June 5, 2005

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HHS Committee Splits on Hospital Study Commission Recommendations
The HHS Committee divides into 3 reports with the majority concentrating on voluntary margin and cost targets and standardized cost reporting.

At a work session on Friday afternoon, June 3, 2005, the HHS Committee split three ways on L.D. 1673, An Act to Implement the Recommendations of the Commission to Study Maine's Community Hospitals.

The 7 members of the majority voted to accept a compromise between the Governor's Office of Health Policy & Finance and the Maine Hospital Association.  It eliminates proposed changes to the Hospital Cooperation Act because a majority of the committee decided that this needed more work.  It also eliminates references to the certificate-of-need program.

It continues a voluntary target of 3% for hospitals' consolidated operating margins based upon data submitted to the Maine Health Data Organization (MHDO) for hospital fiscal years beginning on or after July 1, 2005 through the end of each hospital's fiscal year beginning on or after July 1, 2007.  The mixed inpatient and outpatient cost increase target is no more than 110% of the forecasted increase in the hospital market basket index for the coming federal fiscal year.

It instructs the MHA and the GOHPF to agree by January 1, 2006 on a timetable, format, and methodology for the MHA to measure and report on outpatient cost-efficiency.  It requests the MHA to develop, by January 1, 2006, standardized definitions of various administrative cost categories that hospitals may use when establishing budgets and reporting spending on administrative costs.

It directs the GOHPF to convene a health care administrative streamlining work group to facilitate the creation and implementation of a single portal through which hospitals can access and transmit member eligibility, benefit, and claims information from multiple insurers.  The work group is directed to investigate funding mechanisms, including seeking outside funding for start-up and ongoing operational costs, with the intention that the portal become independent and sustainable over time, and ways to ensure that savings resulting from implementation of such a portal are passed on to purchasers in the form of rate reduction by hospitals and other providers and by reduction in administrative costs by insurers and third-party administrators.  The work group may also consider the incorporation of medical and quality data to the extent possible in the future.  The work group is directed to submit a report and any necessary legislation to the Governor and the HHS & IFS Committees by November 1, 2006.

It instructs the HHS Committee to review all proposals in L.D. 1673 not enacted during the Second Regular Session of the 122nd Legislature and authorizes the Committee to report out legislation.

Two members, Reps. Sarah Lewin (R-Eliot) and Tom Shields, M.D. (R-Auburn), wanted to carry the entire bill over to the second session, but voted "ought not to pass" because a majority of the Committee elected to move forward with an amended bill.  Senator Mayo decided to move forward with only the standardized reporting provision from the original bill.

"Part II" Budget Work Continues Late Into Sunday Evening
The Appropriations Committee continued to work on the "Part II" 2006-2007 biennial budget last week.  The Committee worked late on Friday evening and was still working at 11:15 p.m. on Sunday evening.  The proposals regarding hospital financing issues and the MaineCare "modified drug formulary" remained tabled on Sunday evening.  The MMA has been working with patient advocacy groups to encourage the Committee to reduce the projected savings from the proposed changes in the MaineCare drug management program and to include some patient safety provisions as well.

You can register your concerns about the proposed MaineCare drug formulary or the hospital financing issues by contacting members of the Appropriations Committee:  http://janus.state.me.us/house/jt_com/afa.htm.

Recently, DHHS has disclosed that it needs $24.4 million in additional revenue to meet its obligations for the fiscal year ending June 30, 2005.  In general, there appears to be bipartisan agreement to cover this shortfall with projected end-of-year revenue of $27 million.  It remains to be seen whether the Legislature will address this issue in the "Part II" budget or in a separate supplemental budget.

The "Part I" biennial budget, L.D. 468, remains part of the budget debate late in the session as the Baldacci Administration and the Legislature seeks alternatives to borrowing of approximately $450 million in L.D. 468 as adopted.  The Maine Sunday Telegram story on the budget progress is available on the web at:  http://pressherald.mainetoday.com/news/statehouse/050605newtaxes.shtml. [return to top]

HHS Majority Finally Reports Out Involuntary Treatment Bill
During a work session in the Health & Human Services Committee on Friday, June 3, 2005, members by a 9-2 vote recommended "ought to pass as amended" on L.D. 151, An Act to Improve the Delivery of Maine's Mental Health Services, sponsored by Sen. John Nutting (D-Androscoggin).  Sen. Nutting, whose son has suffered from a severe mental illness, has pushed all session for a positive outcome on his bill to permit the involuntary treatment of individuals suffering from mental illness, under certain conditions, if they do not follow their prescribed course of medication.  While the Department, the Maine Association of Psychiatric Physicians, the MMA, and several other groups have supported the concept of the legislation, the Disability Rights Center, the Maine Association of Mental Health Services, and other patient advocacy organizations have steadfastly refused to agree to any sort of involuntary treatment law.

