April 4, 2005

 
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2006-07 Budget Passes with $3 Million MaineCare Physician Fee Increase
MMA makes progress on MaineCare fee schedule goal established in resolution at 2001 Annual Session; organized medicine will work to match Medicare rates, the highest permitted under federal law.
 

The 122nd Maine Legislature's Democratic majority managed to secure sufficient votes in the House and Senate to pass the Part I or "current services" budget for SFY 2006-2007 on Wednesday evening, March 30, 2005.  With one member absent in both houses, the final votes on enactment of L.D. 468 were 77-73 in the House and 18-16 in the Senate. 

Enactment of this budget is the culmination of nearly four years of advocacy work since the MMA membership identified increasing MaineCare reimbursement rates as its top legislative goal at the 2001 annual meeting.  Thanks to all of you who discussed this issue with the Appropriations Committee members or the rank and file legislators.  As MMA has reported previously, the $3 million planned for each year of the biennium will be matched with federal money to add nearly $10 million annually to the MaineCare physician fee schedule.  MaineCare pays physicians about $50 million annually.  While the program still will not cover your costs, this is a substantial and long-overdue increase.  The MMA must discuss allocation of this money in the fee schedule and will continue to discuss converting the fee schedule to one that is based on Medicare's resource-based model.

You can find the legislative history of L.D 468 on the web at:  http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280015199.

MaineCare Staff Seeks Physician Review of New PDL Web Site

PREVIEW New MaineCare PDL Website

7AM on 4/6/05 to 7AM on 4/7/05

 

The Bureau of Medical Services has redesigned its pharmacy benefit website and is seeking review and input from prescribers and pharmacists during a 24-hour test period.  Please take a moment to review the test website and give us your comments.  The designated viewing period is from 7AM, Wednesday April 6, 2005 to 7AM Thursday, April 7, 2005.  Your comments are valuable; please fill in the “Feedback” portion on the website.  If you have any problems accessing this website during the test period, please contact the pharmacy help desk at 1-866-796-2463.           

 

The website is: www.mainecarepdl.org

The username is: "mainetest"

The password is: "m3Pharm!" (case-sensitive, and include the exclamation point).  [return to top]

Robert McAfee, M.D. Confirmed for Second Term as Dirigo Health Board Member
Retired Portland surgeon Robert E. McAfee, M.D. was confirmed to a second term on the Board of Directors of the Dirigo Health Agency after a confirmation hearing before the Joint Standing Committee on Insurance & Financial Services.  The Committee's vote on confirmation was 6 to 4 with the 4 House Republicans on the Committee expressing their displeasure with the Dirigo Board and work product as opposed to any concern over Dr. McAfee personally.

Dr. McAfee's supporters at the hearing included MMA, Anthem, and Consumers for Affordable Healthcare.  No one spoke in opposition to the re-nomination at the public hearing.

Dr. McAfee is a former President of both MMA and the American Medical Association.  He also has a long history of involvement with important public health inssues in Maine including tobacco control, gun control, prevention of domestic violence, and access to care. [return to top]

MMA Initiates New CME Series "First Fridays", beginning May 6
MMA announces the establishment of a new series of half-day education programs offered in the comfort of MMA's own conference room in Manchester, Maine the first Friday morning of each month.  It is our intent to make these sessions as inexpensive as possible and to include topics that impact on the day to day practice of medicine in Maine.  The target audience includes both physicians and practice managers.  The topics will be socio-economic and practice issues as opposed to clinical talks.  Category one credit will be applied for those programs that qualify.

The first program will be held on Friday, May 6 and the topic will be , "Preventing Prescription Drug Diversion."   Speakers include Roy McKinney, Director of the Maine Drug Enforcement Agency, Chris Baumgartner of the Office of Substance Abuse and MMA EVP Gordon Smith.  Roy will give an update on activities around the state, Chris will describe the new Prescription Drug Monitoring Program and Gordon will offer practical tips on preventing diversion.  One additional speaker will be announced.  The program will be held from 9:00am to noon and the cost is $60.00 which includes a light breakfast and course materials.

