June 27, 2005

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American Medical Association Annual Meeting Highlights
Maine physicians were well represented at last week's annual meeting of the American Medical Association in Chicago. Maine delegates David Simmons, M.D. and Richard Evans, M.D. and alternate delegates John Makin, M.D. and Maroulla Gleaton, M.D. , as well as several physicians from Maine representing specialty societies and former AMA President Robert McAfee, M.D. and MMA President Lawrence Mutty, M.D. all attended and participated in the business of the AMA.
The AMA House of Delegates adopted a number of new policies on such topics as pay-for-performance, minority patients in clinical trials, promoting healthy lifestyles in children and many others.  Maine's only resolution, asking the AMA to lobby the Congress and the federal government to restore coverage of benzodiazepines under Medicare Part D was passed in nearly the same form as presented.  MMA president Lawrence Mutty, M.D., a psychiatrist, spoke at the reference committee in support of the resolution which was originally brought to MMA by the Maine Association of Psychiatric Physicians.

"Passage of this important resolution shows what one state can do to influence national health policy," noted Dr. Mutty after the meeting concluded.  "I am extremely proud of the Maine AMA delegation and of the Psychiatric Association for highlighting this important omission from the upcoming Medicare Part D coverage," he added.

Visit http://www.ama-assn.org/amal/pub/upload/mm/467/refcommhighlights.pdf to read highlights of each reference committee.

Visit http://www.ama-assn.org/ama/pub/category/1616html to learn more about the new policies passed at the meeting.

Family Physician Edward Hill, M.D., of Mississippi was installed as AMA President at the Inaugural Ceremony on Tuesday evening.  William Plested, M.D. of California was elected President-elect.

152nd MMA Annual Session to be held Sept. 9-11, 2005 in Bar Harbor
Emerging Threats in Infectious Disease is the theme topic for this year's upcoming MMA Annual Session to be held Sept. 9-11, 2005 at the new Harborside Hotel & Marina in Bar Harbor.  Eleven hours of category one CME is available at this meeting which combines the annual business of the Association with a first-class CME program.  A  hard working Planning Committee, chaired by Jo Linder, M.D. of Falmouth, is to be congratulated for putting together an outstanding educational program.

The meeting begins with a kick-off luncheon on Friday, Sept. 9 at noon and concludes with a final educational session Sunday morning.  Saturday evening will include the Annual Awards Banquet featuring the installation of in-coming President Jacob Gerritsen, M.D., with current President Lawrence Mutty, M.D. presiding.

Specialty societies representing psychiatry, urology, anesthesia and orthopedic surgery will meet in connection with the meeting at the same hotel and conference center.

Saturday morning will feature the annual "town meeting style" session during which any MMA member may present a resolution for consideration and elections will be held for the Association's officers for the coming year.  A budget will also be adopted for 2006 and bylaw and constitutional amendments considered.

Please consider attending this year's meeting.  If you haven't attended in a few years, we think you will be pleasantly surprised at the changes!

Registration materials were included in your June/July issue of Maine Medicine or call MMA (622-3374) for registration materials.  We hope to see you in Bar Harbor in September. [return to top]

MMA Staff Changes
MMA regrettably announces a down-sizing of its staff from 14 positions to 12, resulting in a redesign of the staff.  Responsibilities of departing staff will be assumed, at least temporarily, by remaining staff.  New assignments will take place for the staffing of specialty societies representing Ob-Gyn, Urology and Emergency Medicine.  New assignments also include staffing of MMA's Public Health Committee and conference room scheduling.

Anna Bragdon will again assume responsibility for the Maine Chapter of the American College of Emergency Physicians.  Gain Begin and Warene Chase-Eldridge will share responsibility for the Maine Urological Association and Chandra Leister will handle the administrative work for the Maine Chapter of the American College of Ob-Gyn.

"It is always difficult to let staff go," noted Gordon Smith, MMA's Executive Vice President., "but unfortunately, MMA is not immune from the same trends affecting medical societies all over the country."  "It is increasingly difficult to get physicians to join and to retain them once they are members.  We find it increasingly difficult to match revenues with expenses and it was important to make these difficult changes in order for MMA to balance its budget and to protect its reserves," he added.