In part, the majority report amends current involuntary commitment laws to establish a type of release from involuntary mental health commitment for persons who are committed to Riverview Psychiatric Center or Bangor Mental Health Institute.  Under this status, patients would be ordered by a judge to participate in a "progressive treatment program," which would provide treatment and care through an assertive community treatment program for a period of 6 months.  Successful completion of the progressive treatment program results in termination of progressive treatment services.  Failure to fully participate and follow the individualized treatment plan that results in deterioration of the person's mental health so that hospitalization is in the person's best interest or the person poses a likelihood of serious harm results in the treatment team applying for the person to be rehospitalized, under the current emergency admission procedure.  If the person is admitted on an emergency basis, and if the Superintendent determines that continued hospitalization is required, within 3 days of admission an application for commitment must be filed with the court under the current involuntary commitment law.  This provision of the law sunsets in 2010.

During the work session, former HHS Senate Chair and current Senate Majority Leader Mike Brennan proposed an alternative plan that would make the process outlined above voluntary.  HHS Committee members Rep. Will Walcott (D-Lewiston) and Rep. David Webster (D-Freeport) voted for Senator Brennan's amendment.

The Maine Association of Psychiatric Physicians (MAPP) and the MMA urge physicians to contact their legislators to urge them to vote for the majority report on L.D. 151.

You can find your Senator on the web at:  http://www.state.me.us/legis/senate/senators/1senator_info_links.htm.

You can find your Representative on the web at:  http://janus.state.me.us/house/reps.htm [return to top]

DHHS Directed to Develop Standards for Physician Incentive Payments
The Legislature is about to enact a bill directing the DHHS to "convene a working group of interested parties to develop standards for the distribution of $3 million in funding appropriated to the MaineCare program for physician incentive payments for increased reimbursement for caring for MaineCare members."  The original bill, sponsored by Rep. Lisa T. Marrache, M.D. was L.D. 1284, Resolve, to Provide Increased MaineCare reimbursement Rates to Physicians with High Ratios of MaineCare Patients.  The amended bill is entitled, Resolve, Regarding Increased Reimbursement for Physicians Caring for MaineCare Members.

DHHS must report to the Health & Human Services Committee on the standards selected by the working group by January 15, 2006. [return to top]

Criminal Justice Committee Recommends Amended Homeland Security Study
The Criminal Justice & Public Safety Committee unanimously has recommended passage of an amended version of L.D. 1645, Resolve, to Establish a Blue Ribbon Commission to Study Maine's Homeland Security Needs.  The amended bill is entitled, Resolve, to Establish the Task Force to Study Maine's Homeland Security Needs.  The proposed task force includes 11 members - 2 Senators, 4 House members, and "five members representing the public interest who are not directly involved in emergency preparedness or homeland security."  Among the task force's duties are a review of Maine's homeland security needs in emergency preparedness and public health.

The legislation directs the task force to submit an initial report and any legislation by December 7, 2005 and a final report and legislation by November 1, 2006.  It does not appear that the unanimous committee report will have any difficulty on the floor. [return to top]

MaineCare Preferred Drug List on Epocrates July 1, 2005
The State announced last week that the Maine RX Plus preferred drug list and the State's Drugs for the Elderly list will be available after July 1, 2005 on Epocrates RX and Rx Pro, designed for the Palm OS and Pocket PC handheld platforms and through the Epocrates Rx Online reference which is available for Internet-connected desktop computers. 

The cost of putting the State's drug list in the Epocrates mobile clinical reference for the first year will be covered by the Maine Health Alliance and the Maine Primary Care Association.

Discounts are available for Maine physicians on palm pilots and Epocrates software, through a grant program operated by the Maine Health Alliance.  The Alliance was able to purchase the highly rated Tungsten E for just over $175, tax and shipping included, said Nancy Morris, the Project Director for the Maine Health Alliance grant.

For more information, contact Nancy Morris at 799-1090 or via e-mail to nmtmha@aol.com. [return to top]

Maine Chapter of the American College of Surgeons Concludes Successful Meeting
The Maine Chapter of the American College of Surgeons held its 2005 Practice Management Seminar and Annual Scientific Meeting this past weekend at the Asticou Inn in Northeast Harbor.  Over 75 persons attended the meeting which featured presentations ranging from Paying for Performance to Electronic Medical Records.  The scientific meeting featured presentations on inflammatory bowel disease, robotic urological surgery, robotic cardiac surgery, partial breast irradiation, component repair for ventral hernia, intraperitoneal hyperthermic chemoperfusion for metastatic disease, gastric pacing for diabetic gastroparesis and CT colonography.