The second program, On Friday, June 3 will be on the Medicare Modernization Act and include the information of Medicare Part D that practices need to know.  Speakers will be announced later in April.

Registration materials will be included in Maine Medicine or can be obtained by contacting Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com

  [return to top]

Hospital Study Commission Presents Report to HHS Committee
On Thursday afternoon, March 31, 2005, the Dirigo Commission to Study Maine's Community Hospitals presented its final report to the Joint Standing Committee on Health & Human Services.  Commission Chair Bill Haggett presented the majority report and Scott Bullock, President of MaineGeneral Medical Center, and John Welsh, CEO of the Rumford Hospital, presented the minority report.

Mr. Haggett opened his presentation by stating that he sees the Commission's report and recommendations as "constructive criticism" of Maine's hospitals and went on to describe the majority report's 20 recommendations designed to lower costs, improve quality, or increase access to hospital services.  The 20 recommendations, described in the Executive Summary cited below, include suggestions in the followng categories:

  • Increasing collaboration among hospitals
  • Supporting statewide implementation of electronic medical records through a bond issue
  • Instituting a snack tax to fund wellness initiatives
  • Continuing the Dirigo Act's voluntary profit margin and cost increase targets
  • Improving the transparency and standardization of financial and cost information
  • Offering consumers incentives to travel for quality medical services
  • Improving the certificate of need process
  • Creating a similar commission to evaluate the health insurance industry in Maine
  • Continuing to look for ways to address cost shifting in the system
  • Examining ways to improve the medical malpractice climate in Maine

Mr. Bullock and Mr. Welsh told the Committee that they agreed with many of the majority report's recommendations, but they objected to the strong regulatory flavor of the majority report and felt that many of the recommendations are duplicative of current law or industry standards and therefore are unnecessary.  Physician representatives on the Commission, Louis Hanson, D.O. and Josh Cutler, M.D., attended the presentation along with several other members.

The Commission then responded to questions from HHS Committee members.  Many of the questions emphasized transparency of hospitals' business and financial practices and some Committee members, in the Democratic majority, seemed to have an expansive view of their authority to oversee the operations of Maine hospitals because of their non-profit, tax-exempt status.  GOHPF Director Trish Riley confirmed that the Governor will submit legislation based upon at least some of the Commission's recommendations.

You can read a press release about the final Commission report on the web at:  http://www.maine.gov/governor/baldacci/healthpolicy/news/2_2_05.htm. [return to top]

RAND Study Finds HMO Backlash Did Not Cause Exodus From Health Plans
According to the first report to study HMO enrollment trends in the period before and after the managed care backlash, patients did not exit the HMO market as quickly as analysts predicted they would.  The study recently released by the RAND Corporation notes that dissatisfaction with HMOs rose when health care costs were rising very slowly.   However, now that consumers are seeing double-digit increases in health care costs, patients are more likely to forgo more choice in exchange for paying less money.

The RAND press release issued March 24, 2005 may be found on the web at:  http://www.rand.org/news/press.05/03.24.html[return to top]

Bureau of Insurance Releases Dirigo Medical Malpractice Insurance Study
On Wednesday, March 30, 2005, the Bureau of Insurance released the medical malpractice study produced in conjunction with the Bureau's consultants, Pinnacle Actuarial Resources, Inc., as a result of the Dirigo Health legislation.  The Dirigo Health bill, P.L. 2003, Chapter 469, directed the Bureau to conduct the study in the following section:

 Sec. E-22. Report on medical malpractice awards. The Superintendent of Insurance shall submit a report, no later than January 1, 2005, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters regarding medical malpractice lawsuits, damage awards for noneconomic damages in those lawsuits and the cost and availability of medical malpractice insurance in this State. As part of its review, the superintendent shall consult with representatives of the medical community, legal community and medical malpractice insurance industry regarding these issues. At a minimum, the report must address the impact on the cost of malpractice insurance of a cap on noneconomic damages of $250,000 in malpractice lawsuits. The joint standing committee of the Legislature having jurisdiction over insurance and financial services matters may report out legislation to the First Regular Session of the 122nd Legislature in response to the report.