Members with questions about the staff redesign should contact Gail Begin, the MMA office manager of Mr. Smith (622-3374). [return to top]

MaineCare Fee Increase On Its Way!
The 15% increase in physician payments under MaineCare, which was preserved in the recently revised state budget, will take effect July 1, 2005.  It will be available for services rendered on or after July 1, which is the beginning of the state's fiscal year.  The state anticipates that the new fees will be loaded into the system by the start of the fiscal year.

The increase amounts to $8,350,857 per year, based upon the same level of services provided in State Fiscal Year '04.  No fees have been decreased and all fees will be brought up to a minimum of 53% of Medicare.  By specialty, the increases range from 1% for psychiatry to 39% for cardiology.  If your specialty is receiving less that the 15% increase, it is because you were already being paid at a level closer to the 53% of Medicare benchmark.

Even with this fee increase, MaineCare payments remain well below both Medicare and commercial rates and in many instances do not cover the cost of providing the care.  This increase should be considered a "down payment" and MMA will continue to seek similar increases in future state budgets.

With the stresses caused by more prior authorization requirements and the malfunctioning of the new claims management system, MaineCare remains a challenge for many practices.  MMA and certainly the state appreciate those physicians whom have remained in the program and are trying to serve MaineCare patients under trying circumstances.  MMA particularly appreciates the efforts of MaineCare Medical Director Laureen Biczak, D.O., in working tirelessly for this well-deserved increase.  At a time when many providers were facing cuts, Maine physicians fared better.

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Canada to Limit U.S. Internet Drug Practices
Canada plans to restrict Internet pharmacies from selling prescription drugs to U.S. consumers, according to the Long Island Newsday.  Canadian Health Minister Jjjal Dosanjh has been studying a number of options on how to restrict the trade.  The options include putting a total ban on exports of price-controlled patented drugs, or banning sales to people who are not a resident of Canada or presently in Canada.  Other options include making it illegal for Canadian doctors to countersign prescriptions for U.S. doctors, banning bulk exports of drugs, or creating a list of drugs that would not be exported to the United States if  shortages or potential  shortages developed.  Canadian officials say the Internet sales endanger the Canadian drug supply, and that is is unethical for Canadian doctors to sign prescriptions without examining patients.  For more information:  http://www.newsday.com/news/health/ats-ap_health12jun23,0,2403309,print.story?coll=ny-leadhealthnews-headlines   [return to top]

Updated Medical Staff Bylaws Document Now Online
The third edition of the AMA's "Physicians' Guide to Medical Staff Organization Bylaws" is available online.

The newest edition guides medical staffs in ensuring the proper protections when caring for patients and  includes sample bylaws provisions that reflect changes in today's health care environment.  It reviews most Joint Commission on Accreditation of Healthcare Organizations medical staff standards and includes  discussions about economic credentialing,  core privileging, Emergency Medical Treatment and Labor Act requirements and disruptive behavior, among other traditional bylaw provisions.  A complete set of model medical staff bylaws is included.

AMA members can visit http://www.ama-assn.org/go/medbylaws  to download it free.  Others can purchase access to the book for $30 through AMA Press by calling (800) 621-8335. [return to top]

Governors Propose Changes in Medicaid Program
On June 15, 2005, National Governors Association Chairman Mark Warner (D-Virginia) and Vice Chairman Mike Huckabee (R-Arkansas) presented the Governors' suggested principles for reforming the Medicaid program to the Senate Finance Committee and the House Energy & Commerce Committee.  Congress expects to cut $10 billion or more from the Medicaid program.  The reform principles include:

  • reducing the cost of prescription drugs by increasing manufacturers' rebates, amending the average wholesale price system, increasing use of generic drugs, and tiering copayments;
  • closing loopholes that allow people to hide or transfer assets in order to qualify for Medicaid coverage of long-term care services;
  • increasing cost-sharing for beneficiaries; and
  • permitting more state flexibility in managing the optional Medicaid categories.