The keynote speaker at the annual banquet Saturday evening was Colin Woodard, veteran journalist and the author of The Lobster Coast.

Congratulations to Chapter President Robert Hawkins, MD, FACS, Secretary-Treasurer Joel LaFleur, MD FACS, and District Governor Charles Tom McHugh, MD on a successful Annual Meeting. [return to top]

More on Medical Mutual Professional Liability Insurance Rate Filing
As noted in last week's Maine Medicine Weekly Update, Medical Mutual Insurance Company of Maine, the state's largest medical liability insurance carrier, recently filed for an increase in its rates, effective Oct. 1, 2005.  While the average increase is approximately 25%, some specialties are lower and many higher, some as high at 79%.  Obviously, the medical liability climate in Maine is continuing to deteriorate.

MMA staff will be meeting with Medical Mutual officials this Monday morning to discuss communications about the filing and more information will be available in next week's newsletter.  Insureds of the company are entitled to review the filing at the Bureau of the Insurance.  The company will also be sending out information on the proposed rates to its policy holders. [return to top]

New Federal Medicaid Study Commission to Report Findings by 2006
The creation of a new federal Medicaid study commission is underway, according to a notice to be published in the Federal Register.  Health and Human Services (HHS) Secretary Mike Leavitt signed a charter this month creating the group.

By December 2006, commission members are to report on recommendations for the future of Medicaid, ways to cut $10 billion from the program over five years and solutions to curtail its increasing costs.

The commission also will address eligibility, benefits and financing structures for three broad categories of beneficiaries such as mothers and children, individuals with disabilities and the elderly.

Up to 15 voting members will be appointed to the group, including federal Medicaid officials, former governors, health care policy experts from public policy organizations, state and local officials and health care providers.


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Governors Adopt Preliminary Medicaid Reform Policy
Making changes to prescription drug programs, including increasing rebates from drug manufacturers, is one of the suggestions in an interim policy on Medicaid reform adopted by the National Governors Association.  The suggestions for greater scrutiny of beneficiary assets when using Medicaid  to pay for long-term care policy also calls for greater scrutiny of beneficiary assets when using Medicaid to  pay for long-term-care coverage, changing the program's cost-sharing rules to require higher out-of-pocket payments by  beneficiaries and the creation of a tax credit for low-income individuals to help them pay for health insurance.  Governors Mark Warner (Va.) and Mike Huckabee (Ark.), who co-chaired the working group that developed the policy, are scheduled to testify before the Senate Finance Committee June 15 on the policy, including specific recommendations for reform.  The association will meet this summer to work on finalizing the policy.  To read the interim policy on Medicaid reform: http://www.nga.org/nga/legislativeUpdate/policyPositionDetailPrint/1,1390,8460.00.html

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Most Doctors Slow to Integrate Quality Data Into Their Practices
According to a survey of 1,837 physicians by the Commonwealth Fund, only one in three physicians have access to data about the quality of their clinical performances and one in three is involved in redesigning their systems to improve care.  In addition, 83% of physicians said it is difficult or impossible to generate lists of patients by their laboratory results which limits the ability to follow-up with high-risk patients.  Seventy-one percent  said that it was acceptable to provide medical group leaders with access to quality-of-care data about physicians.  The study concludes that it is not necessarily that physicians do not want to use quality measures, but that many physicians lack the resources to implement them.  This is especially true for physicians in solo and small groups, as the study found that physicians in larger practices were much more likely than physicians in smaller practices to receive quality data. [return to top]

Apply Now for Your Single Provider Identifier
The Centers for Medicare & Medicaid Services (CMS) urges physicians to apply now for the new single identifier required by the Health Insurance Portability and Accountability Act (HIPAA).

The 10-digit National Provider Identifier (NPI), which became effective May 23, eliminates the use of different identification numbers with multiple health plans, including Medicare and Medicaid.

All health plans are required to implement the new number by May 23, 2007; however small healht plans have until May 23, 2008.

You can apply for an NPI in one of three ways:

  1. Go online at https://nppes.cms.hhs.gov.
  2. Prepare a paper application and send it to the enumerator that will be assigning the NPI beginning July 1, 2005. A copy of the application, including the enumerator's mailing address, will be available at https://nppes.cms.hhs.gov. You may also call the enumerator for a copy, (800) 465-3203.
  3. Permit an organizaiton to submit an application in an electronic file. This means that a professional association or health care provider who employs you could submit an electronic file containing your information and that of other health care providers. This process will be available by Fall 2005.

Health plans will notify you when to begin using the new identifier. Also, CMS recommends safeguarding your NPI after you receive it.

Find information about the NPI at www.cms.hss.gov/hipaa/hipaa2/regulations/identifiers/ [return to top]

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