The report concludes that Maine's medical malpractice premiums are among the lowest in the country, but it does acknowledge that we see some signs of concern and it cites more than 20 studies demonstrating that caps on non-economic damages help to hold down the growth in medical malpractice premiums.  You can find the report on the web at:  http://mainegov-images.informe.org/pfr/120_Legis/reports/ins_medmal_report.pdf.

This report will be an important piece of evidence in the legislature's debate of the medical liability reform bill of the Coalition for Health Care Access & Liability Reform, L.D. 1378, An Act to Preserve the Medical Liability Climate in the State by Capping Non-economic & Punitive Damages. [return to top]

Medicare Part B Premiums Rise in 2006 - Physician Services Cited
In a March 31, 2005 letter to the Medicare Payment Advisory Commission, CMS Administrator Mark B. McClellan, M.D. stated that spending for physician services increased more than 15% in 2004.  As a result, the Part B premium for 2006 will rise $11 to $89.20 per month.  CMS cited 5 factors for the increase in physician spending growth:

  • more office visits
  • increased use of minor procedures, including physical therapy
  • higher utilization of imaging services, such as MRIs
  • more laboratory and other tests, and
  • increased utilization of prescription drugs in physicians' offices.

Dr. McClellan told the Medicare Payment Advisory Commission that he would investigate why physician spending is rising so rapidly.  He offered the opinion that the practice of "defensive medicine" likely is responsible for some increased utilization such as imaging. [return to top]

Insurance Committee Rejects Single Payor Bills
At a work session on Thursday, March 31, 2005, the Insurance & Financial Services Committee voted unanimously "ought not to pass" on L.D. 130, An Act to Establish a Single-payor Health Care System (Rep. Joanne Twomey, D-Biddeford).  A majority of the Committee also recommended against passage of L.D. 32, Resolve, to Reestablish the Health Care System & Health Security Board.  This bill, submitted by members of the Board, sought to extend the work of the single payor study group established during the King Administration until November 1, 2006 and to add to its duties the evaluation of current health care reform efforts in the state, including the Dirigo Health Plan. [return to top]

Labor Committee Addresses Bills on Workers' Comp. Medical Fee Issues
In last week's updates, the MMA reminded you about the business community's efforts at the Workers' Compensation Board to cut the conversion factor in the Maine Workers' Compensation system fee schedule (W.C.B. Rule Chapter 5) and to institute a fee schedule for hospitals and ambulatory surgical facilities.  Last week, the Labor Committee held a public hearing on several bills dealing with this effort.  On Tuesday, March 29, 2005, the Labor Committee held a work session on L.D. 916, An Act to Amend the Workers' Compensation Medical Fee Schedule to Include Hospital Charges and L.D. 996, Resolve, Establishing the Commission to Study Medical Expenses Under the Maine Workers' Compensation Act of 1992.  A majority of the Committee voted "ought not to pass" on L.D. 996, a bill submitted on behalf of the Maine State Chamber of Commerce.  The Committee voted to table L.D. 916 for further work.  The prime sponsor of L.D. 916 is Labor Committee House Chair William Smith (D-Van Buren) who seems committed to pushing the hospital/ASU fee schedule issue.

Also, a majority of the Labor Committee voted "ought not to pass" on L.D. 881, An Act to Amend the Maine Workers' Compensation Act of 1992 to Facilitate Timely Independent Medical Examinations and Benefit Payments, a bill that would make more physicians eligible to conduct independent medical examinations (Section 312 exams) by not disqualifying them for offering employer-requested second opinions (Section 207 exams). [return to top]

NAMI-Maine Fundraising Walk Scheduled for 5/14/05 in Portland
NAMI-Maine is participating in a fundraising event presented by the National Alliance for the Mentally Ill called NAMI Walks for the Mind of America on Saturday, May 14, 2005 on the Back Cove Path in Portland.  Check-in for the 5k walk begins at 9 a.m. and the walk begins at 10 a.m.  For more information call 800-464-5767.  The Maine Psychiatric Association is a Bronze Sponsor of the event. [return to top]

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