine's efforts to provide universal coverage.  Historically, the MaineCare program (Medicaid) had not covered adults without children, regardless of their income.  Not only has enrollment in the category been fairly robust, but spending has been brisk as well.  This particular demographic category tends to have significant health needs to be taken care of once insurance coverage is acquired (one aspect of the adverse selection phenomenon).

Even the 24,000 persons enrolled now are being subject to cuts in services, with the state dropping some optional services such as dental and eye care in May. [return to top]

Dirigo Health to Cover 12,000 Children Beginning April, '05
Governor Baldacci announced last Tuesday that 12,000 children who currently have no health insurance coverage will be eligible for MaineCare beginning in April,  as will their parents, as part of the Dirigo Health program.

The coverage will be offered through the Dirigo Health program. [return to top]

Practice Expense Data Needed for March 9 Medicare Meeting
The Maine Medical Association has been asked by The Urban Institute and RTI International, contractors to the Centers for Medicare and Medicaid Service (CMS), to host a meeting in Manchester, Maine on March 9th, 2005 to review the physician practice expense geographic adjustment data used to support the Medicare physician fee schedule.  Physicians and practice managers, or financial officers, are needed to attend the session to share practice expense data.

Congress included a provision in the Medicare Modernization Act of 2003 (MMA)  mandating a demonstration-based review of the practice expense geographic adjustment data currently utilized in the Medicare physician payment formula.  As part of this review, the MMA  mandates a meeting with organizations representing physicians, and other appropriate persons to review alternative data for the practice expense Geographic Practice Cost Index (GPCI).  The results and ideas from such a meeting will form the starting point for a review of alternative data sources for the practice expense GPCI and a report to Congress.

The goal of the March 9 meeting is to assess current data sources and discuss alternative data sources.  Officials from both RTI and The Urban Institute will be attending.

The meeting will be held from 9:00am to 3:00pm at the Association offices in the Frank O. Stred Building in Manchester, Maine.  If your practice is willing to share some expense data, with the hope that Maine's physicians will benefit from alternative data sources, please communicate with Gordon Smith at MMA via telephone to 622-3374 or via e-mail to gsmith@mainemed.com.

In the 2004 Practice Expense Geographic Practice Cost Index, the Southern Maine payment area index is 0.999 and the remainder of Maine is 0.910.  (The RVU weighted average nationally is 1.0)

GPCI's play a crucial role in determining Medicare physician fees.  GPCI's are combined with relative value units (RVU's) to determine the physician payment for a particular service.  The three GPCI's - for work, practice expense, and malpractice - vary across FSA's (Fee Schedule Areas) causing Medicare fees for the same service to be different in different geographic areas.  The GPCI's are standardized so that an RVU-weighted average is 1.0.   Hence, the Maine values noted above result in Maine physicians receiving lower reimbursement than the national norm.

This meeting, which follows an earlier session in Iowa in December, gives Maine an opportunity to help itself and other rural states.  The MMA participates in the Geographic Equity in Medicare Coalition which seeks to increase the reimbursement to rural areas, by demonstrating the practice expense proxies in the formula are flawed.

Practices attending the session will receive further information on the kinds of expense data needed.

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Maine Cancer Foundation Seeks Grant Applicants

Funds available for research, education and patient support programs

The Maine Cancer Foundation, which distributes funds to a variety of cancer research and education programs in the State of Maine, is currently seeking applicants to receive grants supporting clinical and laboratory research, professional and public education, and for patient support programs.
Organizations selected for research grants must be science-based, and seek to study molecular basis of cancer, improve cancer prevention, detection and treatment, or to analyze treatment outcomes. Grants are awarded to education programs seeking to expand public and professional knowledge of molecular origins of cancer, the role of genetics in cancer, cancer prevention methods, and/or early detection strategies. Patient support programs should seek to create supportive programs that assist patients and their families in dealing with the diagnosis of cancer.
Proposals for grants must be short-term (one year) and have clearly defined goals and measurable results. Grant recipient's work must further the charitable purpose outlined by the Maine Cancer Foundation. MCF reserves the right to make grants at the discretion of its board members.
Information and Applications are available at www.mainecancer.org
 or 207 773-2533. Completed applications are due by April 1, 2005 with funds disbursed by June 30, 2005.  
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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association