While the report is called a consensus document, leading Congressional Democrats, including Ranking Member of the Energy & Commerce Committee Rep. John D. Dingell (D-Michigan), criticized the report for its likely impact on the poorest Americans - - children and the elderly.

The NGA report is on the web at:  www.nga.org.

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Pay for Performance Programs Continue to Grow Nationally
According to Modern Healthcare's Daily Dose, a survey by the Blue Cross and Blue Shield (BCBS) Foundation on Health Care found that BCBS plans in 32 states are already offering physician pay-for-performance programs while plans in 14 other states say they will implement such programs in the near future.  Nearly 7 out of 10 (68 percent) of eligible primary-care physicians and about half (48 percent) of eligible specialists are participating in the programs. Commonly involved practice specialties include obstetrics/gynecology, cardiology, orthopedics, and gastroenterology. A broad range of performance measures, including HEDIS, member satisfaction indicators, electronic connectivity and generic drug utilization are used in the programs.  For more information: http://bcbshealthissues.com/pprroactive/newsroom/releasee.vtml?id=166200 [return to top]

Anthem/Cardiovascular Surgery, P.A. of Bangor Part Company
In a contracting dispute that has found its way onto the front page of local newspapers, Anthem Blue Cross and Blue Shield of Maine and Cardiovascular Surgery, P.A. of Bangor have announced that the practice will leave Anthem's provider network effective Sept. 1.   Anthem announced the action in a press statement this past week.

WIth increasing expenses and decreasing income, the owners of the 18 year old practice had sought an increase in reimbursement rates under the existing three -year contract.  After some discussion, Anthem stopped negotiating, according to Robert Clough, M.D., founding member of the group. The practice performs between 600 and 700 open-heart procedures each year at Eastern Maine Medical Center.  Since the cardiac program was established, over 10,000 cases have been completed. The practice is the only provider of open-heart procedures in northern Maine.

As practices come in and out of Anthem's network all the time, it is not clear why the company, which has posted record profits of late, has chosen to go public with this particular dispute.

Maine Bureau of Insurance Rule Chapter 850, enacted as the result of legislation in the early 1990's, requires an insurer to have a network adequate to provide specialty care within a one-hour drive of the patient's home.  Otherwise, the carrier must ensure "that the covered person obtains the covered benefit at no greater cost to the covered person than if the benefit were obtained from participating providers or shall make other arrangements acceptable to the Superintendent." (from 02-031 Chapter 850, Section 7 B. 5 entitled Access to Services)

While an Anthem spokesman has stated publicly that the decision of the practice to drop out of the network means that Anthem policy holders would likely pay more if they choose the practice for their care, Chapter 850 is designed to protect such patients under these circumstances.  There are some exceptions to Chapter 850, but there is a significant burden on the part of the carrier to show that patients are not disadvantaged.

Health plans offered to employees by self-insured employers are not bound by the provisions of Chapter 850 and therefore can require the patients to travel outside of the area for care or provide incentives for patients to do so. [return to top]

MMA Steering Committee Meets Wednesday to Advance 2005 Goals
The 7 member MMA Steering Committee, chaired by Executive Committee Chairman Kevin Flanigan, M.D. of Pittsfield, meets Wednesday night this week at 6:00pm.  This meeting, scheduled between meetings of the 25 member Executive Committee, will focus on the announced goals for 2005 and their prioritization.

Pursuant to a strategic planning discussion which began at the January 05 retreat, the Association developed five objectives under the theme of Re-aligning for the Future.  The five identified objectives are as follows:

  • Position MMA as a leader in quality improvement
  • Position MMA as a member-centric organization that can act nimbly to address member needs
  • Balance operating budget by re-aligning expenses with available revenue
  • Build existing reserves to twice annual income
  • Develop the necessary leadership to lead MMA in the future

Each objective has been tied to strategy and action items.  Recently, the Executive Committee prioritized the action items and it will be this prioritization that the Committee will focus on Wednesday night.

The Steering Committee welcomes member input into this process.  Any thoughts or comments can be directed to Dr. Flanigan at flanmansvpc@pol.net or to Gordon Smith via e-mail to gsmith@mainemed.com.

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